Implementation of Virtual Reality for Postoperative Recovery in an Adolescent Idiopathic Scoliosis Population

Dear Editor, the publication on “Cite Implementation of Virtual Reality for Postoperative Recovery in an Adolescent Idiopathic Scoliosis Population: a Prospective Pilot Study [1]” is interesting. The use of virtual reality (VR) as a non-pharmacological pain management technique in conjunction with physical therapy following surgery to treat adolescent idiopathic scoliosis is an intriguing idea presented in this study. However, when interpreting and using the data in a therapeutic setting, a number of limitations should be taken into account.First off, statistical power and the capacity to extrapolate to the entire adolescent idiopathic scoliosis patient population are severely hampered by the extremely small sample size (10 people per group). Instead of a true lack of VRs effect, the lack of differences in opioid use, total dose, number of physical therapy sessions, or length of hospital stay could be the result of an underpowered study. Additionally, because the primary outcome is the subjective pain score, the non-randomized, non-blinded design creates potential for selection bias and the expectation effect.Second, it is impossible to distinguish between the “novelty effect” and the therapeutic benefit when a single VR format – an aquatic scene lasting 20 minutes – is used prior to each physical therapy session. Furthermore, short-term evaluations conducted solely during a hospital stay might not capture long-term repercussions or cumulative effects on functional recovery. Although not severe, side effects like weariness, nausea, and dizziness raise the possibility that VR may not be appropriate for all patients. Additionally, it needs to be regarded as a customized intervention.It is possible that VR acts more as “situational analgesia” than as a shift in the overall trajectory of pain, as evidenced by the fact that it lowers pain scores during physical therapy but not during opioid use in general. In other words, while VR may increase tolerance to movement-evoked pain, it won't be sufficient to lower baseline pain or the need for opioids during major spine surgery. This explanation clarifies why VR has an impact on pain scores following physical therapy but not other systemic outcomes.Large-scale randomized controlled trials stratified by preoperative pain, anxiety, or opioid sensitivity levels, as well as the evaluation of behavioral outcomes like participation in physical therapy, movement quality, and long-term patient-reported outcomes, will be helpful in expanding our knowledge of the role of VR in future research directions. Additionally, creating adaptable VR and contrasting it with other non-immersive distractions would aid in clarifying VRs role in multimodal postoperative pain management.The authors declare no conflict.There is no funding.H.P.: 50% ideas, writing, analyzing, and approval. V.W.: 50% ideas, supervision, and approval. There is no declared financial conflict. The author use language editing computational tool in preparation of the article.