scholarly journals Assessment of the Implementation of Critical Pathway in Stroke Patients: A 10-Year Follow-Up Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Yun Jeong Jang ◽  
Dahye Park ◽  
Hyeong Seop Kim ◽  
Chang Han Lee ◽  
Ha Young Byun ◽  
...  
Keyword(s):  
Functional Recovery ◽  
University Hospital ◽  
Rehabilitation Center ◽  
Medical Conditions ◽  
Stroke Patients ◽  
Critical Pathway ◽  
Significant Difference ◽  
Before And After ◽  
Specialized Care ◽  
Functional States

Background. The complications after stroke inhibit functional recovery and worsen the prognosis of patients. The implementation of a critical pathway (CP) can facilitate functional recovery after stroke by enabling comprehensive and systematic structured rehabilitation. Objective. To evaluate the effects of the implementation of CP in stroke patients for 10 years. Methods. The data were collected from 960 patients who were diagnosed with a stroke at the university hospital emergency room, who were transferred to the rehabilitation center after the acute phase, and who were discharged after undergoing comprehensive rehabilitation. Based on data collected over a period of 10 years, changes in demographic and stroke characteristics, preexisting medical conditions, poststroke complications, and functional states, as well as length of stay (LOS), were evaluated before and after CP implementation. The modified Rankin Scale (mRS) and the Korean version of the Modified Barthel Index (K-MBI) were used to evaluate functional states. Results. There were no significant differences in demographic and stroke characteristics before and after CP implementation. For those with preexisting medical conditions, there was no significant difference between before and after CP implementation. The majority of the complications were significantly decreased after the implementation of CP. Except for hemorrhagic stroke patients, the Brunnstrom stage in the ischemic and total stroke patients after CP implementation was significantly increased in the upper and lower extremities. The total hospitalization LOS and rehabilitation center hospitalization times were significantly reduced in ischemic and total stroke patients. There was no statistically significant difference in the functional gain of K-MBI and the efficiency of rehabilitation between before and after CP implementation. Conclusion. The implementation of CP allows for better application of evidence- and guideline-based key interventions and helps to provide early, comprehensive, organized, and more specialized care to stroke patients. Despite limited evidence, CP is still recommended as a means of promoting best practices in hospital care for stroke patients.

scholarly journals Efficacy of repetitive peripheral magnetic stimulation on the functional recovery in stroke patients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
F F Kenawy ◽  
S A Helal ◽  
M M Moustafa ◽  
N M Elnahas ◽  
L M Elnabil ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Lower Limb ◽  
Rating Scale ◽  
Chronic Stroke ◽  
University Hospital ◽  
Control Group ◽  
Stroke Patients ◽  
National Priority ◽  
Significant Difference ◽  
And Control

Abstract © 2018 Institute of Psychiatry, Ain Shams University Copyright r 2018 Institute of Psychiatry, Ain Shams University. Unauthorized reproduction of this article is prohibited. Background Optimizing the management of stroke is a national priority. In Egypt, the mean crude prevalence rate of stroke is 721.6/100,000 1of which almost 30 percent suffer from post stroke spasticity. Theta Burst Stimulation (TBS) is a new faster modality of the conventional rTMS that is used to improve functional recovery after stroke. Objective This work was carried out to assess the effects of peripheral TBS in improving the functional recovery of the lower limb after stroke. Patients and methods A case–control study was conducted to include 27 patients with chronic stroke, who were selected from the attendants of the neurology outpatient clinic in Ain Shams University Hospital, along with 19 participants of age-matched and sex-matched stroke patients as a control group. Case and control groups were subjected to neurological and functional assessment using gait assessment rating scale (GARS) at baseline and after the sessions. An informed written consent was taken from patients included in the study. All patients received 6 sessions of peripheral TBS on affected lower limb. Results There was a statistically significant difference between the two groups in the improvement of functional scale (GARS). Conclusion Peripheral TBS improves gait and functional recovery in chronic stroke patients.

