Efficacy of Virtual Reality vs. Tablet Games for Pain and Anxiety in Children Undergoing Bone Pins Removal: Randomised Clinical Trial.

The study compared VR with an active tablet game, not with no distraction, so it cannot show whether either intervention is better than usual care. Participants and staff knew which intervention was given, although outcome assessors were blinded. The fear/anxiety scale was validated only for children aged 5-10 but was used in children up to 17. Children with cognitive impairment, epilepsy, or conditions preventing VR use were excluded, so the results may not apply to those children. Recruitment was by convenience sampling at three Montreal hospitals, which may limit generalisability. The age subgroup finding for older children was exploratory and was not adjusted for the many comparisons made. Socioeconomic background, prior technology exposure, engagement level, and perceived procedural severity were not measured. Missing data were not imputed, and the primary outcome analysis was restricted to patients assessed for it. The VR intervention was a specific therapeutic game, so findings may not apply to other VR devices or games.

One co-author, Stéphane Bouchard, is president and part owner of In Virtuo, a company that distributes virtual environments (not for pain distraction), and conflicts are managed under UQO policy. Funding was provided by the Canadian Institutes of Health Research.

Do not conclude that VR is better than tablet games for children's pain or anxiety overall. The primary outcomes showed no difference, and the lower anxiety in older children is an exploratory subgroup finding.