Virtual Reality Reduces Fear and Anxiety During Pediatric Orthopaedic Cast Room Procedures: A Randomized Controlled Trial

Abstract

Background: Virtual Reality (VR) has been used as a distraction tool in various medical settings to reduce pain and anxiety associated with procedures. This study evaluates the effectiveness of VR as a distraction tool for decreasing fear, anxiety, and pain in pediatric patients undergoing common outpatient orthopaedic procedures. Methods: A total of 210 patients were recruited from a single orthopaedic clinic between October 2017 and July 2019. Patients were randomized to the VR group or to the control group (standard of care). Outpatient procedures included cast and/or pin removals. Primary outcome measures were collected preprocedure and postprocedure using validated surveys, and included: fear (Children's Fear Scale), anxiety (Children's Anxiety Meter-State), and pain (Numerical Rating Scale). Patients and caregivers in the VR group completed a satisfaction survey at the end of their appointment. Fear, anxiety, and pain scores between the 2 groups were analyzed using multivariable linear regression models, and the satisfaction survey was analyzed using descriptive statistics. Results: One hundred twenty nine patients were included in the final analysis, with 85 patients in the VR group and 44 patients in the control group. During the procedure, patients in the VR group reported significantly lower average fear scores (P < 0.001) and anxiety scores (P = 0.003) as compared with controls. There were no differences between the groups in fear and anxiety scores before and after the procedure, or pain scores before, during, or after the procedure. Overall, patients and caregivers in the VR group reported high satisfaction scores, with 97% of patients and 95% of caregivers recommending this intervention to others. Conclusion:VR technology was found to be an effective distraction tool to improve fear and anxiety during cast removal procedures. Findings build on a body of evidence that supports the use of distraction tools in clinics, specifically pediatric orthopaedics, to improve fear and anxiety. The distraction tools can be easily translated into current practices. Level of Evidence: Level I.

Is Virtual Reality a Game Changer in Pediatrics' Acute Pain Perception?

“…The potential of VR use for pain mitigation during venous access, dental procedures and burn wound care have been the focus of different trials, providing reliable data. VR has been tested in other paediatric procedures, nevertheless, given the small sample sizes analyzed and the paucity of qualitative research, the current data are insufficient to draw any definitive conclusion [22,27,59,60].…”

“…Moreover immersive VR proved to be a tool capable of reducing the intensity of perceived pain in dental procedures requiring local anaesthesia, leading to an improvement in children's compliance and a significantly reduced duration of the dental procedure [57,58]. Finally, while in the cast and/or pin removal, mild to moderate traumatic/non-traumatic pain or minor plastic surgery procedures, VR had no effect in alleviating pain [22,24], it was effective in relieving pain in children undergoing circumcision, active dressing changing in chronic lower limb wounds, nasal and gastrointestinal endoscopies [25][26][27]60].…”

“…No mitigation in the perceived pain has been observed when VR was applied during cast and/or pin removals, acute mild to moderate traumatic/nontraumatic pain or minor plastic surgery procedures [22,24,59]. Two studies focusing on orthopedic procedures, such as cast or pin removal in adolescents, provide conflicting results; while Le May et al reported a significant decrease in pain intensity with VR compared to standard of care (20 children included, 16 with orthopedic issues), Rychey et al found no differences in pain scores before, during, or after the procedure, when VR was compared to verbal anxiolysis from the cast technician (130 children included) [22,23]. Nevertheless, although VR did not correlate with reduced pain in this study, VR was associated with significantly lower average fear scores (P < 0.001) and anxiety scores (P = 0.003) compared to controls [22].…”

“…Two studies focusing on orthopedic procedures, such as cast or pin removal in adolescents, provide conflicting results; while Le May et al reported a significant decrease in pain intensity with VR compared to standard of care (20 children included, 16 with orthopedic issues), Rychey et al found no differences in pain scores before, during, or after the procedure, when VR was compared to verbal anxiolysis from the cast technician (130 children included) [22,23]. Nevertheless, although VR did not correlate with reduced pain in this study, VR was associated with significantly lower average fear scores (P < 0.001) and anxiety scores (P = 0.003) compared to controls [22].…”

“…In recent years, VR has also been used in the orthopaedic field, e.g. during cast or pin removal [22,23], in plastic surgery [24], in minor surgical procedures [24], including circumcision [25], and during nasal [26] and gastrointestinal endoscopies [27], demonstrating that VR is an easy-to-use tool that can be applied in a large number of different hospital settings. This review discusses the current literature on the use of VR as an acute pain management strategy during different procedures and the future directions of the field.…”