@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{onita_autonomic_2025,

title = {Autonomic and Neuroendocrine Reactivity to VR Game Exposure in Children and Adolescents with Obesity: A Factor Analytic Approach to Physiological Reactivity and Eating Behavior},

author = {C. A. Onita and D. -V. Matei and L. -M. Trandafir and D. Petrescu-Miron and C. Corciova and R. Fuior and L. -M. Manole and B. -M. Mihai and C. -G. Dascalu and M. Tarcea and S. Bouchard and V. Mocanu},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105013574948&doi=10.3390%2Fnu17152492&partnerID=40&md5=d1e974dae00d424b9f6fae86b8a7cc6a},

doi = {10.3390/nu17152492},

issn = {20726643 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Nutrients},

volume = {17},

number = {15},

abstract = {Background/Objectives: The aim was to identify patterns of autonomic and neuroendocrine reactivity to an immersive virtual reality (VR) social-emotional stressor and explore their associations with perceived stress and eating behavior. Methods: This one-group pretest–posttest study included 30 children and adolescents with obesity (15 boys and 15 girls), aged 8 to 17 years. The VR protocol consisted of two consecutive phases: a 5 min relaxation phase using the Forest application and a 5 min stimulation phase using a cognitively engaging VR game designed to elicit social-emotional stress. Physiological responses were measured using heart rate variability (HRV) indices and salivary stress biomarkers, including cortisol and alpha amylase. Subjective stress and eating responses were assessed via visual analogue scales (VAS) administered immediately post-exposure. The Three-Factor Eating Questionnaire (TFEQ-R21C) was used to evaluate cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). Results: The cortisol reactivity was blunted and may reflect both the attenuated HPA axis responsiveness characteristic of pediatric obesity and the moderate psychological challenge of the VR stressor used in this study. Two distinct autonomic response patterns were identified via exploratory factor analysis: (1) parasympathetic reactivity, associated with increased RMSSD and SDNN and decreased LF/HF, and (2) sympathetic activation, associated with increased heart rate and alpha-amylase levels and reduced RR intervals. Parasympathetic reactivity was correlated with lower perceived stress and anxiety, but also paradoxically with higher uncontrolled eating (UE). In contrast, sympathetic activation was associated with greater cognitive restraint (CR) and higher anxiety ratings. Conclusions: This study demonstrates that immersive VR game exposure elicits measurable autonomic and subjective stress responses in children and adolescents with obesity, and that individual differences in physiological reactivity are relevantly associated with eating behavior traits. The findings suggest that parasympathetic and sympathetic profiles may represent distinct behavioral patterns with implications for targeted intervention. © 2025 by the authors.},

keywords = {Adolescent, adolescent obesity, alpha amylase saliva isoenzyme, alpha-Amylases, amylase, anthropometry, anxiety assessment, appetite, article, Autonomic Nervous System, autonomic nervous system function, chemistry, Child, childhood obesity, clinical article, controlled study, craving, eating behavior, Electrophysiology, emotional eating, emotional stress, exploratory factor analysis, Factor Analysis, feeding behavior, female, Heart Rate, heart rate variability, human, Humans, Hydrocortisone, hypothalamus hypophysis adrenal system, immersive VR game, male, mental stress, metabolism, neuroendocrine system, Neurosecretory Systems, pathophysiology, Pediatric Obesity, physiology, Psychological, psychology, Saliva, salivary alpha-amylase, salivary cortisol, social stress, Statistical, Stress, stress assessment, subjective stress, three-factor eating questionnaire (TFEQ), Three-Factor-Eating-Questionnaire, video game, Video Games, virtual reality, virtual reality exposure therapy, visual analog scale},

pubstate = {published},

tppubtype = {article}

}

@article{bouchard_using_2012,

title = {Using biofeedback while immersed in a stressful videogame increases the effectiveness of stress management skills in soldiers},

author = {S. Bouchard and F. Bernier and E. Boivin and B. Morin and G. Robillard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84860485827&doi=10.1371%2fjournal.pone.0036169&partnerID=40&md5=4b29a984169d2fe12d54f4c562344723},