Adipokines as Potential Biomarkers in the Neurorehabilitation of Obese Stroke Patients

2020 ◽  
Vol 17 (4) ◽  
pp. 437-445
Author(s):  
Irene Ciancarelli ◽  
Giovanni Morone ◽  
Marco Iosa ◽  
Stefano Paolucci ◽  
Loris Pignolo ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Functional Recovery ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Enzyme Linked Immunosorbent Assay ◽  
Stroke Patients ◽  
Rehabilitation Outcomes ◽  
Before And After ◽  
Forward Stepwise ◽  
Clinical Measures

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. Conclusions: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

scholarly journals Impact of Somatosensory Training on Neural and Functional Recovery of Lower Extremity in Patients with Chronic Stroke: A Single Blind Controlled Randomized Trial

2021 ◽  
Vol 18 (2) ◽  
pp. 583
Author(s):  
Reem M. Alwhaibi ◽  
Noha F. Mahmoud ◽  
Mye A. Basheer ◽  
Hoda M. Zakaria ◽  
Mahmoud Y. Elzanaty ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Lower Extremity ◽  
Functional Recovery ◽  
Intervention Group ◽  
Chronic Stroke ◽  
Post Treatment ◽  
Control Group ◽  
Stroke Patients ◽  
Significant Difference ◽  
Group Post

Recovery of lower extremity (LE) function in chronic stroke patients is considered a barrier to community reintegration. An adequate training program is required to improve neural and functional performance of the affected LE in chronic stroke patients. The current study aimed to evaluate the effect of somatosensory rehabilitation on neural and functional recovery of LE in stroke patients. Thirty male and female patients were recruited and randomized to equal groups: control group (GI) and intervention group (GII). All patients were matched for age, duration of stroke, and degree of motor impairment of the affected LE. Both groups received standard program of physical therapy in addition to somatosensory rehabilitation for GII. The duration of treatment for both groups was eight consecutive weeks. Outcome measures used were Functional Independent Measure (FIM) and Quantitative Electroencephalography (QEEG), obtained pre- and post-treatment. A significant improvement was found in the FIM scores of the intervention group (GII), as compared to the control group (GI) (p < 0.001). Additionally, QEEG scores improved within the intervention group post-treatment. QEEG scores did not improve within the control group post-treatment, except for “Cz-AR”, compared to pretreatment, with no significant difference between groups. Adding somatosensory training to standard physical therapy program results in better improvement of neuromuscular control of LE function in chronic stroke patients.

scholarly journals Role of the nurse in preventing or reducing increase intracrani-al pressure following craniotomy

2017 ◽  
Vol 6 (2) ◽  
pp. 92
Author(s):  
Rasha Abdelmowla ◽  
Abdelhakeem Essa ◽  
Esmat Abdelmaged
Keyword(s):  
Intracranial Pressure ◽  
Educational Program ◽  
Demographic Data ◽  
Quality Care ◽  
Adult Patients ◽  
University Hospital ◽  
Control Group ◽  
Significant Difference ◽  
Before And After ◽  
Nurses Knowledge

Background: Increase intracranial pressure following craniotomy is common and different measures should be taken to prevent or treat it promptly. Aim: Preventing or reducing increase intracranial pressure following craniotomy. Research design: Quasi-experimental.Subjects and methods: All nurses (26) in neurosurgery department at Assiut Neurological, Psychiatric and Neurosurgery University Hospital, in addition to a sample of 124 patients after craniotomy. Control group (62 adult patients before implementing the nursing     educational program) and study group (62 adult patients after implementing the nursing educational program). Nurses’ knowledge and practice were assessed before and after implementation of the nursing educational program. Tools: Structured questionnaire to assess nurses` demographic data and knowledge about intracranial pressure, observation checklist for nurses` practice, patients’ assessment sheet, and teaching booklet for nurses about postoperative increase intracranial pressure. Results: Highly significant differences were found as regarding nurses` knowledge and nurses` practice pre and post implementing the nursing educational program. Significant difference was found between study and control groups as regarding increase intracranial pressure following craniotomy. Conclusion: Nursing educational program had a significant effect on preventing or reducing postoperative increase intracranial pressure.Recommendation: Nurses should have continuous education through programs, workshops, seminars and/or training courses to maintain high quality care.

scholarly journals Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

2020 ◽  
Author(s):  
Nishita Padmanabhan ◽  
Indira Natarajan ◽  
Rachel Gunston ◽  
Marko Raseta ◽  
Christine Roffe
Keyword(s):  
National Institutes Of Health ◽  
University Hospital ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Patient Demographics ◽  
The United Kingdom ◽  
Significant Difference ◽  
Ischaemic Attack ◽  
Provision Of Care

Abstract Introduction The coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients. Methods This retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stoke-on-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019). Results There was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died. Conclusions During the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality.

scholarly journals Retrospective Assessment of the Implementation of Critical Pathway in Stroke Patients in a Single University Hospital

