xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06028360</url>
    </required_header>
    <id_info>
      <org_study_id>SSAHS 2023/02</org_study_id>
      <nct_id>NCT06028360</nct_id>
    </id_info>
    <brief_title>Progressive Muscle Relaxation (PMR) in Stress Management Among Physiotherapy Students</brief_title>
    <official_title>The Effect of Virtual Reality (VR) and Progressive Muscle Relaxation (PMR) in Stress Management Among Physiotherapy Students</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Shalamar Institute of Health Sciences</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>Shalamar Institute of Health Sciences</source>
    <oversight_info>
      <has_dmc>Yes</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        The objective of this clinical trial is to observe the effect of Virtual Reality (VR) and&#xD;
        Progressive muscle relaxation (PMR) in stressed individuals.&#xD;
  &#xD;
        Procedure:&#xD;
  &#xD;
        Students will be invited verbally and procedure will be explained to them. 20 students will&#xD;
        be recruited randomly into control and experimental group. Stress will be predicted using&#xD;
        multiple questionnaires. Pss is given before and after the intervention. The students in&#xD;
        control group will be given 10 mins session of PMR for 3 consecutive days and in intervention&#xD;
        group will be given 10 mins session of PMR followed by 8 mins session of VR for 3 consecutive&#xD;
        days in which specific landscapes i.e mountains, forests, nightskies and beaches.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        Introduction:&#xD;
  &#xD;
        As stress appears to be a natural human response to difficult situations prompting us to&#xD;
        address challenges and threats in our lives, prolonged stress may cause the fight or flight&#xD;
        response to over-ride body's normal physiology and produce multiple psychological and&#xD;
        physiological symptoms resulting in various negative health conditions such as cardiovascular&#xD;
        disorders, GIT disturbances, hypertension etc. Moreover, a global survey of adolescents in 72&#xD;
        countries found 66% of students reported feeling stressed about academics and 37% of students&#xD;
        felt anxiety relating to schoolwork. Many stress reduction interventions such as Progressive&#xD;
        Muscular Relaxation (PMR), mindfulness meditation, deep breathing exercises, and guided&#xD;
        imagery have been shown to reduce stress levels among individuals and are being used as&#xD;
        traditional relaxation interventions.&#xD;
  &#xD;
        Progressive muscle relaxation (PMR) originally known as Jacobson Muscle Relaxation Technique,&#xD;
        was developed by Edmund Jacobson in the 1934. It is an actively engaging technique guiding&#xD;
        the patients to consciously contract muscles to create tension and release it progressively.&#xD;
        This is repeated until patients acquire complete relaxation. Many studies on PMR have proven&#xD;
        it to be beneficial in decreasing stress and anxiety levels in many adults as well as&#xD;
        children worldwide.&#xD;
  &#xD;
        With emerging technology, innovative ideas, such as the use of VR (Virtual Reality) for&#xD;
        stress management, have also been considered and studied. According to Cruz-Neira (1993),&#xD;
        Virtual reality refers to immersive, interactive, multisensory, viewer-centered, 3D computer&#xD;
        generated environments and the combination of technologies required building environments. In&#xD;
        the healthcare sector, VR has been proved beneficial for balance and cognition training in&#xD;
        cerebral palsy and stroke, and also has been observed to mitigate acute and chronic pain. It&#xD;
        can provide rehabilitation, motivation and entertainment all at once. Further studies on its&#xD;
        immersive effect suggest it to be helpful in stress management. Natural environments&#xD;
        (forests, beaches, mountains etc ) viewed through VR, have shown to help individuals reduce&#xD;
        their stress levels, anxiety disorders, and phobias. However, there is little research on&#xD;
        individual preferences of different VR landscapes.&#xD;
  &#xD;
        In Asia, research relevant to VR has been shown to have a positive effect on stress&#xD;
        management in individuals with high stress and mood disorders. Effect of forest and water&#xD;
        landscapes on stress management has also been discussed earlier. However, area for more&#xD;
        research still remains.&#xD;
  &#xD;
        In Pakistan, multiple researches have been conducted on the use of VR in health care and as a&#xD;
        rehabilitative intervention for diseases such as stroke, parkinsons, cerebral palsy and&#xD;
        amblyopia, but very limited evidence is available on the effect of VR on stress management.&#xD;
        No such research has been conducted in this region or in our institution prior to our study.&#xD;
  &#xD;
        A study conducted in India showed that the PSS score decreased from mean 22.2 to 16.5 while&#xD;
        another study conducted in India indicated that PMR and talk therapy in college students,&#xD;
        reduced percieved stress from PSS score of 32.30 to 23.03.&#xD;
  &#xD;
        The purpose of our research is to investigate the effect of VR in stress management, the&#xD;
        individual preferences of landscapes and its comparison with traditional relaxation technique&#xD;
        such as Progressive Muscle Relaxation (PMR). This will help health-care workers improve&#xD;
        stress management in a technology driven community.&#xD;
