Entertainment interventions for pediatric fracture patients during cast room procedures: a scoping review

Children undergoing cast room procedures are usually awake and often experience anxiety, fear, and behavioral resistance, which may hinder the smooth completion of the procedure. Entertainment interventions, as distraction strategies, have been increasingly applied in clinical practice. However, the types of interventions, implementation methods, outcome indicators, assessment tools, and intervention effects remain unclear, limiting their clinical application. Therefore, this study aimed to conduct a scoping review of entertainment interventions used during cast room procedures for pediatric fracture patients to inform clinical practice and future research.

PubMed, Web of Science, Embase, and Cochrane Library databases were searched from inception to October 1, 2025. Studies involving entertainment interventions for children (aged ≤18 years) with fractures during cast room procedures were screened according to predefined inclusion and exclusion criteria. The included literature was systematically organized and narratively analyzed.

A total of 16 studies were included, covering 8 types of entertainment interventions [music, iPad-game, iPad-video, instructional video, virtual reality (VR)-based distraction intervention, VR-game, VR-video, and therapeutic play]. Anxiety and pain were the most commonly reported outcome indicators, followed by fear and behavioral responses, while heart rate was the most frequently used physiological indicator. Standard assessment tools included: heart rate response and the Visual Analogue Scale (VAS) for anxiety; the Numerical Rating Scale (NRS) for pain; the Child Fear Scale (CFS) for fear; and self-created behavior scales for behavioral changes. The results indicated that music, VR-game, iPad-video, VR-video, VR-based distraction intervention and therapeutic play demonstrated positive effects in relieving anxiety; VR-game and instructional video may reduce pain; music and iPad-video showed positive effects in reducing heart rate; VR-game and VR-video reduced fear; and therapeutic play enhanced behavioral performance.

Entertainment interventions vary in implementation approaches and effectiveness. Except for iPad-game interventions, other interventions generally demonstrated positive effects on children's procedural experience in the cast room. Clinical staff may select the most appropriate intervention based on department resources and children's specific responses, such as anxiety, pain, and behavioral resistance. Future studies should develop or optimize new entertainment strategies, expand the range of interventions, and explore individualized strategies for children of different ages, genders, and fracture types to further improve treatment experiences.