JMIR Publications

ABSTRACT

Background:

Virtual reality (VR) has promise as an innovative non-pharmacologic treatment for improving patient quality of life. VR can be used as an adjunct or treatment for many acute and chronic conditions, including serious illnesses.

Objective:

The purpose of this systematic review was to assess the current state of the literature of randomized control trials that utilize VR in patients with serious illnesses. Two secondary aims include assessing components of interventions associated with improved quality of life and functional outcomes among older adults, as well as evaluating how well the randomized controlled trials adhere to consensus standards for VR research.

Methods:

We searched PubMed, EMBASE, and CINAHL for randomized controlled studies published at any time which resulted in 10,799 articles. We screened and accepted studies that reported patient quality of life-related outcomes, provided an immersive VR intervention, and included patients with serious illness. We narratively summarized key attributes of publications that shed light on study efficacy, generalizability, replicability, and clinical utility. All studies were assessed for study quality with the Cochrane Risk of Bias tool and for concordance with eight recent consensus standards for VR research.

Results:

Seventeen studies met inclusion criteria, and of those, fourteen reported a statistically significant improvement in at least one patient quality of life outcome. No included studies had an overall high risk of bias. Seven studies included stroke patients, four studies included cancer patients, four studies included patients with cardiovascular disease, one study included patients with chronic obstructive pulmonary disease and one study included patients that reported pain in the hospital. In all seven studies that included patients with stroke, the main purpose of VR was to improve mobility and strength. These seven studies had higher frequency and longer durations of VR use, ranging from two to nine weeks, as compared to a VR duration of less than two weeks for studies aiming to reduce pain or anxiety. In seven studies, VR was used to provide distraction therapy to reduce pain. Four studies included training, supervision, and assistance in utilization of VR, all of which reported improvements in patient quality of life-related outcomes. With regard to consensus standards for VR research, five studies adhered to all eight criteria and all studies adhered to five or more criteria. Four of the included articles were published prior to the 2019 Birckhead et al., publication that defined the gold standard VR consensus standards criteria.

Conclusions:

Nascent evidence suggests the potential of VR in mitigating pain, anxiety, depression, and improving mobility, among persons with serious illnesses. Most studies did not provide detailed information about unassisted or assisted use, suggesting that VR for older adults is currently most appropriate for observed settings with assistance available. Clinical Trial: We registered our protocol to the PROSPERO database under the registration number CRD42022346178.