  &#xD;
        Statistical analysis:&#xD;
  &#xD;
        data will be entered and analyzed using SPSS 25. Numerical data like age, PSS score will be&#xD;
        presented in the form of mean ± S.D whereas qualitative data like gender, Pre/Post&#xD;
        intervention stress etc. will be presented in the form of Frequency (Percentage). After&#xD;
        fulfilling parametric assumptions, Repeated measure ANOVA will be applied.&#xD;
  &#xD;
        Potential benefits:&#xD;
  &#xD;
          1. The subjects receiving the interventions will experience reduced stress and anxiety.&#xD;
  &#xD;
          2. The subjects will be introduced to an innovative and immersive technology i.e., VR.&#xD;
  &#xD;
          3. A step will be taken forward towards the use of technology in stress management, along&#xD;
             with a traditional relaxation technique such as Progressive muscle relaxation (PMR).&#xD;
  &#xD;
          4. The use of VR for stress management is cost effective and time saving.&#xD;
  &#xD;
        Potential risks:&#xD;
  &#xD;
          1. Motion Sickness It will be tried to minimize by excluding the susceptible subjects,&#xD;
             using Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ). Also&#xD;
             subjects with any psychological or in-corrected eye sight will not be included in the&#xD;
             study. In case the above mentioned risk develops during the intervention, the subject&#xD;
             will be given rest.&#xD;
  &#xD;
          2. Increased Drop Out Rate If the required sample size is not met due to high drop out&#xD;
             rate, new participants will be recruited and the procedure will be repeated until&#xD;
             required amount of data is available.&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">September 4, 2023</start_date>
    <completion_date type="Anticipated">December 31, 2023</completion_date>
    <primary_completion_date type="Anticipated">November 10, 2023</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <intervention_model_description>A Randomized Control Trial with a Control and an Experimental group that will be given intervention 3 consecutive days.</intervention_model_description>
      <primary_purpose>Treatment</primary_purpose>
      <masking>None (Open Label)</masking>
      <masking_description>The participants were blind to allocation. They were allocated by simple randomization through lottery method.</masking_description>
    </study_design_info>
    <primary_outcome>
      <measure>Stress Reduction</measure>
      <time_frame>the outcome will be determine at the base line of the treatment and at the 3rd day after initiation oftreatment</time_frame>
      <description>Reduction in Perceived Stress scale(PSS) from the previous reading will be considered as stress reduction. information will be collected before and after the treatment on each day. The scoring of Perceived Stress scale(PSS) ranges between 0-40, where 0-13 means low stress, 14-26 means moderate stress and 27-40 would be considered as high perceived stress</description>
    </primary_outcome>
    <number_of_arms>2</number_of_arms>
    <enrollment type="Anticipated">20</enrollment>
    <condition>Stress</condition>
    <arm_group>
      <arm_group_label>Progressive Muscle Relaxation</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>Progressive muscle relaxation will be applied for 15-20 minutes for 3 consecutive days for 1 week.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Virtual Reality</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>Virtual reality session will be given for 8 mins for 3 consecutive days for 1 week.</description>
    </arm_group>
    <intervention>
      <intervention_type>Other</intervention_type>
      <intervention_name>Progressive Muscle Relaxation</intervention_name>
      <description>Intervention will be applied for 15-20 minutes 3 consecutive days a week for 1 week</description>
      <arm_group_label>Progressive Muscle Relaxation</arm_group_label>
      <arm_group_label>Virtual Reality</arm_group_label>
      <other_name>PMR</other_name>
    </intervention>
    <intervention>
      <intervention_type>Device</intervention_type>
      <intervention_name>Virtual Reality Therapy</intervention_name>
      <description>Therapy through VR will be given for 8 minutes 3 times a week on consecutively for 1 week</description>
      <arm_group_label>Virtual Reality</arm_group_label>
      <other_name>VR Therapy</other_name>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  Students of either sex, aged between 18-24 years&#xD;
  &#xD;
            -  Students with Stress (through perceived stress scale PSS, any individual with a score&#xD;
               above 14)&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  Students more susceptible to motion sickness (Through VIMSSQ),&#xD;
  &#xD;
            -  Students with in-corrected eye-sight,&#xD;
  &#xD;
            -  Students with phobias relevant to landscapes/views of mountains, forests, beaches and&#xD;
               night-skies.&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>24 Years</maximum_age>
      <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
    </eligibility>
    <overall_official>
      <last_name>Reema Khanam, DPT</last_name>
      <role>Principal Investigator</role>
      <affiliation>Shalamar Medical and Dental College</affiliation>
    </overall_official>
    <overall_official>
      <last_name>Laiba Khan, DPT</last_name>
      <role>Principal Investigator</role>
      <affiliation>Shalamar Medical and Dental College</affiliation>
    </overall_official>
    <overall_official>
      <last_name>Maha Sohail, DPT</last_name>
