Overview
bipolar disorder, calmness, aggressive behavior, psychiatric, depression, self-harm
MUSCLE RELAXATION
The main objective of this quasi-randomized study was to explore the effects of a physical calm room on self-reported well-being compared to a VR calm room for patients admitted to inpatient psychiatric intensive care. We did not find any statistically significant between-group differences in relaxation effects. However, both groups reported increased well-being and decreased HR, albeit with no effect on BP. Effects were not moderated by baseline depression levels despite an overall difference in reported well-being between subgroups.To our knowledge, this is the first study to compare the effects of a physical calm room to VR relaxation. Our findings are, however, in line with previous studies on both physical calm rooms [Relaxation is the state of calmness that fosters positive well-being including strategies, such as breathing exercises, meditation, and guided muscle relaxation. With these strategies, high BP and HR may be lowered [Limitations of this study include lower than the planned statistical power, as well as the quasi-random allocation to the different calm room interventions. According to the initial trial design, the sample was set to include 100 participants with a diagnosis of bipolar disorder. Due to the COVID-19 pandemic, the study was paused between January 2020 and July 2020, making it unfeasible to recruit the target sample size during the study timeframe. In addition, the hospital had a lack of beds, and patients who were diagnosed with other than bipolar disorder were included in the study. The achieved sample size of 60 (40+20) allowed us to detect with 80% power, a between-group difference of d>0.78 postintervention compared to d>0.57 as originally planned. Moreover, the lack of a predefined, clinically anchored, noninferiority limit precludes us from analyzing the study using this approach. Regarding the quasi-random allocation, this was a necessity stemming from running the study at a psychiatric inpatient clinic. Allocation, in this fully naturalistic trial, was based by necessity on clinic prerequisites (eg, bed availability and staffing) and not on study-specific allocation; thus, because it was not fully randomized, allocation was nonetheless seemingly independent of participant factors that could risk confounding results. For example, patients were not allocated to the different wards (and therefore interventions) due to severity of distress.Difference in achieved sample size ratio, as well as some differences in patient characteristics and baseline measures, indicate that the allocation was not completely free of systematic influences. Moreover, almost all the physical calm room group were female (16/29, 80%) compared to an even gender distribution in the VR room group. Furthermore, patients have not had any option to choose the room they wanted to experience, but they were allocated to the respective wards. The gender imbalance considers as a limitation because we cannot report if the intervention equal associated with an induced well-being because of gender as a factor. We may assume that the gender imbalance exists toward the physical sensory room due to different preferences between women and men. Alternatively, supervising personal may assume that women prefer a sensory room. The personal have had the responsibility to check the inclusion and exclusion criteria as well as the clinical characteristics and may have excluded more male patients than females or became influenced by social norms which indicate that males not seeking help [In addition, length of stay was determined for the 2 calm rooms; however, this should not be considered an outcome in itself. The importance of measuring time spent in the intervention is hard to interpret in a quantitative study and should rather be explored in a qualitative way. A previous study shows that the greater amount of time spent in sensory room did not necessarily related with stress-relieving outcomes [Future research could examine whether VR relaxation can decrease the use of sedatives as well as aggressive behavior in the ward. Some studies have found no link between seclusion and aggressive behavior with the use of physical calm rooms. One small study did not find a decreased frequency of self-harm during the test period, although there was a low level of participation [