Virtual reality as a non-pharmacological intervention for pediatric preoperative anxiety: A quality improvement initiative and retrospective analysis
4 affiliations
- 1Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
- 2Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, United States of America
- 3Department of Clinical Practice, College of Pharmacy, Northern Border University, Rafha, Saudi Arabia
- 4Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, United States of America
Abstract
Preoperative anxiety affects a majority of children undergoing surgery and is associated with adverse perioperative and psychological outcomes. Virtual reality (VR) is a promising non-pharmacological option, but real-world implementation data remain limited. We report a nine-month quality-improvement (QI) initiative that implemented a custom VR intervention in a pediatric preoperative holding area, followed by retrospective analysis of prospectively collected data. Using a single-arm, pre-post design without a comparison group, we evaluated within-subject changes in self-reported distress and fear, physiological indicators, and stakeholder experience in 80 children aged 6–15 years. Between the pre-VR and immediately post-VR assessments, distress (0–10 Numerical Rating Scale) decreased by a median of 2.0 points (median 3.0 to 1.0; p < 0.001) and fear (0–4 Children's Fear Scale) by a median of 1.0 point (1.0 to 0.0; p < 0.001). Heart rate fell by a mean of 5.8 beats/min and systolic blood pressure by 4.1 mmHg (both p < 0.001). Acceptance was high: 91% of children were willing to use VR again, 95% of parents would recommend it, and all participating nurses endorsed it, with few, minor adverse effects (3 of 80). In this uncontrolled QI initiative, VR was feasible and safe to implement and was accompanied by clinically meaningful within-subject reductions in anxiety and physiological arousal. Because the design included no comparison group, these changes cannot be attributed to VR alone and may partly reflect natural settling, acclimation, non-specific attention, or regression to the mean. Controlled trials are needed to establish comparative effectiveness before routine adoption. Author summary: Many children feel anxious before surgery, and this anxiety can make surgery harder for children and families. Calming medicines can help but may cause side effects, so we wanted to see whether virtual reality (VR) could offer a drug-free alternative. Our team built a calm, child-friendly virtual world and, over nine months, made it part of routine care in the area where children wait before surgery at a children’s hospital in Richmond, Virginia. We kept improving the program based on feedback from children, parents, and nurses. Eighty children aged 6–15 took part. After using VR, children reported feeling less distressed and less afraid than before, and their heart rate and blood pressure were lower. Nearly all children said they would use VR again, almost all parents would recommend it, and nurses found it easy to fit into their work. Side effects were rare and mild. Because we had no comparison group, controlled trials are still needed to confirm how much of this improvement comes from VR itself. Our experience shows that VR can be built into everyday surgical care safely and smoothly, and that it offers a promising, drug-free way to support children facing surgery.
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BibTeX
@article{rukbah2026virtual,
title = {{Virtual reality as a non-pharmacological intervention for pediatric preoperative anxiety: A quality improvement initiative and retrospective analysis}},
author = {Walaa S. Abu Rukbah and Narendra Vadlamudi and Siri Garrett and Suad Alshammari and Dayanjan S. Wijesinghe},
journal = {PLOS Digital Health},
year = {2026},
month = nov,
doi = {10.1371/journal.pdig.0001219},
url = {https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001219},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Virtual reality as a non-pharmacological intervention for pediatric preoperative anxiety: A quality improvement initiative and retrospective analysis
AU - Walaa S. Abu Rukbah
AU - Narendra Vadlamudi
AU - Siri Garrett
AU - Suad Alshammari
AU - Dayanjan S. Wijesinghe
PY - 2026
DA - 2026/11/05
JO - PLOS Digital Health
DO - 10.1371/journal.pdig.0001219
UR - https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001219
AB - Preoperative anxiety affects a majority of children undergoing surgery and is associated with adverse perioperative and psychological outcomes. Virtual reality (VR) is a promising non-pharmacological option, but real-world implementation data remain limited. We report a nine-month quality-improvement (QI) initiative that implemented a custom VR intervention in a pediatric preoperative holding area, followed by retrospective analysis of prospectively collected data. Using a single-arm, pre-post design without a comparison group, we evaluated within-subject changes in self-reported distress and fear, physiological indicators, and stakeholder experience in 80 children aged 6–15 years. Between the pre-VR and immediately post-VR assessments, distress (0–10 Numerical Rating Scale) decreased by a median of 2.0 points (median 3.0 to 1.0; p < 0.001) and fear (0–4 Children's Fear Scale) by a median of 1.0 point (1.0 to 0.0; p < 0.001). Heart rate fell by a mean of 5.8 beats/min and systolic blood pressure by 4.1 mmHg (both p < 0.001). Acceptance was high: 91% of children were willing to use VR again, 95% of parents would recommend it, and all participating nurses endorsed it, with few, minor adverse effects (3 of 80). In this uncontrolled QI initiative, VR was feasible and safe to implement and was accompanied by clinically meaningful within-subject reductions in anxiety and physiological arousal. Because the design included no comparison group, these changes cannot be attributed to VR alone and may partly reflect natural settling, acclimation, non-specific attention, or regression to the mean. Controlled trials are needed to establish comparative effectiveness before routine adoption. Author summary: Many children feel anxious before surgery, and this anxiety can make surgery harder for children and families. Calming medicines can help but may cause side effects, so we wanted to see whether virtual reality (VR) could offer a drug-free alternative. Our team built a calm, child-friendly virtual world and, over nine months, made it part of routine care in the area where children wait before surgery at a children’s hospital in Richmond, Virginia. We kept improving the program based on feedback from children, parents, and nurses. Eighty children aged 6–15 took part. After using VR, children reported feeling less distressed and less afraid than before, and their heart rate and blood pressure were lower. Nearly all children said they would use VR again, almost all parents would recommend it, and nurses found it easy to fit into their work. Side effects were rare and mild. Because we had no comparison group, controlled trials are still needed to confirm how much of this improvement comes from VR itself. Our experience shows that VR can be built into everyday surgical care safely and smoothly, and that it offers a promising, drug-free way to support children facing surgery.
SN - 2767-3170
ER -