2014 ◽  
Vol 38 (5) ◽  
pp. 603 ◽  
Author(s):  
Jin Hoan Kim ◽  
Ha Young Byun ◽  
Seungnam Son ◽  
Joong Hoon Lee ◽  
Chul Ho Yoon ◽  
...  
Keyword(s):  
University Hospital ◽  
Stroke Patients ◽  
Critical Pathway ◽  
Retrospective Assessment

scholarly journals Pengaruh Edukasi Kesehatan Terhadap Pengetahuan Pasien Stroke dan Keluarga: Peran, Dukungan, dan Persiapan Perawatan Pasien Stroke di Rumah

2018 ◽  
Vol 13 (2) ◽  
pp. 8
Author(s):  
Cecep Eli Kosasih ◽  
Tetti Solehati ◽  
Chandra Isabela Purba
Keyword(s):  
Health Education ◽  
Test Design ◽  
Stroke Patients ◽  
Significant Difference ◽  
The Family ◽  
Before And After ◽  
Post Test ◽  
Level Of Knowledge ◽  
At Home

AbstractStroke patients face a number of problems that include physical, social, emotional, psychological, and spiritual which can cause a decrease in their well-being. Strengthening the role of the family, family support, and preparation for care by the family at home is needed. One effort is to increase the knowledge of stroke patients and families through health education. This study aimed to determine the effect of health education on the knowledge of stroke patients and families on the role, support, and preparation of care at home. The research method used a quasi-experimental design with a one group pre-post test design. The study was conducted at Al Islam Bandung Hospital in 2018. Respondents consisted of 16 stroke patients and 16 stroke family families. The instrument uses a questionnaire. Data analysis using univariate and bivariate analysis. The results showed that before and after the intervention there were significant mean differences in the level of knowledge of patients from 7.94 to 10.38 (p = 0.002), but in the variable readiness of stroke patients there was no significant difference in average seen from the mean value of 14.25 became 15.88 (p = 0.411). In the patient's family, it was shown that before and after the intervention there was a significant of mean difference in the level of knowledge from 5.19 to 6.81 (p = 0.012). Conclusion: health education has been shown to be influential in increasing the level of knowledge of patients and their families regarding stroke, readiness, the role of family carers for stroke patients, psychological support, and preparation for the care of stroke patients at home. However,health education does not affect the level of readiness of stroke patients for transition. Suggestion: readiness to accept the transition in stroke patients is not enough only by health education alone but family participation is needed in providing support to these patients therefore it is recommended that nurses always support the family to support stroke patients. AbstrakPasien stroke menghadapi sejumlah masalah yang mencakup fisik, sosial, emosional, psikologis, dan spiritual yang dapat menyebabkan penurunan kesejateraannya. Diperlukan penguatan peran keluarga, dukungan keluarga, serta persiapan perawatan oleh keluarga di rumah. Salah satu upayanya adalah dengan meningkatkan pengetahuan pasien stroke dan keluarga melalui edukasi kesehatan. Penelitian ini bertujuan untuk mengetahui pengaruh edukasi kesehatan terhadap pengetahuan pasien stroke dan keluarga akan peran, dukungan, dan persiapan perawatan. Metode penelitian menggunakan desain quasi eksperiment dengan rancangan one group pre-post test design. Penelitian dilakukan di Rumah Sakit Al Islam Bandung pada tahun 2018. Responden terdiri dari 16 pasien stroke dan 16 keluarga pasien stroke. Instrumen menggunakan kuesioner. Analisis data menggunakan analisis univariat dan bivariat. Hasil penelitian menunjukan bahwa sebelum dan setelah intervensi terdapat perbedaan rata-rata yang signifikan tingkat pengetahuan pasien dari 7,94 menjadi 10,38 (p = 0,002), tetapi pada variabel kesiapan  pasien stroke tidak  terdapat perbedaan rata-rata yang signifikan terlihat dari rata-rata nilai 14,25 menjadi 15,88 (p = 0,411). Pada keluarga pasien menunjukan bahwa sebelum dan setelah intervensi terdapat perbedaan rata-rata tingkat pengetahuan yang signifikan dari 5,19 menjadi 6,81 (p = 0,012). Simpulan: edukasi kesehatan terbukti berpengaruh dalam meningkatkan tingkat pengetahuan pasien dan keluarganya mengenai stroke, kesiapan, peran keluarga pengasuh pasien stroke, dukungan psikologis, dan persiapan perawatan pasien stroke di rumah. Edukasi Kesehatan tidak berpengaruh terhadap tingkat kesiapan pasien stroke untuk transisi. Saran : kesiapan untuk menerima transisi pada pasien stroke tidak cukup dengan edukasi kesehatan saja tapi diperlukan peran serta keluarga dalam memberikan dukungan kepada pasien tersebut oleh karena itu disarankan agar perawat selalu mensupport keluarga agar melakukan dukunganpada pasien stroke.

