Is Virtual Reality Effective in Orthopedic Rehabilitation? A Systematic Review and Meta-Analysis

Abstract

Background Virtual reality (VR) is an interactive technology that allows customized treatment and may help in delivering effective person-centered rehabilitation. Purpose The purpose of this review was to systematically review and critically appraise the controlled clinical trials that investigated VR effectiveness in orthopedic rehabilitation. Data Sources Pubmed, CINAHL, Embase, PEDro, REHABDATA, and Sage publications were searched up to September 2018. In addition, manual searching and snowballing using Scopus and Web of Science were done. Study Selection Two reviewers screened studies for eligibility first by title and abstract and then full text. Data Extraction Articles were categorized into general or region-specific (upper limbs, lower limbs, and spine) orthopedic disorders. Study quality was assessed using the Evaluation Guidelines for Rating the Quality of an Intervention Study scoring. Meta-analysis quantified VR effectiveness, compared with no treatment, in back pain. Data Synthesis Nineteen studies were included in the quality assessment. The majority of the studies were of moderate quality. Fourteen studies showed that VR did not differ compared with exercises. Compared with the no-treatment control, 5 studies favored VR and 3 other studies showed no differences. For low back pain, the meta-analysis revealed no significant difference between VR and no-treatment control (n = 116; standardized mean difference = −0.21; 95% confidence interval = −0.58 to 0.15). Limitations Limitations included heterogeneity in interventions and the outcome measures of reviewed studies. Only articles in English were included. Conclusion The evidence of VR effectiveness is promising in chronic neck pain and shoulder impingement syndrome. VR and exercises have similar effects in rheumatoid arthritis, knee arthritis, ankle instability, and post-anterior cruciate reconstruction. For fibromyalgia and back pain, as well as after knee arthroplasty, the evidence of VR effectiveness compared with exercise is absent or inconclusive.

Effects of Virtual Reality versus Exercise on Pain, Functional, Somatosensory and Psychosocial Outcomes in Patients with Non-specific Chronic Neck Pain: A Randomized Clinical Trial

“…As far as the authors are concerned, this is the first randomized clinical trial that has studied the use of VR for NS-CNP and compared pain-related, motor and psychological outcomes compared to an exercise group in the short-term. Recent reviews have concluded that more research is needed regarding VR as a treatment of musculoskeletal disorders [24,26,65]. The present study matches the protocol of the reviewed articles where the treatment was delivered during four weeks of chronic pain, with similar immediate results [65].…”

“…Although other studies have failed to demonstrate a hypoalgesic effect of distraction, the majority of studies have shown that distraction does reduce pain, most of them in acute conditions [25]. A meta-analysis published in 2019 [26] showed that VR applied to patients with neck pain was promising in producing positive effects when applied alone or combined with exercises.…”

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

“…Although a significant body of research exists on the use of VR for acute pain management [ 26 , 28 , 30 , 52 - 54 ] and for physical rehabilitation [ 24 , 40 ], the use of VR as a platform to deliver behavioral medicine for chronic pain remains novel and understudied. Research on VR for acute pain is based on the premise that distraction is a primary mechanism of VR analgesia [ 33 , 55 ].…”

“…Promising studies have used VR to reduce pain and improve outcomes in complex regional pain syndrome [ 34 ], chronic headache/migraine pain [ 35 ], fibromyalgia [ 36 , 37 ], and chronic musculoskeletal pain [ 38 , 39 ]. Two recent reviews and meta-analyses reported the efficacy of VR for physical rehabilitation from painful spinal conditions [ 24 ] and for orthopedic rehabilitation in terms of reduced pain and disability [ 40 ]. In such studies, the user may engage with interactive VR alone or within the context of kinematic training.…”

Advanced rehabilitation technology in orthopaedics—a narrative review

“…Clinical trials have assessed VR effectiveness in patients with orthopaedic pathology such as ACL injury, frozen shoulder and chronic neck pain. Most of them used off-the-shelf console games such as Nintendo Wii Fit, making it difficult to differentiate from rehabilitation using CAGS [70].…”