Virtual Reality Immersion Reduces Anxiety, Pain during Limb Deformity Surgery Follow-Up Care

The use of a virtual reality (VR) immersion distraction technique reduced anxiety levels in young patients undergoing external fixator care procedures following limb-lengthening or reconstructive surgery. This finding was reported in an ePoster presented at the AAOS 2025 Annual Meeting.

Christopher A. Iobst, MD, FAAOS, pediatric orthopaedic surgeon at Nationwide Children’s Hospital in Columbus, Ohio, alongside Anirejuoritse Bafor, MD, FACS, a research scientist and international scholar at Nationwide Children’s, conducted a prospective, randomized, controlled crossover clinical trial at their center. They enrolled 29 patients aged 5 to 21 years (mean, 14.5 years) who were scheduled to undergo limb-lengthening or reconstructive surgery with an external fixator.

“The use of external fixators for limb reconstruction procedures involves weekly dressing changes and pin-site care that may be potentially painful and stressful for pediatric patients. VR immersion provides distraction, which has shown promise as a tool for managing pain and anxiety during medical procedures,” Dr. Iobst explained to AAOS Now Daily Edition. “It’s non-invasive and non-pharmacological, added benefits of this technology in patient care.”

During the first four consecutive outpatient postoperative visits for care procedures for their external fixators, patients alternated between undergoing a VR immersion experience during the visit. Patients were randomized to two groups, either receiving VR in the first session (group 1) or no VR in the first session (group 2). The Aqua VR application from the KindVR platform was utilized for the intervention sessions. The primary endpoints were pain and anxiety levels with and without the VR immersion. The Wong-Baker FACES Scale and the Children’s Fear Scale were used for pain and anxiety scores, respectively. For parent proxy scores, the PROMIS (Patient-Reported Outcomes Measurement Information System) Parent Proxy Numeric Rating Scale and the parent-reported Children’s Fear Scale were used. Clinician-provided assessment of pain and anxiety was also collected.

The researchers collected baseline levels for the PROMIS Pediatric Anxiety and the PROMIS Pediatric Pain Interference scores, along with parent proxy surveys. The median number of pin sites was 7. At baseline, the mean PROMIS Pediatric Anxiety score was 17.9 and the mean PROMIS Pain Interference score was 19.8.

Overall, the authors noted “a consistent trend of higher anxiety scores in all patients and from the perspective of the proxies” during sessions that did not utilize the VR platform. Additionally, group 1 demonstrated significantly lower pain and anxiety scores during their non-VR immersion visits compared with scores recorded in group 2. The authors noted that this observation was consistent with proxies and clinicians. “Anxiety scores were generally higher during the first study visit, but it seems having a VR immersion experience during the first study visit was associated with lower anxiety scores during later visits, even if pin-site care procedures were not facilitated by a VR immersion experience,” Dr. Iobst noted.

The clinical takeaways of this study, according to Dr. Iobst, are that “the use of VR immersion during pin-site care procedures is associated with lower anxiety scores. Patients enjoyed the experience and continued to ask for it even after the study portion of their care was concluded.” Dr. Iobst acknowledged the limitation of the relatively small sample size and noted that the researchers are currently exploring the use of VR during physical therapy for patients undergoing limb reconstruction.

Drs. Iobst and Bafor are the coauthors of “Feasibility of Virtual Reality Immersion in Reducing Pain and Anxiety during External Fixator Care Procedures.”

Rebecca Araujo is the managing editor of AAOS Now. She can be reached at raraujo@aaos.org.