Virtual Reality, Music, and Education to Reduce Anxiety in Patients Undergoing Ingrown Toenail Surgery

The Generalized Anxiety Disorder Scale (GAD-7) is a brief questionnaire consisting of 7 questions designed to identify symptoms associated with generalized anxiety disorder. The questions refer to the last 15 days and are answered using a 4-point Likert scale (0 = not at all, 3 = nearly every day), with a maximum score of 21. Based on the final score, anxiety levels are classified into four categories: 0-4 (minimal), 5-9 (mild), 10-14 (moderate), and 15-21 (severe). In this study, the GAD-7 will be used to analyze the relationship between higher preoperative and intraoperative anxiety and the presence of generalized anxiety disorder.

The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-administered 6-item questionnaire that evaluates preoperative anxiety and the patient's need for information regarding surgery. It consists of two subscales: APAIS-A (items 1, 2, 4, and 5), which measures anxiety with scores ranging from 4 (not anxious) to 20 (maximum anxiety), and APAIS-I (items 3 and 6), which measures the need for information and is classified into three levels: 2-4 (no additional information needed), 5-7 (moderate need), and 8-10 (high need). Each item is rated on a 5-point Likert scale, where 1 = "Not at all" and 5 = "Extremely," allowing to obtain clear information from surgical patients about both their level of anxiety and their need for information in the preoperative phase.

The Visual Analogue Scale for Anxiety (VAS-A) is a single-item tool used to assess anxiety. It consists of a 10 cm horizontal line anchored with the descriptors "not anxious at all" on the left end and "extremely anxious" on the right end. Patients are asked to place a mark on the line corresponding to their current level of anxiety. The score is obtained by measuring in millimeters from the left end of the line to the patient's mark, resulting in a range from 0 to 100, where higher values indicate greater anxiety. The VAS-A pre will be used to evaluate the patient's preoperative anxiety.

The Visual Analogue Scale for Anxiety (VAS-A) is a single-item tool used to assess anxiety. It consists of a 10 cm horizontal line anchored with the descriptors "not anxious at all" on the left end and "extremely anxious" on the right end. Patients are asked to place a mark on the line corresponding to their current level of anxiety. The score is obtained by measuring in millimeters from the left end of the line to the patient's mark, resulting in a range from 0 to 100, where higher values indicate greater anxiety. The VAS-A intra will be used to evaluate the patient's anxiety during the surgical procedure. To preserve the immersive experience in the operating room, this questionnaire will be completed after the surgery, but the scale clearly instructs the patient to report how they felt during the procedure

The Visual Analogue Scale for Anxiety (VAS-A) is a single-item tool used to assess anxiety. It consists of a 10 cm horizontal line anchored with the descriptors "not anxious at all" on the left end and "extremely anxious" on the right end. Patients are asked to place a mark on the line corresponding to their current level of anxiety. The score is obtained by measuring in millimeters from the left end of the line to the patient's mark, resulting in a range from 0 to 100, where higher values indicate greater anxiety. The VAS-A post will be used to evaluate the patient's anxiety after the surgical procedure.

The State-Anxiety subscale reflects a transient emotional condition, measuring the anxiety experienced at the present moment. It consists of 20 items, each rated on a 4-point Likert scale according to the intensity of perceived anxiety: 0 ("Almost never/Not at all"), 1 ("Somewhat/Sometimes"), 2 ("Moderately/Often"), and 3 ("Very much/Almost always"). Total scores range from 0 to 60. In this study, the STAI-State subscale will be used exclusively, as we aim to assess the anxiety experienced by the patient at the time of surgery. To preserve the immersive experience in the operating room, this questionnaire will be completed after the surgery, but the scale clearly instructs the patient to report how they felt during the procedure.

The Visual Analogue Scale for Pain (VAS-P) is a single-item tool used to assess pain intensity. It consists of a 10 cm horizontal line anchored with the descriptors "no pain" on the left end and "worst imaginable pain" on the right end. Patients are asked to place a mark on the line corresponding to their pain level. The score is obtained by measuring in millimeters from the left end of the line to the patient's mark, resulting in a range from 0 to 100, where higher values indicate greater pain. VAS-P Max will be used to record the highest level of pain experienced by the patient during surgery. To preserve the immersive experience in the operating room, this scale will be completed after the surgery, but the scale clearly instructs the patient to report how they felt during the procedure.

The Visual Analogue Scale for Pain (VAS-P) is a single-item tool used to assess pain intensity. It consists of a 10 cm horizontal line anchored with the descriptors "no pain" on the left end and "worst imaginable pain" on the right end. Patients are asked to place a mark on the line corresponding to their pain level. The score is obtained by measuring in millimeters from the left end of the line to the patient's mark, resulting in a range from 0 to 100, where higher values indicate greater pain. VAS-P Average will be used to record the average pain experienced by the patient throughout the surgical procedure. To preserve the immersive experience in the operating room, this scale will be completed after the surgery, but the scale clearly instructs the patient to report how they felt during the procedure.

