Immersive virtual reality for preoperative anxiety management in patients undergoing elective lumbar laminectomy: a randomised controlled trial
Journal of Orthopaedic Surgery and Research · 7 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Preoperative anxiety is common in spine surgery patients and is linked to worse pain and recovery, so a drug-free, content-matched way to reduce it is relevant to perioperative counselling.
The evidence
In this single-centre randomised trial, 90 adults scheduled for elective single-level lumbar laminectomy received either an 8-minute immersive 360-degree virtual reality tour of the perioperative pathway or a face-to-face nurse session covering the same script and pictures for the same length of time. One hour before surgery, the VR group had lower state anxiety on the STAI-State (adjusted mean difference -7.4 points, 95% CI -10.8 to -4.0), along with a slightly lower heart rate (-3.8 bpm) and higher satisfaction. Postoperative outcomes were not measured.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
RCTDesign starting point: 59.5
Raised the score
- Blinded outcome assessment+6.8
- Adequately powered+6
Lowered the score
- A positive result from a single centre−4.3
- A positive result from only 90 patients−3.4
Methods at a glance
Recorded assessment- Outcome assessors blindedMet
- Allocation concealedMet
- Random sequence generatedMet
- Intention-to-treat analysisMet
- Adequate statistical powerMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 59.5
- Concealed allocation
- +5.1
- Random sequence generation
- +2.5
- Compared against current standard of care
- +3.4
- Blinded outcome assessment
- +6.8
- Intention-to-treat analysis
- +3.4
- 0% loss to follow-up
- +1.7
- Adequately powered
- +6
- Prospectively registered
- +5.1
- A positive result from only 90 patients
- −3.4
- A positive result from a single centre
- −4.3
- Final rigour score rounded
- 86 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Which patients scheduled for lumbar spine surgery (for example those with high baseline or trait anxiety) would you prioritise for a VR preoperative tour, given that headset access may be limited?
2.If VR lowers preoperative anxiety by about 7 STAI points but postoperative pain and opioid use are unknown, how would you counsel a patient choosing between VR education, standard teaching, or an anxiolytic premedication?
Original publication title
Immersive virtual reality for preoperative anxiety management in patients undergoing elective lumbar laminectomy: a randomized controlled trial