Virtual reality as a distraction technique in pediatric patients undergoing orthopedic procedures: A systematic review and meta-analysis of randomized controlled trials

Introduction: Pain and anxiety are common in pediatric orthopedic procedures such as cast or pin removal, often leading to distress and physiological stress responses. Virtual reality (VR) offers immersive distraction and has shown promise in pediatric procedural care; however, evidence in orthopedic procedures remains limited. This meta-analysis aimed to evaluate the effectiveness of VR compared with standard care in reducing pain, anxiety, and heart rate in children undergoing orthopedic procedures. Methods: A systematic search was conducted in PubMed, Scopus, and Cochrane Library from inception to 20 October 2025 for randomized controlled trials (RCTs) comparing VR distraction and standard care in pediatric patients undergoing orthopedic procedures. Outcomes of interest included pain, anxiety, and heart rate. Statistical analysis was performed with R 4.3.1. Standardized mean differences (SMD) using the Inverse-Variance method and the random-effects method. Results: A total of four RCTs were included in the final meta-analysis, comprising 624 patients, of whom 315 (50%) were distracted with VR during clinical orthopedic procedures (mean age 9.84 years, mean 40% females). In the pooled analysis, VR distraction significantly reduced anxiety (SMD = −0.55, 95% confidence intervals (CI) [−0.76, −0.34]; p < 0.01; I 2 = 0%), pain (SMD = −0.43; 95% CI [−0.68, −0.19]; p < 0.01; I 2 = 44%), and heart rate (SMD = −0.34; 95% CI [−0.60, −0.07]; p = 0.01; I 2 = 53%). Conclusion: In this meta-analysis of four RCTs including 624 pediatric patients, VR distraction reduced procedural anxiety and, in pooled analyses, was associated with modest but statistically significant reductions in pain and heart rate compared with standard care during predominantly cast-related orthopedic clinic procedures. The integration of this child-friendly, nonpharmacological approach provides enhanced procedural comfort and effective anxiety management.