doi = {10.1371/journal.pone.0036169},

issn = {19326203},

year  = {2012},

date = {2012-01-01},

journal = {PLoS ONE},

volume = {7},

number = {4},

abstract = {This study assessed the efficacy of using visual and auditory biofeedback while immersed in a tridimensional videogame to practice a stress management skill (tactical breathing). All 41 participants were soldiers who had previously received basic stress management training and first aid training in combat. On the first day, they received a 15-minute refresher briefing and were randomly assigned to either: (a) no additional stress management training (SMT) for three days, or (b) 30-minute sessions (one per day for three days) of biofeedback-assisted SMT while immersed in a horror/first-person shooter game. The training was performed in a dark and enclosed environment using a 50-inch television with active stereoscopic display and loudspeakers. On the last day, all participants underwent a live simulated ambush with an improvised explosive device, where they had to provide first aid to a wounded soldier. Stress levels were measured with salivary cortisol collected when waking-up, before and after the live simulation. Stress was also measured with heart rate at baseline, during an apprehension phase, and during the live simulation. Repeated-measure ANOVAs and ANCOVAs confirmed that practicing SMT was effective in reducing stress. Results are discussed in terms of the advantages of the proposed program for military personnel and the need to practice SMT. © 2012 Bouchard et al.},

keywords = {adult, Arousal, article, Biofeedback, clinical trial, controlled clinical trial, controlled study, explosion, feedback system, first aid, Heart Rate, human, human experiment, Humans, Hydrocortisone, male, mental stress, metabolism, methodology, Military Personnel, military phenomena, normal human, pathophysiology, Psychological, psychological aspect, psychology, Psychophysiology, randomized controlled trial, recreation, Saliva, saliva level, simulation, soldier, Stress, Stress management, Video Games},

pubstate = {published},

tppubtype = {article}

}

@article{robillard_anxiety_2003,

title = {Anxiety and Presence during VR Immersion: A Comparative Study of the Reactions of Phobic and Non-phobic Participants in Therapeutic Virtual Environments Derived from Computer Games},

author = {G. Robillard and S. Bouchard and T. Fournier and P. Renaud},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-0142063106&doi=10.1089%2f109493103769710497&partnerID=40&md5=0d245828ebefb17548822c4c316f5721},

doi = {10.1089/109493103769710497},

issn = {10949313 (ISSN)},

year  = {2003},

date = {2003-01-01},

journal = {Cyberpsychology and Behavior},

volume = {6},

number = {5},

pages = {467–476},

abstract = {Virtual reality can be used to provide phobic clients with therapeutic exposure to phobogenic stimuli. However, purpose-built therapeutic VR hardware and software can be expensive and difficult to adapt to individual client needs. In this study, inexpensive and readily adaptable PC computer games were used to provide exposure therapy to 13 phobic participants and 13 non-phobic control participants. It was found that anxiety could be induced in phobic participants by exposing them to phobogenic stimuli in therapeutic virtual environments derived from computer games (TVEDG). Assessments were made of the impact of simulator sickness and of sense of presence on the phobogenic effectiveness of TVEDGs. Participants reported low levels of simulator sickness, and the results indicate that simulator sickness had no significant impact on either anxiety or sense of presence. Group differences, correlations, and regression analyses indicate a synergistic relationship between presence and anxiety. These results do not support Slater's contention that presence and emotion are orthogonal.},

keywords = {Adolescent, adult, Anxiety, article, clinical article, computer, computer program, Computer Simulation, Computer-Assisted, controlled study, correlation analysis, Desensitization, emotion, exposure, female, game, human, Humans, male, Matched-Pair Analysis, Middle Aged, Neuropsychological Tests, phobia, Phobic Disorders, Psychologic, psychotherapy, Reality Testing, Reference Values, regression analysis, Self Concept, Space Perception, symptom, Therapy, User-Computer Interface, Video Games, virtual reality, visual stimulation},

pubstate = {published},

tppubtype = {article}

}