JMIR Publications

ABSTRACT

Virtual reality (VR) has been increasingly used as a non-pharmacological method for chronic pain management. Within VR applications, an important distinction can be made between immersive and non-immersive media, which differs in spatial presences. We conducted this systematic review of randomized control trials (RCTs) to assess the effectiveness of VR-assisted physical therapy versus conventional controls in chronic musculoskeletal pain, and to analyze the effects of immersive versus non-immersive VR on pain outcomes. Seven databases were searched from inception to 15th April 2023. Primary outcome was pain intensity; secondary outcomes included functional disability and kinesiophobia. Available data were pooled in meta-analysis. Studies were graded by Cochrane risk-of-bias tool 2. Twenty-five RCT (n=1010) with some concerns to high risk of bias were identified, of which 22 were included in meta-analysis. In low back pain, short-term outcomes (post-intervention) found that non-immersive VR was effective in reducing pain (SMD -1.79, 95% CI: -2.72 to -0.87, P=0.0001), improving disability (SMD: -0.44, 95% CI: -0.72 to -0.16, P=0.002) and kinesiophobia (SMD: -2.94, 95% CI: -5.20 to -0.68, P=0.01); intermediate-term outcomes measured at 6 months also showed that non-immersive VR was effective in reducing pain (SMD: -8.15, 95% CI: -15.29 to -1.01, P=0.03) and kinesiophobia (SMD: -4.28, 95% CI: -8.12 to -0.44, P=0.03). For neck pain, immersive VR reduced pain intensity (SMD: -0.48, 95% CI: -0.75 to -0.21, P=0.0004) but not disability and kinesiophobia in short-term. No statistical significances were detected for knee pain or other pain regions at all time points.