scholarly journals Pengaruh Dukungan Keluarga Terhadap Konsep Diri Pasien Stroke Yang Mengalami Kelumpuhan Di Poli Klinik Saraf Rumah Sakit Stroke Nasional Bukittinggi Tahun 2018

2019 ◽  
Vol 10 (1) ◽  
pp. 85
Author(s):  
Weni Lidya Hendayani ◽  
Devi Mekar Sari
Keyword(s):  
Health Education ◽  
Family Support ◽  
Health Workers ◽  
T Test ◽  
The Self ◽  
Self Concept ◽  
P Value ◽  
Stroke Patients ◽  
Significant Difference ◽  
Before And After

ABSTRAK            Menurut survei tahun (2015),   stroke merupakan pembunuh nomor satu di RS Pemerintah di seluruh Indonesia. Diperkirakan ada 550.000 penduduk yang terkena stroke.Keluarga memiliki peran yang sangat penting dalam pemenuhan kebutuhan pasien yang mengalami stroke. Penelitian ini merupakan penelitian quasieksperimenpre danpostonegroup design. Populasi dalam penelitian ini adalah seluruh pasien stroke yang masuk ke Rumah Sakit Stroke Nasional (RSSN) Bukittinggi yang berjumlah 366 orang dengan teknik pengambilan sampel AccidentialSampling. Penelitian ini dilakukan pada bulan Juni 2017 - Juni 2018. Hasil uji-T untuk dukungan keluarga pada pasien stroke sebelum dan sesudah dilaksanakan penyuluhan kesehatan didapatkan p-value 0,000 (α≤0,05) artinya, terdapat perbedaan yang signifikan antara dukungan keluarga yang diberikan pada pasien stroke sebelum dan sesudah dilakukan penyuluhan kesehatan. Hasil uji-T pada konsep diri pasien stroke sebelum dan sesudah didapatkan p-value 0,000 (α≤ 0,05) artinya, terdapat perbedaan yang signifikan antara konsep diri pasien stroke sebelum dan sesudah dilakukan penelitian. Sehingga dapat disimpulkan bahwa ada pengaruh dukungan keluarga terhadap konsep diri pasien stroke yang mengalami kelumpuhan di Poli Klinik Saraf Rumah Sakit Stroke Nasional Bukittinggi ditandai dengan p-value 0,000 (α≤0,05). Diharapkan tenaga kesehatan perlu memberikan pendidikan kesehatan mengenai perawatan pasien stroke yang mengalami kelumpuhan dan tentang bagaimana pasien stroke untuk mempertahankan dirinya.Kata Kunci   : DukunganKeluarga; Konsep Diri; Pasien Stroke The Effect of Family Support on Self-Concept of Stroke Patients Who Have Paralysis at the Nerve Polyclinic of the National Stroke HospitalBukittinggi Year 2018 ABSTRACT            According to a 2015 survey, strokes are the number one killer in Government hospitals throughout Indonesia. More than 550,000 people were stroked. This research is a quasi-experimental pre and post one group design. The population in this study were 366 stroke patients who entered the National Stroke Hospital in Bukittinggi with Accidential Sampling sampling techniques. This study was conducted in June 2017 - June 2018. The results of the T-test for family support for stroke patients before and after the implementation of health counseling obtained p-value 0,000 (α≤0,05) which means that there was a significant difference between family support given in stroke patients before and after health education. The T-test results on the self-concept of stroke patients before and after obtaining p-value 0,000 (α≤ 0,05) means that there is a significant difference between the self-concept of stroke patients before and after the research. So it can be concluded that there is an effect of family support on the self-concept of stroke patients who experience paralysis at the Neural Stroke Clinic of Bukittinggi National Stroke Hospital marked by p-value 0,000 (α (0,05). I hope health workers need to provide health education about the care of stroke patients who experience paralysis and about how stroke patients maintain themselves.Kata Kunci     : Family Support; self-concept; stroke patients

scholarly journals Effect of Designing and Implementing Nursing Guidelines on Nurses' Performance in Caring Women with Ectopic Pregnancy

