JMIR Publications

ABSTRACT

Background:

Early rehabilitation is crucial for functional recovery in critically ill patients. Virtual reality-based early rehabilitation intervention (VR-ERI) is an emerging strategy, but evidence on its feasibility, safety, and efficacy is inconsistent and lacks systematic synthesis.

Objective:

To synthesize evidence from randomized controlled trials (RCTs) on the feasibility and safety of VR-ERI in adult critically ill patients and evaluate its effects on functional outcomes during ICU stay and at short-term follow-up (≤3 months post-ICU).

Methods:

This review followed the PRISMA 2020 guidelines. We searched ten databases (PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, etc.) from inception to October 5, 2025, for Chinese and English publications. RCTs comparing VR-ERI with control measures initiated early (within 72 hours of ICU admission) in adult patients were included. Two researchers independently screened studies, extracted data, and assessed risk of bias using the revised Cochrane Risk of Bias tool (RoB 2). Data were synthesized narratively or via meta-analysis in R Studio using a random-effects model (Hartung-Knapp-Sidik-Jonkman adjustment). Effects were expressed as standardized mean differences (SMD with Hedges' g correction) with 95% confidence intervals(95%CI), and 95% prediction intervals(95%PI) were calculated. Subgroup and sensitivity analyses were performed to explore heterogeneity and assess the robustness of the findings. The Grading of Recommendations, Assessment, Development and Evaluations framework was used to assess the quality of evidence.

Results:

Sixteen RCTs (published 2020-2025) involving 1,356 patients (mean age 60-70 years; including cardiac, post-surgical, trauma patients) were included. During ICU stay, VR-ERI showed trends toward reducing anxiety (SMD = -0.86，95%CI[-1.85, 0.13]; 95%PI[-3.75, 2.03]) and improving subjective sleep quality (SMD=3.36, 95%CI[0.77, 5.94]). In the subgroup using the Richards-Campbell Sleep Questionnaire tool, the improvement in sleep quality was more pronounced (SMD=5.12, 95%CI [0.54, 9.71]), with a significant subgroup difference. At short-term follow-up, VR-ERI improved balance function (Berg Balance Scale: SMD=.97, 95%CI[.74,1.20]; 95%PI [.37, 1.58]) and showed a trend for improved limb motor function (Functional Mobility Scale: SMD = 1.40, 95% CI [-0.23, 3.02]). No significant differences were found for objective sleep, pain during ICU, or cognitive function at follow-up. No serious adverse events were reported; minor reactions (dizziness, nausea, fatigue) occurred infrequently.

Conclusions:

This review is the first to explore VR-ERI effects specifically within the early ICU intervention window. VR-ERI shows potential for improving anxiety, subjective sleep quality, balance, and limb motor function, but its effects on cognition and pain remain unclear, and safety monitoring requires enhancement. Due to high risk of bias, heterogeneity, and imprecision, most evidence is of low quality, warranting cautious interpretation. VR technology may serve as a non-pharmacological adjunct in early ICU rehabilitation, but its clinical translation requires consideration of cost and patient suitability, and relies on future rigorous studies to establish long-term value. Clinical Trial: PROSPERO CRD420251114439. https://www.crd.york. ac. uk/ PROSPERO/view/CRD420251114439