Cast removal can be a painful and worrying process, especially for kids. Virtual reality (VR) and playing games through VR have been shown in the past to be useful tools to distract and support kids through different medical procedures. This study explored the use of VR and games during kids’ cast removal specifically, and how it can help to reduce anxiety levels experienced by kids during the removal process. We also aimed to find ways to improve the efficiency, and usefulness of future trials in this area.

We conducted a randomized control trial with kids ages 4-18 years old, who were orthopaedic patients at the British Columbia Children’s Hospital getting their casts removed. We randomly assigned patients to either use VR or to go through the usual process without VR. This allowed us to compare the effects of VR use to a typical cast removal.

We measured anxiety levels during the cast removal procedure using the Children’s Emotional Manifestation Scale (CEMS). We also considered anxiety levels before and after the removal using the Short State Anxiety Inventory Scale (SAIS). Sometimes, a side effect with VR games can be nausea, so we used a kid-friendly scale (Baxter Retching Faces Scale) to assess whether VR users felt nauseous.

During the cast removal, kids who were given VR played the Snowthrow VR game using the Oculus Go. Through the game, kids aim snowballs at gifts hidden behind blocks of snow. We chose this game as it is easy to learn, age-appropriate, and accessible to our participants. It also didn’t require much movement that could cause issues for doctors during the cast removal process.

In our usual process, kids did not get to use VR, so after the procedure, we invited them to play the VR game for 5 minutes. We asked everyone about their interest in using VR in the future at hospital visits.

We found that anxiety levels during and after the cast removal were reduced significantly. Kids were 18% less worried after the removal, and 24% less worried during the removal. 90% of kids said they would like to use VR again, and 9% said they might like to. We also found that kids using VR usually did not experience nausea as a result. This was great news - our study showed that VR can be a useful way to reduce kids’ anxiety levels during cast removals. We also found that while younger kids reported being more worried in general for their cast removals, kids of all ages were interested in using VR in the future. This suggests VR may be a well-liked and useful distraction tool for cast removals for kids of all ages.