@article{guingo_efficacy_2026,

title = {Efficacy of Virtual Reality vs. Tablet Games for Pain and Anxiety in Children Undergoing Bone Pins Removal: Randomised Clinical Trial},

author = {E. Guingo and M. H. Debeurme and R. P. Santos and S. Addab and P. Rainville and S. Bouchard and K. Chougui and A. Tsimicalis and M. -L. Nault and T. Ducruet and O. Ledjiar and M. Noel and K. St-Arneault and C. Cotes-Turpin and N. Hung and P. Ouimet and S. Parent and J. Gardner and M. Bernstein and S. Le May},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105004216228&doi=10.1111%2Fjan.16991&partnerID=40&md5=9200a82b5c9572abcc5170e9c9d6142b},

doi = {10.1111/jan.16991},

issn = {03092402 (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {Journal of Advanced Nursing},

volume = {82},

number = {2},

pages = {1791–1802},

abstract = {Aims: To verify the efficacy of virtual reality compared to tablet games for pain and anxiety management in children undergoing percutaneous bone pin and/or suture removal procedures. Design: Randomised clinical trial using two parallel groups: (1) virtual reality or (2) tablet game. Methods: Three-center, randomised pragmatic clinical trial, using a parallel design with two groups (experimental group: immersive virtual reality; active comparator: tablet games). Children aged 6–17 requiring percutaneous pins and/or sutures were recruited between 2020 and 2022 from three outpatient orthopaedic clinics in paediatric hospitals. Pain was measured with the Numerical Rating Scale and anxiety with the Child Fear Scale before and immediately after the procedure. Results: A total of 188 participants were assigned to either the virtual reality group (96 participants) or the tablet group (92 participants). At the first assessment, there was no noticeable difference between the two groups in terms of pain or anxiety levels. However, further analysis revealed that participants aged 13 and older in the virtual reality group experienced significantly lower anxiety. Conclusion: Virtual reality was not more efficacious than games on a tablet for pain and anxiety of children undergoing removal of bone pins or sutures. However, virtual reality demonstrated a benefit in reducing anxiety for teenagers, particularly those aged 13-older. Implication for the Professional and/or Patient Care: Virtual reality games provide an immersive, non-pharmacological alternative of for anxiety management of teenagers during pins and/or sutures removal. Impact: This study showed that a virtual reality game may help reduce anxiety during pins and/or sutures removal procedures in patients aged 13 years and older. Reporting Method: We adhered to the CONSORT checklist for reporting results. Patient or Public Contribution: A patient partner reviewed the study design, methods and final manuscript. Trial Registration: NCT03680625. © 2025 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.},

keywords = {Adolescent, analgesia, Anxiety, Bone Nails, Child, Children, clinical trial, comparative study, controlled study, female, human, Humans, intramedullary nailing, male, multicenter study, Pain Management, procedural pain, procedures, randomized controlled trial, Therapy, video game, Video Games, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{le_may_immersive_2021,

title = {Immersive virtual reality vs. non-immersive distraction for pain management of children during bone pins and sutures removal: A randomized clinical trial protocol [沉浸式虚拟现实与非沉浸式分心治疗儿童骨钉和缝合线疼痛的比较:随机临床试验方案]},

author = {S. Le May and A. Tsimicalis and M. Noel and P. Rainville and C. Khadra and A. Ballard and E. Guingo and C. Cotes-Turpin and S. Addab and K. Chougui and M. Francoeur and N. Hung and M. Bernstein and S. Bouchard and S. Parent and M. Hupin Debeurme},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85093928841&doi=10.1111%2fjan.14607&partnerID=40&md5=57256b68253aa1c6288a603f795aceb4},

