The Effect of Virtual Forest Bathing on Bariatric Surgery Patients

NCT07152054 | Not Yet Recruiting

• 1 other identifier: Muazzez TORAMAN
• Study Type: interventional
• Target: 70
• Locations: 0 countries
• Sites: N/A

Brief Summary

This study will be conducted at the General Surgery Clinic of City Hospital in Erzurum between August 2025 and April 2026 using a randomized controlled experimental design. In the power analysis, it was determined that the sample of the study should be 70 patients in total, 35 patients in each group, with a medium effect size of 0.5% according to Cohen (42), a margin of error of 0.05%, a confidence interval of 0.95%, and a 95% universe representation power. Patients will be assigned to either the experimental or control groups using a random number generator using a two-block randomization method (random.org). Given that exposure to nature through virtual reality increases physiological arousal and promotes positive mood, the study aimed to evaluate the effects of virtual forest bathing on pre- and postoperative pain, anxiety, fear, sleep, vital signs, and cortisol levels in patients undergoing bariatric surgery.

Conditions

Bariatric Surgery; Virtual Reality; Anxiety

Outcome Measures

Primary Outcomes (6)

• Personal Information Form:

  This questionnaire, developed by the researcher based on a literature review related to the topic, consists of 16 questions addressing variables such as gender, age, education level, marital status, and previous surgical history.

  up to 24 hours

• Surgical Fear Questionnaire (SFQ)

  Surgical Fear Questionnaire (SFQ): Developed by Theunissen et al. in 2014 to assess the fear levels of patients scheduled for surgical procedures, this 8-item Likert-type scale evaluates short-term surgical fears with items 1-4 and long-term surgical fears with items 5-8. Each item is scored on a scale from 0 ("not afraid at all") to 10 ("very afraid"), resulting in a total score ranging from 0 to 80. Higher scores indicate greater levels of surgical fear (Theunissen et al., 2014). The Turkish validity and reliability study conducted by Bağdigen and Özlü (2018) reported a Cronbach's alpha coefficient of 0.93.

  up to 24 hours

• Richard-Campbell Sleep Questionnaire (RCSQ)

  Developed by Richards in 1987 (Richards, 1987) and adapted into Turkish by Özlü and Özer in 2015 (Özlü \& Özer, 2015), this scale consists of six items evaluating sleep depth, time to fall asleep, frequency of awakenings, time to return to sleep after awakening, sleep quality, and environmental noise level. Each item is scored between 0 and 100. In total score calculation, the sixth item (noise level) is excluded, and scoring is based on the remaining five items. Higher scores indicate better sleep quality. Final scores are calculated by dividing the total score by the number of items. Scores between 0-25 indicate "very poor" sleep quality, while scores between 76-100 indicate "very good" sleep quality.

  up to 24 hours

• Visual Analog Scale (VAS)

  Developed by Price et al. (1983), this scale measures the intensity of pain using a 10 cm vertical or horizontal line with endpoints labeled as "no pain" (0) and "worst possible pain" (10). The patient marks a point corresponding to their perceived pain intensity, and the distance from the "no pain" end to the marked point is measured in centimeters, representing the pain score. Higher scores indicate greater pain intensity.

  up to 24 hours

• State-Trait Anxiety Inventory (STAI-STAII)

  It is a test developed by Spielberger et al. that measures state and trait anxiety levels. Its validity and reliability in Turkey was done by Oner and Le Compte. The scale consists of two parts, the 'state anxiety scale', which is created with the aim of determining the instantaneous feelings, and the 20-item 'trait anxiety scale', which was created to determine the feelings in general. It is a four degree scale ranging from 'Nothing' to 'All'. Scores range from 20 (low anxiety) to 80 (high anxiety).

  up to 24 hours

• Tracking Form for Parameters

  Before and after bariatric surgery, patients' heart rate, blood pressure, and oxygen saturation will be measured and recorded in this form. In addition, to assess stress levels, blood cortisol measurements will be performed. Blood samples for cortisol will be collected in the morning (between 07:30-08:30) in appropriate tubes, promptly transported to the laboratory, and analyzed under cold chain conditions. Serum or plasma will be separated and analyzed using standard devices. All procedures will be carried out in the Erzurum City Hospital laboratory according to existing standard protocols and high-quality criteria, and results will be recorded.

  up to 24 hours

Study Arms (1)

Experimental: Virtual Forest Bathing

EXPERIMENTAL

Patients in the experimental group will undergo the routine surgical procedure implemented in the hospital, and their evaluations will be carried out using the predetermined questionnaires. In addition, they will receive a virtual forest bathing intervention on the evening prior to surgery and on the first postoperative day. On the day of admission for bariatric surgery, the researcher will administer, face-to-face, the Personal Information Form, Surgical Fear Questionnaire, Richard-Campbell Sleep Questionnaire, Visual Analog Scale (VAS) for pain assessment, State-Trait Anxiety Inventory, and the parameter recording form. Following the virtual forest bathing sessions conducted on the evening before surgery and on the first postoperative day, the Surgical Fear Questionnaire, Richard-Campbell Sleep Questionnaire, Visual Analog Scale (VAS), State-Trait Anxiety Inventory, and parameter recording form will be completed again.

Device: virtual forest bathing

Interventions

virtual forest bathing DEVICE

Virtual reality (VR) is an advanced computer technology and a novel technique used in healthcare to alleviate pain and provide patient comfort. It enables individuals to interact with a 360-degree virtual environment through a headset device. It has been observed that painful or emotionally stressful stimuli from the external world are diminished within the VR environment, with the individual's attention redirected and focused on this immersive setting. In our study, a 20-minute VR video will be used, providing the sensation of walking through a calming 360-degree virtual forest environment accompanied by natural sounds, viewed through VR headsets. Unlike some commercially available VR headsets, the Oculus Quest 2 model will be utilized, as it serves as both the computer and display system, eliminating the need for a smartphone. This device is preferred for its ability to deliver high-quality video without interruptions that might negatively affect the VR experience. After explaining

Experimental: Virtual Forest Bathing

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Willingness to participate in the study
• Ability to communicate verbally
• Absence of any psychiatric disorder
• Undergoing bariatric surgery
• No prior experience with virtual forest bathing

You may not qualify if:

• Inability to establish communication
• Presence of major hearing or visual impairment
• Presence of any condition that may affect decision-making ability (e.g., psychological disorders, dementia)
• Use of medications that may affect cognitive status (e.g., sedatives, antipsychotics)
• Patients who report having previously experienced virtual forest bathing will be excluded from the sample

Sponsors & Collaborators

• Ataturk University: lead

MeSH Terms

Conditions

Anxiety Disorders

Condition Hierarchy (Ancestors)

Mental Disorders

Study Officials

• Muazzez Merve TORAMAN

  Atatürk Üniversity

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Muazzez Merve TORAMAN

CONTACT

05548307383; lalemervetoraman@gmail.com

Zeynep KARAMAN ÖZLÜ, Prof. Dr.

CONTACT

zynp_krmnzl@hotmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Research Assistant

Study Record Dates

• First Submitted: August 10, 2025
• First Posted: September 3, 2025
• Study Start: August 25, 2025
• Primary Completion: December 25, 2025
• Study Completion (Estimated): August 25, 2026
• Last Updated: September 3, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share