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Meta-Analysis
. 2023 Apr 3:25:e38256.
doi: 10.2196/38256.

Virtual Reality Intervention for Patients With Neck Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials

Qifan Guo #  1 , LIMing Zhang #  1 , Chenfan Gui  1 , Guanghui Chen  2 , Yi Chen  1 , Huixin Tan  1 , Wei Su  1 , Ruishi Zhang  1 , Qiang Gao  1
Affiliations
Meta-Analysis

Virtual Reality Intervention for Patients With Neck Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials

Qifan Guo et al. J Med Internet Res. .

Abstract

Background: Neck pain is a prevalent condition that causes an enormous health care burden due to the lack of efficient therapies. As a promising technology, virtual reality (VR) has shown advantages in orthopedic rehabilitation. However, there is no meta-analysis evaluating the effectiveness of VR in neck pain management.

Objective: This study aims to review original randomized controlled trials (RCTs) evaluating the effectiveness of VR for neck pain and to provide evidence for the clinical application of a new alternative approach for pain management.

Methods: A total of 9 electronic databases were systematically searched for relevant articles published from inception to October 2022. RCTs in English or Chinese that investigated VR therapy for participants with neck pain were included. The methodological quality and the evidence level were assessed using the Cochrane Back and Neck Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline, respectively.

Results: A total of 8 studies with 382 participants were included for the final analysis. For the pain intensity, the overall pooled effect size was 0.51, with a standardized mean difference (SMD) of -0.51 (95% CI -0.91 to -0.11; GRADE: moderate), favoring VR therapy compared with controls. Subgroups analyses revealed that significant differences in pain intensity were found in the multimodal intervention (VR in combination with other therapies) than in other interventions (SMD -0.45, 95% CI -0.78 to -0.13; GRADE: moderate), and better analgesic effects were also observed in patients with chronic neck pain receiving VR intervention (SMD -0.70, 95% CI -1.08 to -0.32; GRADE: moderate) and patients treated in the clinic or research unit (SMD -0.52, 95% CI -0.99 to -0.05; GRADE: moderate) than controls. Regarding other health outcomes, the VR experienced less disability, lower kinesiophobia, and greater kinematic function (cervical range of motion, mean and peak velocity). Nevertheless, the follow-up effects of VR therapy on pain intensity and disability were not found.

Conclusions: Existing moderate evidence support VR as a beneficial nonpharmacological approach to improve pain intensity in patients with neck pain, with advantages to multimodal intervention, people with chronic neck pain, and clinic or research unit-based VR therapy. However, the limited quantity and high heterogeneity of the articles limit our findings.

Trial registration: PROSPERO CRD42020188635; https://tinyurl.com/2839jh8w.

Keywords: disability; meta-analysis; neck pain; systematic review; virtual reality.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow chart of the review process.
Figure 2
Figure 2
Summary of the quality evaluation and risk of bias in the included studies.
Figure 3
Figure 3
Forest plot of the effectiveness of virtual reality (VR) therapy in reducing pain intensity. NRS: numeric rating scale; VAS: visual analog scale.
Figure 4
Figure 4
Forest plot of the effectiveness of different virtual reality (VR) interventions in reducing pain intensity.
Figure 5
Figure 5
Forest plot of the effectiveness of virtual reality (VR) therapy for different stages of pain.
Figure 6
Figure 6
Forest plot of the effectiveness of virtual reality (VR) therapy in different clinical operational models.
Figure 7
Figure 7
Forest plot of the follou-up effects of VR therapy in reducing pain intensity. VAS: visual analog scale.
See this image and copyright information in PMC

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