      <role>Principal Investigator</role>
      <affiliation>Shalamar Medical and Dental College</affiliation>
    </overall_official>
    <overall_contact>
      <last_name>Masooma Gull, M.S.</last_name>
      <phone>+92-42-111-205-205</phone>
      <phone_ext>528</phone_ext>
      <email>masooma.gull@sihs.org.pk</email>
    </overall_contact>
    <overall_contact_backup>
      <last_name>Javeria Aslam, Ph.D</last_name>
      <phone>+92-42-111-205-205</phone>
      <email>javeria.aslam@sihs.org.pk</email>
    </overall_contact_backup>
    <location>
      <facility>
        <name>Shalamar Medical and Dental College</name>
        <address>
          <city>Lahore</city>
          <state>Punjab</state>
          <zip>46994</zip>
          <country>Pakistan</country>
        </address>
      </facility>
      <contact>
        <last_name>Dr. Masooma Gull, MSc</last_name>
        <email>masoomagull2@ymail.com</email>
      </contact>
      <investigator>
        <last_name>Reema Khanam, DPT</last_name>
        <role>Principal Investigator</role>
      </investigator>
      <investigator>
        <last_name>Laiba Khan, DPT</last_name>
        <role>Principal Investigator</role>
      </investigator>
      <investigator>
        <last_name>Maha Sohail, DPT</last_name>
        <role>Principal Investigator</role>
      </investigator>
      <investigator>
        <last_name>Dr. Masooma Gull, MSc</last_name>
        <role>Principal Investigator</role>
      </investigator>
    </location>
    <location_countries>
      <country>Pakistan</country>
    </location_countries>
    <reference>
      <citation>Gao T, Zhang T, Zhu L, Gao Y, Qiu L. Exploring Psychophysiological Restoration and Individual Preference in the Different Environments Based on Virtual Reality. Int J Environ Res Public Health. 2019 Aug 26;16(17):3102. doi: 10.3390/ijerph16173102.</citation>
      <PMID>31455015</PMID>
    </reference>
    <reference>
      <citation>Wang X, Shi Y, Zhang B, Chiang Y. The Influence of Forest Resting Environments on Stress Using Virtual Reality. Int J Environ Res Public Health. 2019 Sep 5;16(18):3263. doi: 10.3390/ijerph16183263.</citation>
      <PMID>31491931</PMID>
    </reference>
    <reference>
      <citation>Allison S, Irwin Hamilton K, Yuan Y, Wallis Hague G. Assessment of Progressive Muscle Relaxation (PMR) as a Stress-Reducing Technique for First-Year Veterinary Students. J Vet Med Educ. 2020 Dec;47(6):737-744. doi: 10.3138/jvme.2018-0013. Epub 2019 Nov 15.</citation>
      <PMID>31738679</PMID>
    </reference>
    <reference>
      <citation>Ruotolo I, Berardi A, Sellitto G, Panuccio F, Polimeni A, Valente D, Galeoto G. Criterion Validity and Reliability of SF-12 Health Survey Version 2 (SF-12v2) in a Student Population during COVID-19 Pandemic: A Cross-Sectional Study. Depress Res Treat. 2021 Aug 4;2021:6624378. doi: 10.1155/2021/6624378. eCollection 2021.</citation>
      <PMID>34394986</PMID>
    </reference>
    <reference>
      <citation>Levenstein S, Prantera C, Varvo V, Scribano ML, Berto E, Luzi C, Andreoli A. Development of the Perceived Stress Questionnaire: a new tool for psychosomatic research. J Psychosom Res. 1993 Jan;37(1):19-32. doi: 10.1016/0022-3999(93)90120-5.</citation>
      <PMID>8421257</PMID>
    </reference>
    <reference>
      <citation>Keshavarz B, Murovec B, Mohanathas N, Golding JF. The Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ): Estimating Individual Susceptibility to Motion Sickness-Like Symptoms When Using Visual Devices. Hum Factors. 2023 Feb;65(1):107-124. doi: 10.1177/00187208211008687. Epub 2021 Apr 19.</citation>
      <PMID>33874752</PMID>
    </reference>
    <reference>
      <citation>Ahmadpour N, Randall H, Choksi H, Gao A, Vaughan C, Poronnik P. Virtual Reality interventions for acute and chronic pain management. Int J Biochem Cell Biol. 2019 Sep;114:105568. doi: 10.1016/j.biocel.2019.105568. Epub 2019 Jul 12.</citation>
      <PMID>31306747</PMID>
    </reference>
    <reference>
      <citation>Browning MHEM, Shin S, Drong G, McAnirlin O, Gagnon RJ, Ranganathan S, Sindelar K, Hoptman D, Bratman GN, Yuan S, Prabhu VG, Heller W. Daily exposure to virtual nature reduces symptoms of anxiety in college students. Sci Rep. 2023 Jan 23;13(1):1239. doi: 10.1038/s41598-023-28070-9.</citation>
      <PMID>36690698</PMID>
    </reference>
    <reference>
      <citation>Kashif M, Ahmad A, Bandpei MAM, Farooq M, Iram H, E Fatima R. Systematic review of the application of virtual reality to improve balance, gait and motor function in patients with Parkinson's disease. Medicine (Baltimore). 2022 Aug 5;101(31):e29212. doi: 10.1097/MD.0000000000029212.</citation>
      <PMID>35945738</PMID>
    </reference>
    <verification_date>September 2023</verification_date>
    <study_first_submitted>August 31, 2023</study_first_submitted>
    <study_first_submitted_qc>August 31, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">September 8, 2023</study_first_posted>
    <last_update_submitted>September 8, 2023</last_update_submitted>
    <last_update_submitted_qc>September 8, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">September 13, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Sponsor</responsible_party_type>
    </responsible_party>
    <keyword>Psychological stress</keyword>
    <keyword>progressive muscle relaxation (PMR)</keyword>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06028360
  org study id: SSAHS 2023/02
  nct id: NCT06028360
  lead sponsor: 
  has dmc: Yes
  is fda regulated drug: No
  is fda regulated device: No
  The objective of this clinical trial is to observe the effect of Virtual Reality (VR) and
        Progressive muscle relaxation (PMR) in stressed individuals.
  
