The Effect of a Virtual Reality Environment and Hand Massage Applied in the Preoperative Area on Patient Outcomes

Purpose The aim of this study was to evaluate the effects of virtual reality-based three-dimensional videos and classical hand massage applied in the preoperative waiting area on preoperative anxiety, vital signs, pain, and patient satisfaction in patients undergoing elective surgery compared with routine care. Design This study was designed as a three-group, single-blind, randomized controlled trial. Methods The study was conducted in the preoperative waiting unit of a training and research hospital in southern Turkey. Based on the pilot study results, the final sample size was set at 78 participants (26 virtual reality, 26 hand massage, and 26 control). Eligible participants were allocated to study groups using a day-based cluster randomization approach, and participants were not informed about group allocation. Participants were not informed of their group assignment. The virtual reality group watched a three-dimensional video using virtual reality goggles, the hand massage group received classic hand massage, and no intervention was applied to the control group. Data were collected before and after the interventions using a Personal Information Form, the Surgical Anxiety Scale, and the Visual Analog Scale for pain and patient satisfaction. Vital signs, including respiration rate, pulse, and mean arterial pressure, were also measured at the same time points. Findings Both virtual reality and hand massage interventions resulted in significant reductions in surgical anxiety scores compared with baseline measurements. Between-group comparisons showed that post-intervention surgical anxiety scores were significantly higher in the control group than in the intervention groups (p = 0.006). Both interventions significantly reduced total and subscale anxiety scores (p=0.003; p=0.001; p<0.001 and p<0.001; p=0.033; p=0.013, respectively). Additionally, the reduction in health-related anxiety was greater in the hand massage group (p = 0.003), whereas greater decreases were observed in recovery anxiety (p = 0.011) and procedure-related anxiety (p = 0.038) in the virtual reality group. No significant difference was found between the intervention groups in overall anxiety reduction. Conclusions Hand massage and virtual reality applications were effective in reducing preoperative anxiety and increasing patient satisfaction in the preoperative waiting area. Both interventions may be considered practical, nonpharmacological approaches for reducing preoperative anxiety and supporting patients in the immediate preoperative period. Clinical Trial Number This randomized controlled trial was registered with ClinicalTrials.gov on 19 March 2025 (ID: NCT06883916). © 2026 The American Society of PeriAnesthesia Nurses.