@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{guingoEfficacyVirtualReality2026,

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/pages/publications/105004216228?origin=resultslist},

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},

publisher = {John Wiley and Sons Inc},

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{guingoEfficacyVirtualReality2026a,

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{guingo_efficacy_2025,

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=4862f57a6a524f825f04fb1a70bb5a21},

doi = {10.1111/jan.16991},

issn = {03092402 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Journal of Advanced Nursing},

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.},

note = {Publisher: John Wiley and Sons Inc},

keywords = {Anxiety, Children, Pain Management, procedural pain, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{silva_childrens_2022,

title = {Children's perception of phobogenic stimuli in virtual reality},

author = {C. Silva and S. Bouchard and C. Bélanger},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85117586475&doi=10.1016%2fj.ijcci.2021.100417&partnerID=40&md5=d853c1851b4b9574a7c67f2bce83b8e1},

doi = {10.1016/j.ijcci.2021.100417},

issn = {22128689 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {International Journal of Child-Computer Interaction},

volume = {32},

publisher = {Elsevier B.V.},

abstract = {Background: There has been a growing interest in treatments involving exposure in virtual reality (VR) for a number of anxiety disorders and phobias. Contrary to expectations, this technique has proven less popular with phobic children and is less appealing to them than to adults. The hypothesis is that children may be more apprehensive about virtual aversive stimuli than adults. Methods: In Study 1, the perception of virtual phobogenic stimuli was assessed in 523 participants between the ages of 7 and 60. To analyze to what extent anxiety and phobic fear predict apprehension, 38 school-aged children took part in Study 2. Results: The results show that children apprehend phobic virtual stimulus more than adults and that apprehension is associated with specific phobic fear rather than a general anxiety state. Conclusion: Results are discussed in terms of clinical interest, children's cognitive development, and a priori fear of virtual reality stimuli. © 2021},

note = {Publisher: Elsevier B.V.},

keywords = {Age-differences, Anxiety, Apprehension, Children, exposure, Spider phobia, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{silvaChildrensPerceptionPhobogenic2022,

title = {Children's perception of phobogenic stimuli in virtual reality},

author = {C. Silva and S. Bouchard and C. Bélanger},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85117586475&doi=10.1016%2fj.ijcci.2021.100417&partnerID=40&md5=d853c1851b4b9574a7c67f2bce83b8e1},

doi = {10.1016/j.ijcci.2021.100417},

issn = {22128689 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {International Journal of Child-Computer Interaction},

volume = {32},

publisher = {Elsevier B.V.},

abstract = {Background: There has been a growing interest in treatments involving exposure in virtual reality (VR) for a number of anxiety disorders and phobias. Contrary to expectations, this technique has proven less popular with phobic children and is less appealing to them than to adults. The hypothesis is that children may be more apprehensive about virtual aversive stimuli than adults. Methods: In Study 1, the perception of virtual phobogenic stimuli was assessed in 523 participants between the ages of 7 and 60. To analyze to what extent anxiety and phobic fear predict apprehension, 38 school-aged children took part in Study 2. Results: The results show that children apprehend phobic virtual stimulus more than adults and that apprehension is associated with specific phobic fear rather than a general anxiety state. Conclusion: Results are discussed in terms of clinical interest, children's cognitive development, and a priori fear of virtual reality stimuli. © 2021},

keywords = {Age-differences, Anxiety, Apprehension, Children, exposure, Spider phobia, 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{dumoulinRandomizedControlledTrial2019,

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.},

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{bouchard_evaluation_2013,

title = {Evaluation of a primary prevention program for anxiety disorders using story books with children aged 9-12 years},

author = {S. Bouchard and J. Gervais and N. Gagnier and C. Loranger},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84884505645&doi=10.1007%2fs10935-013-0317-0&partnerID=40&md5=3e1b6f6ada6ce459480bcf236ae70e5e},

doi = {10.1007/s10935-013-0317-0},

issn = {0278095X (ISSN)},

year  = {2013},

date = {2013-01-01},

journal = {Journal of Primary Prevention},

volume = {34},

number = {5},

pages = {345–358},

abstract = {This article reports the results of a study evaluating a book-supported primary prevention program "Dominique's Handy Tricks" for anxiety disorders in children aged 9-12 years. This cognitive-behavioural program is delivered using a combination of storybooks and workshop sessions. The originality of the program comes from the use of storybooks that were not developed specifically for anxiety management. Every session is based on a story describing characters facing common stressors and how they manage to cope with their daily problems. In our randomized control trial with 46 children, participation in the program led to a significant improvement in coping skills, perceived self-efficacy, anxiety sensitivity, as well as in symptoms of anxiety and fear. The theoretical and practical elements underlying the delivery of this primary prevention program are described. Conclusion: It is suggested that such an approach, without any labelling specific to anxiety disorders, can be useful in primary prevention programs. © 2013 Springer Science+Business Media New York.},

keywords = {Adaptation, adaptive behavior, Anxiety disorder, Anxiety Disorders, Anxiety sensitivity, article, Bibliotherapy, book, Books, Child, Children, cognitive therapy, controlled clinical trial, controlled study, female, human, Humans, male, methodology, Primary Prevention, procedures, Program Evaluation, Psychological, randomized controlled trial, Self Concept, Self Efficacy, Self-efficacy, treatment outcome},

pubstate = {published},

tppubtype = {article}

}

@article{bouchardEvaluationPrimaryPrevention2013,

title = {Evaluation of a primary prevention program for anxiety disorders using story books with children aged 9-12 years},

author = {S. Bouchard and J. Gervais and N. Gagnier and C. Loranger},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84884505645&doi=10.1007%2fs10935-013-0317-0&partnerID=40&md5=3e1b6f6ada6ce459480bcf236ae70e5e},

doi = {10.1007/s10935-013-0317-0},

issn = {0278095X (ISSN)},

year  = {2013},

date = {2013-01-01},

journal = {Journal of Primary Prevention},

volume = {34},

number = {5},

pages = {345–358},

abstract = {This article reports the results of a study evaluating a book-supported primary prevention program "Dominique's Handy Tricks" for anxiety disorders in children aged 9-12 years. This cognitive-behavioural program is delivered using a combination of storybooks and workshop sessions. The originality of the program comes from the use of storybooks that were not developed specifically for anxiety management. Every session is based on a story describing characters facing common stressors and how they manage to cope with their daily problems. In our randomized control trial with 46 children, participation in the program led to a significant improvement in coping skills, perceived self-efficacy, anxiety sensitivity, as well as in symptoms of anxiety and fear. The theoretical and practical elements underlying the delivery of this primary prevention program are described. Conclusion: It is suggested that such an approach, without any labelling specific to anxiety disorders, can be useful in primary prevention programs. © 2013 Springer Science+Business Media New York.},

keywords = {Adaptation, adaptive behavior, Anxiety disorder, Anxiety Disorders, Anxiety sensitivity, article, Bibliotherapy, book, Books, Child, Children, cognitive therapy, controlled clinical trial, controlled study, female, human, Humans, male, methodology, Primary Prevention, procedures, Program Evaluation, Psychological, randomized controlled trial, Self Concept, Self Efficacy, Self-efficacy, treatment outcome},

pubstate = {published},

tppubtype = {article}

}