doi = {10.1111/jan.14607},

issn = {03092402},

year  = {2021},

date = {2021-01-01},

journal = {Journal of Advanced Nursing},

volume = {77},

number = {1},

pages = {439–447},

publisher = {Blackwell Publishing Ltd},

abstract = {Aims: To examine the efficacy of an immersive virtual reality distraction compared with an active non-immersive distraction, such as video games on a tablet, for pain and anxiety management and memory of pain and anxiety in children requiring percutaneous bone pins and/or suture removal procedures. Design: Three-centre randomized clinical trial using a parallel design with two groups: experimental and control. Methods: Study to take place in the orthopaedic department of three children hospital of the Montreal region starting in 2019. Children, from 7–17 years old, requiring bone pins and/or suture removal procedures will be recruited. The intervention group (N = 94) will receive a virtual reality game (Dreamland), whereas the control group (N = 94) will receive a tablet with video games. The primary outcomes will be both the mean self-reported pain score measured by the Numerical Rating Scale and mean anxiety score, measured by the Child Fear Scale. Recalls of pain and anxiety will be measured 1 week after the procedure using the same scales. We aim to recruit 188 children to achieve a power of 80% with a significance level (alpha) of 5%. Discussion: While multiple pharmacological methods have previously been tested for children, no studies have evaluated the impact of immersive virtual reality distraction for pain and anxiety management in the orthopaedic setting. Impact: Improved pain management can be achieved using virtual reality during medical procedures for children. This method is innovative, non-pharmacological, adapted to the hospital setting, and user-friendly. Trial Registration: NCT03680625, registered on clinicaltrials.gov. © 2020 John Wiley & Sons Ltd},

note = {Publisher: Blackwell Publishing Ltd},

keywords = {Adolescent, analgesia, bone nail, Bone Nails, Child, human, Humans, Pain, Pain Management, randomized controlled trial (topic), Randomized Controlled Trials as Topic, suture, Sutures, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{dumoulin_are_2020,

title = {Are cognitive load and focus of attention differentially involved in pain management: An experimental study using a cold pressor test and virtual reality},

author = {S. Dumoulin and S. Bouchard and C. Loranger and P. Quintana and V. Gougeon and K. L. Lavoie},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85090185237&doi=10.2147%2fJPR.S238766&partnerID=40&md5=38278e890412e4529b0a740f4a6a881e},

doi = {10.2147/JPR.S238766},

issn = {11787090 (ISSN)},

year  = {2020},

date = {2020-01-01},

journal = {Journal of Pain Research},

volume = {13},

pages = {2213–2222},

publisher = {Dove Medical Press Ltd},

abstract = {Objective: The aim of this study is to assess whether distraction (lack of attentional focus) and attention (cognitive load) are differentially involved in the analgesic effect of virtual reality (VR) immersions during a cold pressor test (CPT). Methods: Thirty-one participants were randomly assigned to four experimental conditions (high and low cognitive load, attention with or without a reminder of the pain stimuli) and performed three CPTs. Pain was assessed based on the duration of the CPT (pain tolerance), a visual analog rating scale of perceived pain intensity during the CPT and the subjective pain scale of the Short form McGill Pain Questionnaire (SF-MPQ). Results: The statistical analyses revealed that VR immersions were associated with less pain compared to the baseline (all p <0.001), but for the experimental manipulations, only the conditions where there was an increase in cognitive load (ie, from low cognitive load at Immersion 1 to high cognitive load at Immersion 2) were effective for increasing pain tolerance (significant Time X Conditions interaction). The interactions were not significant for pain intensity assessed with the VAS or the SF-MPQ. Conclusion: The results suggest that increases in cognitive load play an important role in the analgesic effect of VR immersion, although the combination of attentional focus and cognitive load may be important. Suggestions are given for designing a replication study. © 2020 Dumoulin et al.},

note = {Publisher: Dove Medical Press Ltd},

keywords = {adult, analgesia, analgesic activity, article, attention, clinical article, Cognitive load, cold pressor test, controlled study, CPT, Distraction, experimental study, female, human, immersion, male, McGill Pain Questionnaire, Pain, pain intensity, pain threshold, randomized controlled trial, rating scale, replication study, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{dumoulin_randomized_2019,

title = {A Randomized Controlled Trial on the Use of Virtual Reality for Needle-Related Procedures in Children and Adolescents in the Emergency Department},

author = {S. Dumoulin and S. Bouchard and J. Ellis and K. L. Lavoie and M. -P. Vézina and P. Charbonneau and J. Tardif and A. Hajjar},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85070371865&doi=10.1089%2fg4h.2018.0111&partnerID=40&md5=7e08321a27d48f8221f1aa092a77dbda},

