Abstract
Introduction: Pediatric procedures, particularly cast removal, often provoke anxiety in children, negatively affecting their cooperation and emotional responses during the procedure. Therefore, this randomized clinical trial aimed to compare active versus passive distraction for anxiety reduction during cast removal in children.
Methods: This randomized controlled trial was conducted on 105 children aged 8–12 years undergoing cast removal at Valiasr Hospital in Arak, Iran. Participants were randomly assigned to three groups: passive distraction with music, active distraction with tablet-based video games, and a control group receiving routine care. Anxiety was assessed using the Facial Anxiety Scale and the Children’s Emotion Management Scale (CEMS). Data were analyzed using the chi-square test, Fisher’s exact test, paired t-test, one-way analysis of variance, and Tukey’s post hoc test.
Results: Post-intervention heart rate was significantly lower in the music group (108.22±9.59 bpm) than in the active distraction group (114.62±11.10 bpm) and the control group (115.45±10.99 bpm), with a mean difference of −7.23 bpm versus the control group (95% CI, −13.25 to −1.21; P=0.014). Emotional expression scores were also lower in the music group (14.77±4.16) than in the active distraction group (16.65±4.91) and the control group (17.68±4.43), with a mean difference of −2.91 versus the control group (95% CI, −5.48 to −0.35; P=0.022). Mean anxiety rank was significantly lower in the music group (43.69) than in the control group (63.23; P=0.006).
Conclusion: Passive distraction with music was associated with lower anxiety than routine care and a lower heart rate than active distraction with tablet-based video games during cast removal in children. Music-based distraction may represent a simple, feasible, and low-cost supportive strategy in pediatric orthopedic settings.