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Meta-Analysis
. 2024 Aug 19:26:e48787.
doi: 10.2196/48787.

Immersive and Nonimmersive Virtual Reality-Assisted Active Training in Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis

Hermione Hin Man Lo  1   2 , Mengting Zhu  2 , Zihui Zou  2 , Cho Lee Wong  1 , Suzanne Hoi Shan Lo  1 , Vincent Chi-Ho Chung  2 , Samuel Yeung-Shan Wong  2 , Regina Wing Shan Sit  2
Affiliations
Meta-Analysis

Immersive and Nonimmersive Virtual Reality-Assisted Active Training in Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis

Hermione Hin Man Lo et al. J Med Internet Res. .

Abstract

Background: Virtual reality (VR) in different immersive conditions has been increasingly used as a nonpharmacological method for managing chronic musculoskeletal pain.

Objective: We aimed to assess the effectiveness of VR-assisted active training versus conventional exercise or physiotherapy in chronic musculoskeletal pain and to analyze the effects of immersive versus nonimmersive VR on pain outcomes.

Methods: This systematic review of randomized control trials (RCTs) searched PubMed, Scopus, and Web of Science databases from inception to June 9, 2024. RCTs comparing adults with chronic musculoskeletal pain receiving VR-assisted training were included. The primary outcome was pain intensity; secondary outcomes included functional disability and kinesiophobia. Available data were pooled in a meta-analysis. Studies were graded using the Cochrane Risk-of-Bias Tool version 2.

Results: In total, 28 RCTs including 1114 participants with some concerns for a high risk of bias were identified, and 25 RCTs were included in the meta-analysis. In low back pain, short-term outcomes measured post intervention showed that nonimmersive VR is effective in reducing pain (standardized mean difference [SMD] -1.79, 95% CI -2.72 to -0.87; P<.001), improving disability (SMD -0.44, 95% CI -0.72 to -0.16; P=.002), and kinesiophobia (SMD -2.94, 95% CI -5.20 to -0.68; P=.01). Intermediate-term outcomes measured at 6 months also showed that nonimmersive VR is effective in reducing pain (SMD -8.15, 95% CI -15.29 to -1.01; P=.03), and kinesiophobia (SMD -4.28, 95% CI -8.12 to -0.44; P=.03) compared to conventional active training. For neck pain, immersive VR reduced pain intensity (SMD -0.55, 95% CI -1.02 to -0.08; P=.02) but not disability and kinesiophobia in the short term. No statistical significances were detected for knee pain or other pain regions at all time points. In addition, 2 (8%) studies had a high risk of bias.

Conclusions: Both nonimmersive and immersive VR-assisted active training is effective in reducing back and neck pain symptoms. Our study findings suggest that VR is effective in alleviating chronic musculoskeletal pain.

Trial registration: PROSPERO CRD42022302912; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302912.

Keywords: VR; arthritis; chronic pain; disability; immersive; kinesiophobia; knee pain; low back pain; musculoskeletal; musculoskeletal pain; neck pain; osteoarthritis; pain; physical therapy; physiotherapy; review methodology; review methods; shoulder pain; simulation; simulations; systematic; virtual reality.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
PRISMA flowchart for study selection. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT: randomized control trial; VR: virtual reality.
Figure 2
Figure 2
Risk-of-bias assessment of the included studies.
Figure 3
Figure 3
(a) Short-term effects of VR-assisted vs conventional active training in back pain intensity (nonimmersive VR via flat screen; immersive VR via HMDs). (b) Funnel plots for short-term effects of VR-assisted vs conventional active training in back pain intensity. (c) Intermediate effects of nonimmersive VR–assisted vs conventional active training in back pain intensity. HMD: head-mounted device; VR: virtual reality.
Figure 4
Figure 4
Short-term effects of nonimmersive VR–assisted vs conventional active training in back functional disability. VR: virtual reality.
Figure 5
Figure 5
(a) Short-term effects of VR-assisted vs conventional active training in back kinesiophobia (nonimmersive VR via flat screen; immersive VR via HMDs). (b) Intermediate effects of nonimmersive VR–assisted vs conventional active training in back kinesiophobia. HMD: head-mounted device; VR: virtual reality.
Figure 6
Figure 6
Short-term effects of immersive VR–assisted vs conventional active training in neck pain intensity. VR: virtual reality.
Figure 7
Figure 7
Short-term effects of immersive VR–assisted vs conventional active training in neck functional disability. VR: virtual reality.
Figure 8
Figure 8
Short-term effects of immersive VR–assisted vs conventional active training in neck kinesiophobia. VR: virtual reality.
Figure 9
Figure 9
Short-term effects of nonimmersive VR–assisted vs conventional active training in knee pain intensity. VR: virtual reality.
Figure 10
Figure 10
Short-term effects of nonimmersive VR–assisted vs conventional active training in knee functional disability. VR: virtual reality.
See this image and copyright information in PMC

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