JMIR Publications

ABSTRACT

Background:

Extended reality (XR) technologies are increasingly being used for reduction of health and procedural anxieties. The global effectiveness of these interventions is uncertain, and there is a lack of understanding about how patient outcomes might vary between different contexts and modalities.

Objective:

The present research used panoramic meta-analysis to synthesise evidence across the diverse clinical contexts in which XR is used to address common outcomes of health and procedural anxiety.

Methods:

Review-level evidence was obtained from four databases (MEDLINE, Embase, APA PsycINFO, Epistemonikos) from the beginning of 2013 until 30 May 2023. Reviews were included that performed meta-analysis of randomised controlled trials relating to patient-directed XR interventions for health and procedural anxiety. Analyses followed a pre-registered, publicly available protocol. Study effect sizes were extracted from reviews and expressed as standardised mean differences, which were entered into a three-level generalised linear model. Here, outcomes were estimated for patients (level one), studies (level two), and anxiety indications (level three), while meta-regressions explored possible influences of age, immersion, and different mechanisms of action. Where relevant, the quality of reviews was appraised using the AMSTAR-2 tool.

Results:

Data from 83 individual trials were extracted from 18 eligible meta-analyses. Most studies involved paediatric patient groups and focused on procedural, as opposed to general, health anxieties (e.g., relating to needle insertion, dental operations, acute surgery contexts). Interventions targeted distraction-, education- and/or exposure-based mechanisms and were provided via a range of immersive and non-immersive systems. These interventions proved broadly effective in reducing patient anxiety, with models revealing significant but heterogenous effects for both procedural (d= -0.75, 95% CI [-0.95, -0.54]) and general health (d= -0.82, 95% CI [-1.20, -0.45]) indications (when compared to non-treatment or usual care control conditions). For procedural anxieties, effects may be influenced by publication bias and appear more pronounced for children (versus adults) and non-immersive (versus immersive) technology interventions, but they were not different by indication.

Conclusions:

Results demonstrate that XR interventions have successfully reduced patient anxiety across diverse clinical contexts. However, significant uncertainty remains about the generalisability of effects within various unexplored indications, and existing evidence is limited in methodological quality. Although current research is broadly positive in this area, it is premature to assert that XR interventions are effective for any given health or procedural anxiety indication.