Virtual Reality Therapy Reduced Anxiety Levels for Post-Stroke Patients undergoing Hyperbaric Oxygen Therapy: A Pilot Clinical Trial

Background: Hyperbaric oxygen therapy (HBOT) is an effective post-stroke treatment, but its efficacy is often compromised by treatment-related anxiety and claustrophobia, leading to poor adherence. Virtual reality (VR) distraction is a promising non-pharmacological intervention to mitigate this anxiety. Objective: This pilot study aimed to compare the effects of AI-generated personalized VR versus self-selected standard VR on anxiety and cognitive function in post-stroke patients during HBOT, against a control group. Methods: A three-arm pilot clinical trial was conducted with 15 post-stroke patients randomly assigned to: 1) Personalized VR (AI-generated, silent 360° images), 2) Standard VR (self-selected, audio-enabled 360° videos from YouTube), or 3) a no-VR Control group. The intervention was delivered for 10 minutes before each of two HBOT sessions. Anxiety was measured using the Hamilton Anxiety Rating Scale and cognitive function with the Montreal Cognitive Assessment (MoCA). Results: While all groups showed reduced anxiety post-intervention, a significant reduction was found only in the Standard VR (YouTube) group compared to the control (p=0.005). The AI-generated VR group showed no significant difference from the control (p=0.128). There were no significant differences in MoCA scores across groups before or after the intervention. Conclusion: A brief, audio-enabled VR distraction intervention can significantly reduce anxiety in post-stroke patients undergoing HBOT. The multisensory nature of standard VR content appears more effective for immediate anxiety reduction than silent, personalized AI-generated environments. Sensory immersion may be more critical than personalization for rapid anxiolysis.