doi = {10.1089/g4h.2018.0111},

issn = {2161783X (ISSN)},

year  = {2019},

date = {2019-01-01},

journal = {Games for Health Journal},

volume = {8},

number = {4},

pages = {285–293},

publisher = {Mary Ann Liebert Inc.},

abstract = {Objective: A large number of children report fear and distress when undergoing blood work and intravenous placement. In pediatric departments, Child Life interventions are considered to be the gold standard in nonmedical pain management techniques. Virtual reality (VR) has also been identified as an effective tool for pain distraction in children undergoing painful medical procedures. The aim of this study was to document the efficacy of VR as a mode of distraction during a medical procedure compared with two comparison conditions: watching television (TV, minimal control condition) and distraction provided by the Child Life (CL, gold standard control condition) program. Materials and Methods: A total of 59 children aged 8-17 years (35% female) were recruited through the emergency department (ED) of the Children's Hospital of Eastern Ontario and randomly assigned to one of the three conditions. The key outcome measures were visual analog scale ratings of pain intensity and fear of pain, administrated before and right after the procedure. Patient satisfaction was also measured after the intervention. Results: A significant reduction in fear of pain and pain intensity was reported in all three conditions. A larger and statistically significant reduction in fear of pain was observed among children who used VR distraction compared with the CL and TV conditions, but this effect was not observed for pain intensity. The children's satisfaction with the VR procedure was significantly higher than for TV and comparable to CL. Discussion: The advantages of using VR in the ED to manage pain in children are discussed. © 2019, Mary Ann Liebert, Inc.},

note = {Publisher: Mary Ann Liebert Inc.},

keywords = {Adolescent, analgesia, analysis of variance, Child, Child Life, Children, controlled study, Distraction, Emergency Service, Fear, female, Hospital, hospital emergency service, human, Humans, male, Ontario, organization and management, Pain analgesia, Pain Management, Phlebotomy, procedures, psychology, randomized controlled trial, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{khadra_projector-based_2018,

title = {Projector-based virtual reality dome environment for procedural pain and anxiety in young children with burn injuries: A pilot study},

author = {C. Khadra and A. Ballard and J. Déry and D. Paquin and J. -S. Fortin and I. Perreault and D. R. Labbe and H. G. Hoffman and S. Bouchard and S. LeMay},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85042207962&doi=10.2147%2fJPR.S151084&partnerID=40&md5=dd16abbee6363ab5006bdfa63fa8c7c0},

doi = {10.2147/JPR.S151084},

issn = {11787090},

year  = {2018},

date = {2018-01-01},

journal = {Journal of Pain Research},

volume = {11},

pages = {343–353},

publisher = {Dove Medical Press Ltd.},

abstract = {Background: Virtual reality (VR) is a non-pharmacological method to distract from pain during painful procedures. However, it was never tested in young children with burn injuries undergoing wound care. Aim: We aimed to assess the feasibility and acceptability of the study process and the use of VR for procedural pain management. Methods: From June 2016 to January 2017, we recruited children from 2 months to 10 years of age with burn injuries requiring a hydrotherapy session in a pediatric university teaching hospital in Montreal. Each child received the projector-based VR intervention in addition to the standard pharmacological treatment. Data on intervention and study feasibility and acceptability in addition to measures on pain (Face, Legs, Activity, Cry, Consolability scale), baseline (Modified Smith Scale) and procedural (Procedure Behavior Check List) anxiety, comfort (OCCEB-BECCO [behavioral observational scale of comfort level for child burn victims]), and sedation (Ramsay Sedation Scale) were collected before, during, and after the procedure. Data analyses included descriptive and non-parametric inferential statistics. Results: We recruited 15 children with a mean age of 2.2±2.1 years and a mean total body surface area of 5% (±4). Mean pain score during the procedure was low (2.9/10, ±3), as was the discomfort level (2.9/10, ±2.8). Most children were cooperative, oriented, and calm. Assessing anxiety was not feasible with our sample of participants. The prototype did not interfere with the procedure and was considered useful for procedural pain management by most health care professionals. Conclusion: The projector-based VR is a feasible and acceptable intervention for procedural pain management in young children with burn injuries. A larger trial with a control group is required to assess its efficacy. © 2018 Khadra et al.},

note = {Publisher: Dove Medical Press Ltd.},

keywords = {analgesia, Anxiety, article, burn, Child, child behavior, clinical article, clinical outcome, feasibility study, female, human, hydrotherapy, infant, male, Pain, pain measurement, pilot study, sedation, virtual reality, wound care},

pubstate = {published},

tppubtype = {article}

}