Doctor-Related Fear, Forearm Fractures, Procedural Anxiety
Conditions
Keywords
Virtual Reality, Pediatric Forearm Fracture, Cast Application, Procedural Distress, Educational Animation
Brief summary
This prospective randomized controlled trial will evaluate whether virtual reality can reduce procedural distress in children undergoing cast application for forearm fractures. Children will be assigned to either a virtual reality group or a standard care group. In the virtual reality group, children will watch a 3-minute child-friendly animated educational video using a VR headset during cast application. The video explains the casting procedure, how to protect the cast, and what the child should do after the cast is applied. The study will compare pain, anxiety, heart rate response, caregiver anxiety, and procedure-related fear between the two groups. The casting team will assess the child during the procedure. One day after cast application, each child will undergo an approximately 30-minute evaluation by a child psychiatry clinician who is blinded to group allocation. This follow-up assessment will evaluate the child's current anxiety, anxiety related to the cast experience, fear of returning to the hospital or doctor, and fear-related behaviors after the procedure.
Detailed description
Forearm fractures are common injuries in children and frequently require cast immobilization. Although cast application is a routine orthopedic procedure, children may experience pain, anxiety, fear, and physiologic stress during the procedure. In some children, this experience may also lead to fear of returning to the hospital or doctor, sometimes referred to as doctor-related or white coat-related fear. Virtual reality may help children during medical procedures by providing immersive visual and auditory distraction. In addition, an age-appropriate educational video may reduce uncertainty by explaining what will happen during the procedure and how the child should care for the cast afterward. This study is designed as a prospective, randomized, parallel-group clinical trial. Children with forearm fractures requiring cast application will be randomized into two groups: a virtual reality group and a standard care group. Children in the virtual reality group will wear a Meta Quest 3 headset during cast application and watch a 3-minute child-friendly animated educational video generated using Google Flow. The video explains the cast application process, cast protection, and post-cast care instructions. Children in the standard care group will undergo routine cast application without virtual reality. Apart from the virtual reality intervention, all clinical care will be the same between the two groups. During cast application, the orthopedic casting team will record procedural pain, procedural anxiety, heart rate before the procedure, mean heart rate during the procedure, heart rate after a 2-minute recovery period, procedure duration, whether the virtual reality headset was removed, and whether nausea, dizziness, or discomfort occurred. Caregivers will also rate the child's anxiety, their own anxiety, and the child's pain before and after the procedure. One day after cast application, each child will undergo an approximately 30-minute follow-up assessment by a child psychiatry clinician who is blinded to group allocation. Children and caregivers will be instructed not to disclose whether virtual reality was used. This blinded assessment will evaluate the child's current anxiety, anxiety related to the cast experience, anxiety while returning to the hospital or doctor, reluctance to return to the doctor, fear-related behaviors at home such as crying or sleep disturbance, and distress when remembering the cast procedure. The primary objective of the study is to determine whether virtual reality reduces cast-related anxiety and subsequent doctor-related fear after cast application. Secondary objectives include evaluating the effect of virtual reality on procedural pain, procedural anxiety, heart rate response, caregiver anxiety, procedure duration, virtual reality tolerability, and caregiver preference for future use of virtual reality during similar procedures.
Interventions
BEHAVIORALVirtual Reality-Based Educational Animation
Children assigned to the virtual reality group will watch a 3-minute child-friendly educational animated video through a VR headset during cast application. The video explains the cast application procedure, cast protection, and post-cast care instructions. The intervention is intended to reduce procedural distress through immersive visual and auditory distraction and age-appropriate education.
OTHERStandard Care
Children assigned to the control group will undergo routine cast application without virtual reality. Standard verbal explanation and routine orthopedic care will be provided by the casting team.
Sponsors
Başakşehir Çam & Sakura City Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Masking description
Children, caregivers, and the orthopedic casting team cannot be blinded because the VR headset is visible during cast application. However, the child psychiatry clinician who performs the approximately 30-minute follow-up assessment 1 day after cast application will be blinded to group allocation. Children and caregivers will be instructed not to disclose whether virtual reality was used during the procedure.
Intervention model description
Participants will be randomized into two parallel groups: a virtual reality-assisted cast application group and a standard cast application group. Children in the virtual reality group will watch a 3-minute educational animated video using a VR headset during cast application, while children in the control group will receive standard cast application without virtual reality. Outcomes will be compared between the two groups.
