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

INTERVENTION: 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. CONDITION: end stage renal diseases; ; end stage renal diseases Inflammatory and Immune System ‐ Other inflammatory or immune system disorders Mental Health ‐ Anxiety Mental Health ‐ Depression Physical Medicine / Rehabilitation ‐ Physiotherapy Renal and Urogenital ‐ Kidney disease PRIMARY OUTCOME: Anxiety[the Hospital Anxiety and Depression Scale (HADS) Baseline and one month post‐commencement of intervention] Depression[the Hospital Anxiety and Depression Scale (HADS) Baseline and one month post‐commencement of intervention] INCLUSION CRITERIA: • consent to participate in the study, • diagnosed chronic renal failure (CKD), • hemodialysis treatment for at least 3 months prior to the start of the study, • adequate dialysis therapy: dialysis adequacy inde XKt/V >1.2; protein catabolism coefficient (PCR) 0.8–1.4 g protein/kg body weight/day, • ability to perform a full cognitive function test, • satisfactory cognitive function (MMSE > 23) enabling reliable psychological testing, • age 40–70 years. SECONDARY OUTCOME: assessment of physical activity[actigraph Baseline and one month post‐commencement of intervention] assessment of physical activity[International Physical Activity Questionnaire ‐ IPAQ Baseline and one month post‐commencement of intervention] balance[Pedobarographic platform from ZEBRIS (Medical GmbH). Baseline and one month post‐commencement of intervention] Biochemical testing: a complete blood count (CBC) with a differential blood count (DBC) [SII (systemic immune inflammation index) Baseline and one month post‐commencement of intervention] Biochemical testing: a complete blood count (CBC) with a differential blood count (DBC) [SIRI (systemic inflammation response index) Baseline and one month post‐commencement of intervention] Handgrip strength[A Jamar hydraulic dynamometer will be used to measure handgrip strength. Baseline and one month post‐commencement of intervention] Inflammatory classifiers: NLR (neutrophil‐to‐lymphocyte ratio)[Biochemical testing: a complete blood count (CBC) with a differential blood count (DBC) Baseline and one month post‐commencement of intervention] Level of illness acceptance[the Acceptance of Illness Scale (AIS) Baseline and one month post‐commencement of intervention] life satisfaction[the Satisfaction with Life Scale (SWLS) Baseline and one month post‐commencement of intervention] mood and level of illness acceptance[the Patient Health Questionnaire‐9 (PHQ‐9) Baseline and one month post‐commencement of intervention] muscle elastoplastic properties [Myometer (Myoton PRO) on the mid‐belly of the quadriceps tendon Baseline and one month post‐commencement of intervention] muscle elastoplastic properties [Myometer (Myoton PRO) on the mid‐belly of the rectus femoris muscle Baseline and one month post‐commencement of intervention] perceived self‐efficacy [the General Self‐Efficacy Scale (GSES) Baseline and one month post‐commencement of intervention] perceived self‐efficacy [the Perceived Stress Scale (PSS‐10) Baseline and one month post‐commencement of intervention] quality of life[the Kidney Disease Quality of Life (KDQOL‐36™) questionnaire Baseline and one month post‐commencement of intervention] stress levels and inflammation[Biochemical testing: a complete blood count (CBC) with a differential blood count (DBC) Baseline and one month post‐commencement of intervention] the range and dynamics of body temperature [Thermographic assessment before and after dialysis, using a ThermoVision FLIR SYSTEM thermal imaging camera. Baseline and one month post‐commencement of intervention]