JMIR Publications

ABSTRACT

Background:

Breast cancer survivors (BCS) can present with various physical and psychological symptoms and functional deficits that impact their quality of life. Virtual reality (VR) technology is being used in breast cancer rehabilitation management to improve the emotional, cognitive, and physical well-being of BCS.

Objective:

This systematic review aimed to examine the effectiveness of VR-based interventions on health-related outcomes in BCS. A meta-analysis was conducted to evaluate the effectiveness of VR-based interventions in the rehabilitation management of BCS.

Methods:

A systematic search was conducted on PubMed, Web of Science, Embase, CINAHL for full text, the Cochrane Central Register of Controlled Trials, CNKI, Wanfang, VIP, and CBM, from inception until May 25, 2021. The inclusion criteria of the selected studies were as follows: (1) population: adults diagnosed with breast cancer; (2) any type of VR-based interventions (immersive and non-immersive virtual environment); (3) comparison of traditional rehabilitation methods; (4) outcomes including pain, depression, anxiety, fatigue, cognitive function, shoulder range of motion, hand grip strength, lymphedema, cybersickness symptoms, fear of movement, bleeding, effusion, and flap necrosis, both during and after treatment; and (5) randomized controlled trials (RCTs), case-controlled trials, and quasi-experimental studies. The Cochrane Collaboration tool was used to evaluate the risk of bias. Review Manager V.5.3 (Cochrane Collaboration) was used to conduct the meta-analysis. The mean difference and standard deviations with 95% confidence intervals (CIs) were used to calculate continuous variables.

Results:

Twelve articles were included in this systematic review, of which, ten contributed information to the meta-analysis. A total of 604 participants were analyzed. The statistical analysis showed significant results for flexion (standard mean difference [SMD], 1.79; 95% CI, 0.55–3.03), extension (SMD, 1.54; 95% CI, 0.83–2.25), abduction (mean difference [MD], 17.53; 95% CI, 14.33–20.72), adduction (MD, 15.81; 95% CI, 13.85–17.77), internal rotation (SMD, 1.34; 95% CI, 1.00–1.67), external rotation (SMD, 0.96; 95% CI, 0.62–1.29), anxiety (MD, −6.46; 95% CI, −7.20 to −5.72), depression (MD, −4.27; 95% CI, −4.64 to −3.91), pain (MD, −1.32; 95% CI, −2.56 to −0.09), and cognitive function (MD, 8.80; 95% CI, 8.17–9.43). The meta-analysis indicated little to no difference in hand grip strength (MD, 1.96; 95% CI, –0.93–4.85).

Conclusions:

The current findings noted a weak but consistent positive association between VR-based interventions and outcomes. However, these results must be interpreted with caution due to the limited number of controlled trials analyzed, small sample sizes, and poor methodological quality. Well‐designed, large, high‐quality trials may have a significant impact on our confidence in the results. Future studies should identify specific aspects that improve the clinical impact of VR-based interventions on major outcomes in BCS in the clinical setting.