JMIR Publications

ABSTRACT

Background:

Adults receiving long-term hemodialysis often experience a multidimensional symptom burden that affects their functional status and daily activities. Effective symptom management may help reduce this burden, preserve functional status, and improve the overall treatment experience. However, evidence remains limited for non-pharmacological interventions that are safe, acceptable, and easy to integrate into routine hemodialysis care. Virtual reality may be a promising approach for symptom relief and supportive management, but its overall effectiveness and safety in adults receiving hemodialysis remain unclear.

Objective:

To determine whether virtual reality-based interventions improve symptom-related outcomes and are safe for adults receiving hemodialysis.

Methods:

A comprehensive search was conducted across 12 electronic databases and trial registries from inception to January 2026. Eligible studies were randomized controlled trials evaluating virtual reality-based interventions for symptom-related outcomes in adult patients receiving hemodialysis. The methodological quality of the included trials was appraised using the Cochrane risk-of-bias tool for randomized trials, version 2. Quantitative synthesis was conducted in RevMan 5.4 when appropriate. For continuous variables, treatment effects were summarized as mean differences or standardized mean differences according to outcome measurement consistency. Statistical heterogeneity was examined using the chi-square test and I² value, and the choice between fixed-effect and random-effects models was based on the degree of heterogeneity. Outcomes unsuitable for meta-analysis were summarized descriptively.

Results:

Of the 11,192 records identified, 19 randomized controlled trials from 10 countries were included in the systematic review, involving 1,228 participants. Thirteen studies used immersive VR, and six used non-immersive VR. All interventions were delivered during hemodialysis. Compared with usual care, VR interventions significantly reduced pain scores during arteriovenous fistula cannulation (mean difference [MD] −2.44, 95% CI −2.91 to −1.97; P<.001; I²=66%). VR interventions also improved gait speed (standardized mean difference [SMD] 0.46, 95% CI 0.11 to 0.81; P=.01; I²=0%) and 6-minute walk distance (MD 74.77 m, 95% CI 40.55 to 108.99; P<.001; I²=43%). For psychological symptoms, VR interventions reduced trait anxiety scores (MD −7.72, 95% CI −13.72 to −1.71; P=.01; I²=61%) and depressive symptom scores (MD −3.48, 95% CI −6.77 to −0.18; P=.04; I²=33%). However, VR interventions showed no consistent effects on state anxiety, several lower-limb function outcomes, or vital signs. No included study reported serious VR-related adverse events.

Conclusions:

Virtual reality may be a useful adjunctive non-pharmacological strategy for symptom management in adults receiving hemodialysis, particularly for reducing pain during arteriovenous fistula cannulation. Potential benefits were also observed for physical function, depressive symptoms, selected aspects of health-related quality of life, treatment experience, and participation in intradialytic exercise. However, the evidence remains limited by small study numbers, heterogeneous interventions, and short follow-up. More rigorous, long-term pragmatic randomized trials are needed to confirm the sustained effectiveness, safety, and feasibility of VR in this population. Clinical Trial: The protocol was registered with PROSPERO (CRD420261341833);https://www.crd.york.ac.uk/PROSPERO/view/CRD420261341833.