2019 ◽  
Vol 1 (3) ◽  
pp. 13
Author(s):  
Hanan A. F. Mohamed ◽  
Mahmoud R. Fayed ◽  
Somaya O. Abd El Meneam ◽  
Ola M. El-Sayed
Keyword(s):  
Ectopic Pregnancy ◽  
Nursing Care ◽  
University Hospital ◽  
Obstetrics And Gynecology ◽  
Significant Difference ◽  
Before And After ◽  
Quasi Experimental ◽  
Knowledge And Practice ◽  
Nursing Guidelines ◽  
Nurses Knowledge

Context: Ectopic pregnancy is a condition presenting as a significant health problem for women of the childbearing period. Ectopic pregnancy remains one of the primary causes of maternal mortality. Aim: The study aimed to evaluate the effect of nursing guidelines for improving maternity nurses' performance regarding ectopic pregnancy. Methods: A quasi-experimental design used to achieve the aim of the study. The study conducted at Obstetrics and Gynecology Department at Benha University Hospital. A convenient sample of all nurses (90 nurses) working in Obstetrics and Gynecology departments at Benha university hospital. Tools of data collection included a structured self-administrated questionnaire to assess nurses' knowledge regarding ectopic pregnancy, an observational checklist to evaluate nursing practice regarding ectopic pregnancy before and after the implementation of the nursing guidelines. Results: shows that 78.9% of the studied nurses had total incorrect knowledge pre-program, which improved to 88.9% of them, had correct knowledge post-program. The study also shows that 47.2% of the studied nurses had unsatisfactory total practice score pre-program, which improved to 54.4%  of the studied nurses had high satisfactory total practice post-program. There was a highly statistically significant difference before and after nursing guidelines of the studied nurses’ knowledge and practice regarding ectopic pregnancy (P ≤ 0.001). Conclusion: The study concluded that nursing guidelines have a positive effect on the nurses' performance in terms of their knowledge and practice regarding ectopic pregnancy. The study recommended that simple guidelines regarding ectopic pregnancy nursing care should be distributed to nurses in the emergency obstetrics department to standardized and optimized nursing care provided to women with ectopic pregnancy. Continuous refreshment courses and follows up programs for nurses regarding ectopic pregnancy.

scholarly journals Virtual Reality Hypnosis for Anxiety and Pain Management in Intensive Care Units. A Prospective Randomized Trial Among Cardiac Surgery Patients.

2020 ◽  
Author(s):  
Floriane Marie Rousseaux ◽  
Nadia Dardenne ◽  
Paul B Massion ◽  
Didier Ledoux ◽  
Marie-Elisabeth Faymonville ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Units ◽  
University Hospital ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Significant Difference ◽  
Before And After ◽  
French Speaking

Abstract Background: Although non-pharmacological tools are nowadays commonly used in medical settings, virtual reality and hypnosis are little studied in complex contexts such as intensive care, where patients need significant physical and psychological assistance. The aim of the project is to evaluate the benefits of hypnosis, virtual reality (VR) and the combination of hypnosis and virtual reality (VRH) on anxiety and pain on patients before and after a cardiac surgery.Methods: This prospective randomized and controlled clinical trial was conducted in the University Hospital of Liege (Belgium). Participants are adults undergoing cardiac surgery, French speaking. Exclusion criteria are patients with psychiatric diseases, claustrophobia, acrophobia, heavy hearing impairment, visual impairment, extreme fatigue, verbal incoherence, surgery cancelled or postponed. The day before the surgery, patients were randomly assigned to four arms (control, hypnosis, VR and VRH) and had 20 minutes of one of the technique. They received the same intervention one day after surgery, in intensive care units. Anxiety, pain, fatigue, relaxation and physiological parameters were evaluated before and after each session.Results: 100 patients (66.38 ± 11.48 years; 76 men, 24 women) were included. Results showed that anxiety decreased from baseline to postoperative day in all groups. Relaxation increased in all groups in preoperative (p = .000) and postoperative period (p = 0.03). There were no significant results for pain and fatigue (p > 0.05). There was no significant difference between control group and hypnosis, VR or VRH.Conclusion: Anxiety decreased and relaxation increased in all groups, including control group. We cannot affirm that one technique is better than another is. Nevertheless, this study helps to expand the knowledge regarding application of virtual reality, hypnosis and virtual reality hypnosis in the specific contexts of cardiac surgery and intensive care units. Additional studies are required to compare and evaluate the costs-effectiveness of these techniques for critical care patients and caregivers (see Figure 1).Trial registration: ClinicalTrials.gov: NCT03820700. https://clinicaltrials.gov/ct2/show/NCT03820700. Registered on January 29 2019. Retrospectively registered.

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