        Procedure:
  
        Students will be invited verbally and procedure will be explained to them. 20 students will
        be recruited randomly into control and experimental group. Stress will be predicted using
        multiple questionnaires. Pss is given before and after the intervention. The students in
        control group will be given 10 mins session of PMR for 3 consecutive days and in intervention
        group will be given 10 mins session of PMR followed by 8 mins session of VR for 3 consecutive
        days in which specific landscapes i.e mountains, forests, nightskies and beaches.
  Introduction:
  
        As stress appears to be a natural human response to difficult situations prompting us to
        address challenges and threats in our lives, prolonged stress may cause the fight or flight
        response to over-ride body's normal physiology and produce multiple psychological and
        physiological symptoms resulting in various negative health conditions such as cardiovascular
        disorders, GIT disturbances, hypertension etc. Moreover, a global survey of adolescents in 72
        countries found 66% of students reported feeling stressed about academics and 37% of students
        felt anxiety relating to schoolwork. Many stress reduction interventions such as Progressive
        Muscular Relaxation (PMR), mindfulness meditation, deep breathing exercises, and guided
        imagery have been shown to reduce stress levels among individuals and are being used as
        traditional relaxation interventions.
  
        Progressive muscle relaxation (PMR) originally known as Jacobson Muscle Relaxation Technique,
        was developed by Edmund Jacobson in the 1934. It is an actively engaging technique guiding
        the patients to consciously contract muscles to create tension and release it progressively.
        This is repeated until patients acquire complete relaxation. Many studies on PMR have proven
        it to be beneficial in decreasing stress and anxiety levels in many adults as well as
        children worldwide.
  
