Use of Multimodal Distraction to Reduce Anxiety During Cast Removal in Pediatric Patients; A Quasi-Experimental Study

Cast removal can be an anxiety-provoking medical procedure for children. Distraction emerges as the safest and most effective intervention to reduce anxiety. Although various distractions have been studied, none of them have proven simple and inexpensive enough to meet the needs of orthopaedic clinics. The present study aims to evaluate whether multimodal distraction incorporating music, drawings in a mirror, and finger puppets, can decrease children's anxiety during cast removal compared with standard of care.

A before and after quasi-experimental design was implemented with children aged 3 to 12 years old. The control group received standard care during cast removal, while the intervention group was offered distractions, including noise-cancelling headphones for music, finger puppets, and a mirror for drawing or observing the reflection of their healthy limb. Anxiety levels before, during, and after cast removal were assessed using the Children's Fear Scale (CFS) and the Faces, Legs, Activity, Cry and Consolability (FLACC) Scale. Parent and cast technician satisfaction was evaluated through homemade questionnaires and the Short Assessment of Patient Satisfaction (SAPS).

One hundred two children participated in this study, with the first 51 assigned to the control group and the subsequent 51 to the intervention group. On the FLACC Scale, the median anxiety level was at 0 points in both groups at all 3 time points. On the CFS, the median anxiety level during cast removal was at 0.5 points for the intervention group and 1 point for the control group ( P = 0.71). The level of anxiety was very low for both groups. Finally, 77% of parents indicated they would like their children to use distraction again.

The multimodal distraction presented in this study did not demonstrate a reduction in anxiety levels during cast removal in children compared with standard care provided at the institution. However, it provides a potentially more positive experience for children and is well accepted by the orthopaedic clinical team.

Level II-prospective comparative study.