ENHANCING HYSTEROSALPINGOGRAPHY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS ON THE USE OF VIRTUAL REALITY OR MUSIC FOR REDUCING PAIN AND ANXIETY

Abstract

Background
Hysterosalpingography (HSG) is a diagnostic procedure used to assess the uterus and fallopian tubes, often associated with pain and anxiety. This systematic review and meta-analysis evaluate the effectiveness of virtual reality (VR) and auditory stimuli in reducing pain and anxiety during HSG, exploring non-pharmacological strategies to enhance patient comfort and outcomes.
Materials & Methods
We conducted a systematic search in November 2024 using PubMed, Ovid Medline, and Ovid Cochrane databases. The Revised Cochrane Risk of Bias (RoB2) assessment tool was utilized to assess the risk of bias of the included randomized controlled trials (RCTs). The data were analyzed using RevMan software.
Results
This systematic review and meta-analysis included five RCTs with a total of 513 women undergoing hysterosalpingography (HSG). Pain levels, measured using the Visual Analog Scale (VAS), were significantly lower in the VR group compared to the control group, with a mean difference (MD) of -2.35 (95% CI [-3.90, -0.80], P = 0.003) during HSG. Additionally, pain 15 minutes after the procedure was significantly reduced in the VR group (MD = -3.19, 95% CI [-5.71, -0.68], P = 0.01). Regarding anxiety, no significant difference was found between the VR group and the control group (MD = -2.40, 95% CI [-7.56, 2.76], P = 0.36), but auditory stimuli significantly reduced post-HSG anxiety (MD = -8.93, 95% CI [-17.28, -0.59], P = 0.04). The risk of bias assessment revealed "some concerns" in most included studies.
Conclusion
While virtual reality significantly reduces pain during hysterosalpingography, its effect on anxiety is minimal, whereas auditory stimuli effectively reduce post-procedural anxiety, highlighting the need for further research to optimize these non-pharmacological interventions.