        With emerging technology, innovative ideas, such as the use of VR (Virtual Reality) for
        stress management, have also been considered and studied. According to Cruz-Neira (1993),
        Virtual reality refers to immersive, interactive, multisensory, viewer-centered, 3D computer
        generated environments and the combination of technologies required building environments. In
        the healthcare sector, VR has been proved beneficial for balance and cognition training in
        cerebral palsy and stroke, and also has been observed to mitigate acute and chronic pain. It
        can provide rehabilitation, motivation and entertainment all at once. Further studies on its
        immersive effect suggest it to be helpful in stress management. Natural environments
        (forests, beaches, mountains etc ) viewed through VR, have shown to help individuals reduce
        their stress levels, anxiety disorders, and phobias. However, there is little research on
        individual preferences of different VR landscapes.
  
        In Asia, research relevant to VR has been shown to have a positive effect on stress
        management in individuals with high stress and mood disorders. Effect of forest and water
        landscapes on stress management has also been discussed earlier. However, area for more
        research still remains.
  
        In Pakistan, multiple researches have been conducted on the use of VR in health care and as a
        rehabilitative intervention for diseases such as stroke, parkinsons, cerebral palsy and
        amblyopia, but very limited evidence is available on the effect of VR on stress management.
        No such research has been conducted in this region or in our institution prior to our study.
  
        A study conducted in India showed that the PSS score decreased from mean 22.2 to 16.5 while
        another study conducted in India indicated that PMR and talk therapy in college students,
        reduced percieved stress from PSS score of 32.30 to 23.03.
  
        The purpose of our research is to investigate the effect of VR in stress management, the
        individual preferences of landscapes and its comparison with traditional relaxation technique
        such as Progressive Muscle Relaxation (PMR). This will help health-care workers improve
        stress management in a technology driven community.
  
        Statistical analysis:
  
        data will be entered and analyzed using SPSS 25. Numerical data like age, PSS score will be
        presented in the form of mean ± S.D whereas qualitative data like gender, Pre/Post
        intervention stress etc. will be presented in the form of Frequency (Percentage). After
        fulfilling parametric assumptions, Repeated measure ANOVA will be applied.
  
        Potential benefits:
  
          1. The subjects receiving the interventions will experience reduced stress and anxiety.
  
          2. The subjects will be introduced to an innovative and immersive technology i.e., VR.
  
          3. A step will be taken forward towards the use of technology in stress management, along
             with a traditional relaxation technique such as Progressive muscle relaxation (PMR).
  
          4. The use of VR for stress management is cost effective and time saving.
  
        Potential risks:
  
          1. Motion Sickness It will be tried to minimize by excluding the susceptible subjects,
             using Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ). Also
             subjects with any psychological or in-corrected eye sight will not be included in the
             study. In case the above mentioned risk develops during the intervention, the subject
             will be given rest.
  
