Age-Stratified Impact of Early Virtual Reality Intervention on Preoperative Anxiety in Children: A Randomized Trial

Abstract

Aim of the Study

Although it is known that virtual reality (VR) reduces presurgical anxiety, it has neither been stratified by age to determine its effect, nor has been applied before the day of surgery. This study has a novel age-stratified design offering VR months before surgery to address these unstudied issues.

Methods

This was a unicentered, blinded clinical trial with parallel groups stratified by age (5–8 and 9–12 years), including major outpatient surgery patients. VR video showing the course of surgery was offered months before surgery. This study had ethical committee approval. The main variable was the modified Yale Preoperative Anxiety Scale (mYPAS) before entering the operating room. The Child Behavior Checklist (CBCL) measured basal anxiety and the Posthospitalization Behavior Questionnaire (PHBQ) measured behavior after 1 month. For comparison, Student's t-test or Kruskal–Wallis test was used.

Results

Of 72 patients, 6 met exclusion criteria and 5 withdrew consent. Of the remaining 61, 56 completed mYPAS. The mYPAS decrease was significant for children aged 5 to 8 years (28.33 VIDEO vs. 35.83 non-VIDEO; p = 0.042) (rank coefficient 0.45 [0.05–0.72]). In the children aged 9 to 12 years (32.91 vs. 33.33; p = 0.864), a tiny correlation (r = 0.04 [0.38–0.45]) was found. A total of 96.67% of CBCLs (n = 58) scored normal. The 57 completed PHBQs had very low scores, both in non-VIDEO (0.00 [0.00–4.50]) and in VIDEO groups (0.00 [0.00–4.50]). No differences were found; neither globally (p > 0.05), nor depending on age (5–8 years, p = 0.508/9–12 years, p = 0.661).

Conclusion

VR may reduce preoperative anxiety in younger children (5 to 8 years), though its effect in the entire group was borderline. Larger multicenter studies are needed to confirm age and timing benefits.

Keywords

virtual reality - preoperative anxiety - behavior problems

Publikationsverlauf

Eingereicht: 24. Juli 2025

Angenommen: 23. November 2025

Accepted Manuscript online:
26. November 2025

Artikel online veröffentlicht:
15. Dezember 2025

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