Assessment of depressive and anxiety in dialysis patients undergoing virtual reality (VR) therapy

The aim of the project is to assess the impact of relaxation therapies using virtual reality (VR) on the level of depressive and anxiety disorders in relation to inflammation, circulatory system performance and muscle condition in patients with end-stage renal disease. The study group will consist of 80 patients from the hospital dialysis center in Wroclaw and Boleslawiec, Poland. All participants were recruited for participation in the program by a nephrologist and a psychologist, who administered Mini Mental State Examination (MMSE) to assess the cognitive status of patients. Study Procedure: All participants will be selected for participation in the program by a nephrologist and a psychologist (MMSE scale). Written consent will be obtained from patients to participate in the study, which will be preceded by an explanation of the purpose and procedure of the study, assurance of confidentiality of the collected data, and information about the voluntary nature of participation and the possibility of withdrawal at any time. Selected patients will be randomly divided into two groups: Group I – study group – hemodialysis patients undergoing VR therapy (40 participants) Group II – comparator group – hemodialysis patients not participating in VR therapy (40 participants). Training will be conducted over a period of 4 weeks, 3 times per week (during hemodialysis treatment), with each session lasting 20 minutes. The cognitive, emotional and functional state of dialysis patients will be assessed twice (before and after completing VR therapy). A complete blood count (CBC) with a differential blood count (DBC) will be performed to measure stress levels and inflammation. Blood sampling will be performed as part of a routine dialysis patient assessment. Blood will be collected twice from the antecubital vein (2 x 8 mL) before the start of VR training (pre-dialysis) and after one month of VR training (maximum 14 sessions) at the hospitals dialysis centers in Wroclaw and Boleslawiec. Inflammatory classifiers such as NLR (neutrophil-to-lymphocyte ratio), SII (systemic immune inflammation index) and SIRI (systemic inflammation response index) will be calculated based on blood counts and compared to the reference values proposed by Luo et al. All procedures performed as part of the study will be performed by professional, qualified specialists with extensive clinical and research experience, using the most modern equipment available and evidence-based practice and skills. Relaxation therapy will be conducted using immersive VR goggles (Meta Quest3, USA). VR therapies are considered acceptable and safe for the patient, with limited adverse effects of VR exposure (nausea, dizziness, malaise). Strategies used to monitor adherence to the intervention - supervision by research staff. Patients were also informed that VR therapy could be discontinued if adverse reactions occurred (e.g., nausea, dizziness, visual discomfort). At the beginning of the intervention, a short interview was conducted with each patient to explain and introduce the patient to the technical aspects of using VR goggles and safety rules. During the passive VR therapy, various realistic scenarios were presented, including selected 360° videos and standard 2D landscape videos with relaxation music. Active, full-immersive applications, requiring the operation of controllers, were excluded for safety reasons. After every session, a short form interview was conducted to assess any adverse reactions. There were no resignations noted due to the adverse reactions to VR therapy.