TREE: Reducing the Use of REstrictive Practices on Psychiatric Wards through Virtual REality Immersive Technology Training
Authors: Phiri Peter , Pemberton Laura , Li Yang , Yang Xiaojie , Salmon Joe , Boulter Isabel , Sajid Sana , Clark Jackie , McMillan Andy , Shi Jian , Delanerolle Gayathri 
Published: November 2023

BACKGROUNDRestrictive practices are defined by measures linked to physical and chemical restraints to reduce the movement or control behaviours during any emergency. Seclusion is an equal part of restrictive practices intended to isolate and reduce the sensory stimulation to safeguard the patient and those within the vicinity. Using interventions by way of virtual reality (VR) could assist with reducing the need for restrictive practices as it could help reduce anxiety or agitation by way of placing users into realistic and immersive environments. This could also aid staff to and change current restrictive practices.AIMTo assess the feasibility and effectiveness of using a VR platform to provide reduction in restrictive practice (RRP) training. METHODSThe study received ethics approval was obtained prior to starting the study from the Health Research Authority in United Kingdom (22/HRA/3030 REFERENCE). A randomised controlled feasibility study was conducted alongside of an evaluation at at 1 month and 6 within inpatient psychiatric wards at Southern Health NHS Foundation Trust, UK. Virti Virtual Reality scenarios will be used on VR headsets to provide training on reducing restrictive practices in 3 inpatient psychiatric wards. Outcome measures included General Self-Efficacy (GSE) scale, Generalised Anxiety Disorder Assessment 7 (GAD-7), Burnout Assessment Tool (BAT-12), The Everyday Discrimination (EDS) Scale, and the Compassionate Engagement and Action (CEA) Scale. RESULTSThe statistical significance of most variables is high, with the exception of the BAT12 score, compassionate engagement to others score, compassionate to others total score, compassionate engagement from others score, and compassionate from others total score, which exhibit lower statistical power in two-sample t-tests. To assess the acceptability, preference, and adherence of users to the Virti VR technology for RRP training, we calculated the System Usability Scale (SUS) scores and visualized the program's completion using pie charts. The majority of respondents reported SUS scores exceeding 70, with a mean SUS score of 71.79. In accordance with the insights provided by Bangor et al. (38), the VR platform demonstrated superior usability compared to approximately 62% of other products. we utilized the GAD7 score to assess the confidence levels within the two groups. We compared the data for the VR group and the control group after one month, as well as the baseline and one-month data for both the VR group and the control group. Given that the p-values are below 0.05 and the statistical power is high, it can be concluded that there are no statistically significant differences in confidence levels between the VR and control groups at baseline and day-30. CONCLUSIONSOur study has revealed the challenges associated with implementing such a program, even though the staff has given it high usability ratings. With the ongoing advancement of VR technology, we have the capability to create scenarios and simulations tailored to various healthcare environments. This empowers staff to receive more comprehensive and effective training for handling a wide range of situations.