          2. Increased Drop Out Rate If the required sample size is not met due to high drop out
             rate, new participants will be recruited and the procedure will be repeated until
             required amount of data is available.
  allocation: Randomized
  intervention model: Parallel Assignment
  intervention model description: A Randomized Control Trial with a Control and an Experimental group that will be given intervention 3 consecutive days.
  primary purpose: Treatment
  masking: None (Open Label)
  masking description: The participants were blind to allocation. They were allocated by simple randomization through lottery method.
  measure: Stress Reduction
  time frame: the outcome will be determine at the base line of the treatment and at the 3rd day after initiation oftreatment
  description: Reduction in Perceived Stress scale(PSS) from the previous reading will be considered as stress reduction. information will be collected before and after the treatment on each day. The scoring of Perceived Stress scale(PSS) ranges between 0-40, where 0-13 means low stress, 14-26 means moderate stress and 27-40 would be considered as high perceived stress
  arm group label: Progressive Muscle Relaxation
  arm group type: Active Comparator
  description: Progressive muscle relaxation will be applied for 15-20 minutes for 3 consecutive days for 1 week.
  arm group label: Virtual Reality
  arm group type: Experimental
  description: Virtual reality session will be given for 8 mins for 3 consecutive days for 1 week.
  intervention type: Other
  intervention name: Progressive Muscle Relaxation
  description: Intervention will be applied for 15-20 minutes 3 consecutive days a week for 1 week
  arm group label: Progressive Muscle Relaxation
  arm group label: Virtual Reality
  other name: PMR
  intervention type: Device
  intervention name: Virtual Reality Therapy
  description: Therapy through VR will be given for 8 minutes 3 times a week on consecutively for 1 week
  arm group label: Virtual Reality
  other name: VR Therapy
  criteria: 
  gender: All
  minimum age: 18 Years
  maximum age: 24 Years
  healthy volunteers: Accepts Healthy Volunteers
  last name: Reema Khanam, DPT
  role: Principal Investigator
  affiliation: Shalamar Medical and Dental College
  last name: Laiba Khan, DPT
  role: Principal Investigator
  affiliation: Shalamar Medical and Dental College
  last name: Maha Sohail, DPT
  role: Principal Investigator
  affiliation: Shalamar Medical and Dental College
  last name: Masooma Gull, M.S.
  phone: +92-42-111-205-205
  phone ext: 528
  email: masooma.gull@sihs.org.pk
  last name: Javeria Aslam, Ph.D
  phone: +92-42-111-205-205
  email: javeria.aslam@sihs.org.pk
  facility: 
  contact: 
  investigator: 
  investigator: 
  investigator: 
  investigator: 
  country: Pakistan
  citation: Gao T, Zhang T, Zhu L, Gao Y, Qiu L. Exploring Psychophysiological Restoration and Individual Preference in the Different Environments Based on Virtual Reality. Int J Environ Res Public Health. 2019 Aug 26;16(17):3102. doi: 10.3390/ijerph16173102.
  PMID: 31455015
  citation: Wang X, Shi Y, Zhang B, Chiang Y. The Influence of Forest Resting Environments on Stress Using Virtual Reality. Int J Environ Res Public Health. 2019 Sep 5;16(18):3263. doi: 10.3390/ijerph16183263.
  PMID: 31491931
  citation: Allison S, Irwin Hamilton K, Yuan Y, Wallis Hague G. Assessment of Progressive Muscle Relaxation (PMR) as a Stress-Reducing Technique for First-Year Veterinary Students. J Vet Med Educ. 2020 Dec;47(6):737-744. doi: 10.3138/jvme.2018-0013. Epub 2019 Nov 15.
  PMID: 31738679
  citation: Ruotolo I, Berardi A, Sellitto G, Panuccio F, Polimeni A, Valente D, Galeoto G. Criterion Validity and Reliability of SF-12 Health Survey Version 2 (SF-12v2) in a Student Population during COVID-19 Pandemic: A Cross-Sectional Study. Depress Res Treat. 2021 Aug 4;2021:6624378. doi: 10.1155/2021/6624378. eCollection 2021.
  PMID: 34394986
  citation: Levenstein S, Prantera C, Varvo V, Scribano ML, Berto E, Luzi C, Andreoli A. Development of the Perceived Stress Questionnaire: a new tool for psychosomatic research. J Psychosom Res. 1993 Jan;37(1):19-32. doi: 10.1016/0022-3999(93)90120-5.
  PMID: 8421257
  citation: Keshavarz B, Murovec B, Mohanathas N, Golding JF. The Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ): Estimating Individual Susceptibility to Motion Sickness-Like Symptoms When Using Visual Devices. Hum Factors. 2023 Feb;65(1):107-124. doi: 10.1177/00187208211008687. Epub 2021 Apr 19.
  PMID: 33874752
  citation: Ahmadpour N, Randall H, Choksi H, Gao A, Vaughan C, Poronnik P. Virtual Reality interventions for acute and chronic pain management. Int J Biochem Cell Biol. 2019 Sep;114:105568. doi: 10.1016/j.biocel.2019.105568. Epub 2019 Jul 12.
  PMID: 31306747
  citation: Browning MHEM, Shin S, Drong G, McAnirlin O, Gagnon RJ, Ranganathan S, Sindelar K, Hoptman D, Bratman GN, Yuan S, Prabhu VG, Heller W. Daily exposure to virtual nature reduces symptoms of anxiety in college students. Sci Rep. 2023 Jan 23;13(1):1239. doi: 10.1038/s41598-023-28070-9.
  PMID: 36690698
  citation: Kashif M, Ahmad A, Bandpei MAM, Farooq M, Iram H, E Fatima R. Systematic review of the application of virtual reality to improve balance, gait and motor function in patients with Parkinson's disease. Medicine (Baltimore). 2022 Aug 5;101(31):e29212. doi: 10.1097/MD.0000000000029212.
  PMID: 35945738
  responsible party type: Sponsor