Pediatric Wounds, Procedural Fear, Procedural Pain, Procedure-Related Anxiety
Conditions
Keywords
Virtual Reality, Distraction Techniques, Game Card Distraction, Immersive Distraction, Pediatric Wound Care, Child-Centered Care, Non-Pharmacological Intervention, Procedural Pain Management, Procedural Anxiety
Brief summary
This completed randomized study compared two distraction approaches with standard care during pediatric open wound care. Ninety children aged 5-10 years were assigned to standard care alone, standard care plus distraction game cards, or standard care plus immersive audiovisual virtual reality. Fear, state anxiety, pain, heart rate, and peripheral oxygen saturation were assessed immediately before and shortly after wound care. The purpose was to compare psychological and physiological responses among the three groups and to assess whether virtual reality provided additional benefit compared with game cards.
Detailed description
Open wound care procedures may cause fear, anxiety, pain, and physiological stress in children. This study was conducted in the pediatric emergency department of Ağrı Training and Research Hospital, Turkey, between April and May 2023. Children aged 5-10 years who required open wound care were randomly allocated in a 1:1:1 ratio to standard care alone, standard care plus distraction game cards, or standard care plus immersive virtual reality. Standard care included wound cleansing, debridement, suturing when clinically indicated, and dressing. In the game card group, a trained researcher used laminated illustrated cards with visual-search and pattern-recognition tasks and provided structured prompts throughout the procedure. In the virtual reality group, children viewed a preset sequence of passive, non-interactive, age-appropriate 360-degree three-dimensional audiovisual videos using a smartphone-based virtual reality headset throughout the procedure. Fear, state anxiety, pain, heart rate, and peripheral oxygen saturation were measured immediately before wound care and within 5 minutes after completion. The study compared psychological and physiological responses among the three groups.
Interventions
BEHAVIORALDistraction Game Cards
The distraction activity began immediately before wound care and continued throughout the procedure. A trained researcher used structured prompts approximately every 15-30 seconds to maintain engagement.
BEHAVIORALVirtual Reality Distraction
A smartphone-based VR BOX 3.0 headset displayed a preset sequence of age-appropriate 360-degree three-dimensional videos with background music and ambient sounds. No hand controllers, gaze-based selection, or other interactive controls were used. The intervention began immediately before wound care and continued throughout the procedure.
Sponsors
Agri Ibrahim Cecen University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Masking description
Participants and intervention providers were not masked. A separate research assistant who did not deliver the interventions and was not informed of group allocation administered the outcome measures and entered the data. Psychological outcomes were child self-reports, and participants were aware of the intervention they received.
Intervention model description
Participants were randomly assigned in a 1:1:1 ratio to three parallel groups: standard care alone, standard care plus distraction game cards, or standard care plus immersive audiovisual virtual reality.
Eligibility
Sex/Gender
ALL
Age
5 Years to 10 Years
Healthy volunteers
No
Inclusion criteria
* Aged 5-10 years * Presented with an open wound requiring cleansing, dressing, debridement, and/or suturing * Hemodynamically stable at baseline, with peripheral oxygen saturation of at least 95 percentage and heart rate within age-appropriate limits * Able to communicate sufficiently to complete the study assessments * Written informed consent provided by a parent or legal guardian * Verbal assent provided by the child
Exclusion criteria
* Neurodevelopmental or communication disorder that could interfere with study assessments * Significant visual or hearing impairment * Head or facial wound preventing use of the virtual reality headset * History of motion sickness or a previous adverse reaction to virtual reality * Receipt of sedatives or systemic opioid analgesics within 6 hours before the procedure * Requirement for procedural sedation during wound care * Any clinical condition judged by the attending physician to make participation inappropriate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Children's Fear Scale Score | Immediately before wound care and within 5 minutes after completion of wound care | Fear was measured using the Children's Fear Scale. Scores range from 0 (no fear) to 4 (extreme fear), with higher scores indicating greater fear. |
| State-Trait Anxiety Inventory for Children-State Subscale Score | Immediately before wound care and within 5 minutes after completion of wound care | State anxiety was measured using the State-Trait Anxiety Inventory for Children-State subscale. Scores range from 20 to 60, with higher scores indicating greater state anxiety. |
| Wong-Baker FACES Pain Rating Scale Score | Immediately before wound care and within 5 minutes after completion of wound care | Pain intensity was measured using the Wong-Baker FACES Pain Rating Scale. Scores range from 0 (no pain) to 10 (worst possible pain), with higher scores indicating greater pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Heart Rate | Immediately before wound care and within 5 minutes after completion of wound care | Heart rate was measured in beats per minute using a fingertip pulse oximeter after a stable 30-second recording. |
| Peripheral Oxygen Saturation (SpO₂) | Immediately before wound care and within 5 minutes after completion of wound care | Peripheral oxygen saturation was measured as a percentage using a fingertip pulse oximeter after a stable 30-second recording. |
Countries
Turkey (Türkiye)
Outcome results
None listed