Eligibility
Sex/Gender
ALL
Age
4 Years to 15 Years
Healthy volunteers
No
Inclusion criteria
* Children aged 4 to 15 years. * Diagnosis of an isolated forearm fracture requiring cast application with traction (greenstick injuries plastic deformation if NOT over 20 degrees bayonet apposition ok if \<10 years and growth remains) * First cast application for the current fracture episode. * Typically developing children without a known developmental delay or cognitive impairment that would prevent participation in the study assessments. * Ability of the child to understand age-appropriate instructions and respond to pain, anxiety, and fear-related assessments with caregiver assistance when necessary. * At least one upper extremity free of immobilization, allowing heart rate assessment during the procedure. * Parent or legal guardian able to provide written informed consent. * Child assent when appropriate according to age and local ethics committee requirements. * Ability and willingness of the child and caregiver to attend an approximately 30-minute blinded child psychiatry assessment 1 day after cast application.
Exclusion criteria
* Open forearm fracture. * Multiple trauma or an additional painful injury that may affect pain, anxiety, or fear assessment. * Need for emergency surgery, procedural sedation, or general anesthesia during cast application. * Previous participation in this study. * Known developmental delay, cognitive impairment, autism spectrum disorder with inability to complete study assessments, or severe psychiatric disorder that may interfere with questionnaire-based evaluation. * Known epilepsy, photosensitive seizure disorder, severe motion sickness, vestibular disorder, or any condition considered unsafe for VR headset use. * Visual or hearing impairment preventing use of the VR intervention or completion of the assessments. * Head, face, or scalp injury preventing safe or comfortable use of a VR headset. * Nausea, dizziness, or severe discomfort before the procedure that would prevent VR use. * Refusal of the child or caregiver to participate. * Inability to complete the 1-day child psychiatry follow-up assessment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Child Psychiatry-Assessed Cast Experience Anxiety Score at 1 Day | 1 day after cast application | Cast-related fear and anxiety will be assessed 1 day after cast application by a child psychiatry clinician blinded to group allocation using a structured questionnaire. The assessment will evaluate the child's fear or anxiety related to the cast experience, reluctance to return to the doctor or hospital, fear-related behaviors at home such as crying or sleep disturbance, and distress when remembering the cast procedure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Procedural Anxiety Score During Cast Application | During cast application | The orthopedic casting team will assess the child's anxiety during cast application using a 0-100 score, where higher scores indicate greater procedural anxiety. |
| Procedural Pain Score During Cast Application | During cast application | The orthopedic casting team will assess the child's pain during cast application using a 0-10 score, where higher scores indicate greater procedural pain. |
| Change in Heart Rate During Cast Application | Before, during, and 2 minutes after cast application | Heart rate will be recorded before cast application, during the procedure, and after a 2-minute recovery period. Changes in heart rate from baseline to the procedural and recovery periods will be compared between groups. |
| Procedure Duration | During cast application | The duration of cast application will be recorded in minutes from the start of the cast application procedure to completion of the procedure. Procedure duration will be compared between the virtual reality group and the standard care group. |
| Physician-Rated Procedural Difficulty Score | During cast application | The physician performing the cast application will rate the procedural difficulty using a 0-10 score according to the child's cooperation, movement, crying, fear response, and overall behavioral reaction during cast application. Higher scores indicate greater procedural difficulty. |
| Child Behavioral Response During Cast Application | During cast application | The child's behavioral response during cast application will be assessed by the casting physician. The assessment will include cooperation, crying, avoidance behavior, agitation, movement during the procedure, and overall tolerance of the cast application. |
| Caregiver-Rated Child Anxiety | Immediately after cast application | Caregivers will rate how anxious they think their child is using a 0-100 score, where higher scores indicate greater child anxiety. |
| Caregiver Anxiety Score | Immediately after cast application | Caregivers will rate their own anxiety using a 0-100 score, where higher scores indicate greater caregiver anxiety. |
| Caregiver-Rated Child Pain Before and After Cast Application | Before and immediately after cast application | Caregivers will rate the child's pain before and after cast application using a 0-10 score, where higher scores indicate greater pain. |
| Doctor-Related Fear at Follow-up | 1 day after cast application | Doctor-related fear after the cast experience will be assessed by a blinded child psychiatry clinician using a structured questionnaire. The assessment will include anxiety while returning to the hospital or doctor and reluctance to return to the doctor after the cast experience. |
| Post-Procedural Fear-Related Behaviors at Home | From cast application to 1-day follow-up | Fear-related behaviors at home after cast application will be assessed by the blinded child psychiatry clinician using caregiver and child responses. These behaviors may include fear, crying, sleep disturbance, reluctance to visit the doctor, or other procedure-related distress. |
| Distress When Remembering the Cast Procedure | 1 day after cast application | The child's distress when remembering the cast application procedure will be assessed by the blinded child psychiatry clinician using a structured questionnaire item. Higher scores or more severe responses indicate greater procedure-related distress. |
| Caregiver Preference for Future Virtual Reality Use | Immediately after cast application | Caregivers will be asked whether they would want virtual reality to be used again if a similar procedure is required. Responses will be recorded as yes, no, or undecided. |
Countries
Turkey (Türkiye)
Contacts
CONTACTLezgin Mert, MD
Outcome results
None listed