Systolic blood pressure will be measured in millimeters of mercury (mmHg) using a validated automatic blood pressure monitor, with the patient seated and after 5 minutes of rest. A single value will be recorded prior to the start of surgery to characterize the patient's baseline hemodynamic status.

Diastolic blood pressure will be measured in millimeters of mercury (mmHg) using a validated automatic blood pressure monitor, with the patient seated and after 5 minutes of rest. A single value will be recorded prior to the start of surgery to characterize the patient's baseline hemodynamic status.

Heart rate will be measured in beats per minute (bpm) using a validated automatic monitor or pulse oximeter, with the patient seated and after 5 minutes of rest. A single value will be recorded prior to the start of surgery to characterize the patient's baseline cardiovascular status.

Oxygen saturation (SpO₂) will be measured as a percentage using a validated pulse oximeter, with the patient seated and after 5 minutes of rest. A single value will be recorded prior to the start of surgery to characterize the patient's baseline respiratory status.

Systolic blood pressure (mmHg) will be measured using a validated automatic blood pressure monitor at four predefined moments during the surgery: (1) disinfection of the surgical area, (2) application of local anesthesia, (3) first incision or invasive technique, and (4) final bandaging. This will allow monitoring of hemodynamic changes during the procedure.

Diastolic blood pressure (mmHg) will be measured using a validated automatic blood pressure monitor at four predefined moments during the surgery: (1) disinfection of the surgical area, (2) application of local anesthesia, (3) first incision or invasive technique, and (4) final bandaging. This will allow monitoring of hemodynamic changes during the procedure.

Heart rate (beats per minute) will be measured using a validated automatic monitor at four predefined moments during the surgery: (1) disinfection of the surgical area, (2) application of local anesthesia, (3) first incision or invasive technique, and (4) final bandaging. This will allow monitoring of cardiovascular response during the procedure.

Oxygen saturation (%) will be measured using a validated pulse oximeter at four predefined moments during the surgery: (1) disinfection of the surgical area, (2) application of local anesthesia, (3) first incision or invasive technique, and (4) final bandaging. This will allow monitoring of respiratory function during the procedure.

Systolic blood pressure (mmHg) will be measured using a validated automatic blood pressure monitor once the patient has exited the operating room and is in the pre-recovery area. This measurement will assess the patient's hemodynamic status immediately after the surgery.

Diastolic blood pressure (mmHg) will be measured using a validated automatic blood pressure monitor once the patient has exited the operating room and is in the pre-recovery area. This measurement will assess the patient's hemodynamic status immediately after the surgery.

Heart rate (beats per minute) will be measured using a validated automatic monitor once the patient has exited the operating room and is in the pre-recovery area. This measurement will assess the patient's cardiovascular response immediately after the surgery.

Oxygen saturation (%) will be measured using a validated pulse oximeter once the patient has exited the operating room and is in the pre-recovery area. This measurement will assess the patient's respiratory status immediately after the surgery.

Participants will rate their satisfaction with the information they have received regarding the surgical procedure using a 5-point Likert scale (1 = Not satisfied at all, 2 = Slightly satisfied, 3 = Neutral, 4 = Very satisfied, 5 = Completely satisfied). This measure will capture the patient's perception of the adequacy and clarity of preoperative information.

Participants in the experimental groups will rate their satisfaction with the educational video they have viewed prior to the surgery using a 5-point Likert scale (1 = Not satisfied at all, 2 = Slightly satisfied, 3 = Neutral, 4 = Very satisfied, 5 = Completely satisfied). This measure assesses the participant's perception of the video's usefulness and clarity. Participants in the control group will not complete this measure, as they will not have viewed the video.

Participants will rate their satisfaction with the surgical procedure they have just undergone using a 5-point Likert scale (1 = Not satisfied at all, 2 = Slightly satisfied, 3 = Neutral, 4 = Very satisfied, 5 = Completely satisfied). This measure captures the patient's perception of the quality and outcome of the surgery.

Participants will rate their satisfaction with the anesthesia administered during the surgical procedure using a 5-point Likert scale (1 = Not satisfied at all, 2 = Slightly satisfied, 3 = Neutral, 4 = Very satisfied, 5 = Completely satisfied). This measure captures the patient's perception of comfort and adequacy of anesthesia.

Participants in the experimental group 1 will rate their satisfaction with the use of virtual reality glasses during the surgical procedure using a 5-point Likert scale (1 = Not satisfied at all, 2 = Slightly satisfied, 3 = Neutral, 4 = Very satisfied, 5 = Completely satisfied). This measure assesses the participant's experience and comfort with the virtual reality intervention. Participants in other groups will not complete this measure.

Participants in the experimental group 2 will rate their satisfaction with listening to music during the surgical procedure using a 5-point Likert scale (1 = Not satisfied at all, 2 = Slightly satisfied, 3 = Neutral, 4 = Very satisfied, 5 = Completely satisfied). This measure captures the participant's experience and comfort with the music intervention. Participants in other groups will not complete this measure.