Feasibility of Virtual Reality Immersion in Reducing Pain and Anxiety during External Fixator Care Procedures

Abstract

Abstract Introduction External fixator care after limb reconstruction often involves pin-site cleaning and frame adjustments that can be painful and anxiety-provoking, particularly for paediatric patients. Virtual reality (VR) immersion may support procedural coping. This feasibility study evaluated the practicality and tolerability of VR during fixator care and explored pain and anxiety trends. Patients and methods A prospective, randomised feasibility study enrolled 29 patients aged 5–21 years undergoing limb lengthening or reconstruction with external fixators. Participants were randomised to ‘VR first’ or ‘no-VR first’ groups and attended four postoperative visits, alternating between visits with and without VR using Aqua VR (KindVR® platform). Pain and anxiety were assessed before, during, and after each procedure using Wong-Baker FACES and Children's Fear Scale (CFS). Parent proxy and provider assessments were collected using Patient-Reported Outcomes Measurement Information System (PROMIS) Parent Proxy, Face, Legs, Activity, Cry, and Consolability (FLACC), and CFS. Results Twenty-nine participants (16 male, 13 female; mean age, 14.5 ± 3.1 years) completed the study. Median pin sites numbered 7 (range, 7–14). Virtual reality was feasible and tolerated during fixator care. Patient-reported pain scores were similar between VR and non-VR visits. Virtual reality visits showed a trend toward lower anxiety, although differences were not statistically significant. Patients exposed to VR first showed more consistent decreases in pain and anxiety across subsequent visits, suggesting possible carryover. Conclusion Virtual reality immersion during fixator care appears feasible and well tolerated in paediatric and adolescent patients. Observed trends suggest potential benefit for anxiety reduction, particularly with early VR exposure; however, larger studies are needed to evaluate clinical efficacy.