116 Virtual reality vs non-immersive distraction during orthopedic procedures for children’s pain and anxiety (PINS Trial): Secondary analyses of an RCT
Bibliographic record
Abstract
Abstract Background Children undergoing outpatient orthopedic procedures often experience severe pain and anxiety. Orthopedic bone pin and suture removal are frequently performed without any analgesia or non-pharmacological interventions, causing significant anxiety and pain for children. Furthermore, traditional methods such as analgesics and topical anesthetics often fall short in addressing children’s specific needs and require a delay. Narcotics and sedation require close monitoring and may have side effects. This randomized clinical trial (RCT) explored Virtual Reality (VR) as a child-friendly, distraction-based intervention for pain and anxiety management. Objectives This RCT primarily aimed to compare the effectiveness of VR to non-immersive distraction in reducing pain and anxiety during outpatient paediatric orthopedic procedures. This abstract provides results of secondary outcomes. Design/Methods We conducted a prospective RCT across three paediatric centres in Montreal with 188 children aged 6-17 years old undergoing bone pin or suture removal. The experimental group used VR distraction, while participants in the control group played a video game on a tablet. Secondary outcomes assessed at either T0 (Baseline) and/or T1 (post-procedure) were: 1- Pain characteristics using the Graphic Rating Scale, 2- Anxiety with a salivary biomarker (Alpha-Amylase added measure at mid-trial), 3- Satisfaction levels, and 4- Side effects using a checklist. Analyses were completed with 80% power and a 2.5% significance level. Results There was no significant difference between the VR and Tablet groups on the mean score of pain (p = 0.90). Participants in the VR group thought less about pain (4.2±3.0 v. 4.4±2.9; p=0.57), had lower pain unpleasantness (4.5±3.0 v. 5.0±3.0; p=0.22), and lower worst pain (4.8±2.9 v. 5.6±3.0; p=0.069), but results were not statistically significant. VR users tended to have more fun during the sessions (8.0±2.6 v. 7.3±3.1; p=0.098) and were significantly more satisfied with the treatment received (9.2±1.2 v. 8.6±1.9; p=0.015). Tablet users had slightly more nausea (0.2±1.0 v. 0.1±0.6 for VR; p=0.37). SAA levels were lower at T2 in the VR group but the difference was not significant (p=0.26). Conclusion Secondary analyses related to this study found that children using VR reported lower pain, higher pleasure, and very few side effects, highlighting VR’s potential to improve paediatric patient experiences in clinical settings. While adding alpha-amylase measures mid-trial limited power, it demonstrated feasibility for future VR studies. These results underscore VR's promise to create a more positive environment for children, warranting further research on its benefits in paediatric healthcare procedures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.013 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.007 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".