Review	Focus of Review	Study Details Number (N) Year Target Population	Methods Database Outcomes QoE	Main Findings	Limitations
Goudmann et al. [19]	Evaluate the effect of VR on several outcome parameters related to the application of VR in patients with chronic pain	2022 N Studies = 41 N participants = 1232 Chronic pain (Fibromyalgia, Low back pain, neck pain, upper limb complex regional pain syndrome and phantom limb pain)	4 Database Risk of bias varied between 8 out of 28 and 25 out of 28 Data from 25 studies were included in the meta-analysis Pain-related Outcomes kinesiophobia and fear, mood, satisfaction, expectations of pain, pain focus, time spent thinking about pain, self-efficacy, emotions, motivation, stress, catastrophizing, acceptability, global impression of change, ownership, and agency Functional outcomes Functional capacity Mobility Neuropsychological functions Experience of VR technology	A total of 23 studies used immersive VR techniques, and 18 used non-immersive techniques. VR intervention in patients with chronic pain had a positive effect on decrease pain, increase mobility and functional capacity. Overall effect of VR on several outcome measurements is not moderated by the type of VR intervention, type of pain or the objective of VR.	None of the included studies qualified for excellent methodological quality. Much heterogeneity is present in studies with VR methodology Authors mainly focused on the primary outcome variables and secondary outcomes were not always described in full detail an asymmetrical plot in experience of VR technology outcomes, which might be interpreted as an indication of publication bias.
Wittkopf et al. [145]	Evaluate the effect of immersive and non-immersive interactive VR on pain perception in patients with a clinical pain condition.	2019 N Studies = 13 N participants = 469 Chronic pain (Low back pain, neck pain, neuropathic pain, phantom limb pain, ankylosing spondylitis, subacromial impingement syndrome and post-mastectomy)	5 databases High risk of bias and small sample sizes. A meta-analysis could not be conducted due to differences in study designs and types of controls. Pain-related Outcomes were included	A total of 5 studies used immersive VR techniques, and 8 used non-immersive techniques. No difference in efficacy in immersive or non-immersive VR intervention. Interactive VRmay reduce pain	High risk of bias and small sample sizes on studies included Much heterogeneity in VR methodology (type, frequency, and duration of VR treatment)
Grassini [146]	Assessment of the efficacy of the use of VR for chronic pain management	2022 N Studies = 9 N participants = 524 Chronic pain (Low back pain and neck pain)	6 databases Low risk of bias and small sample sizes. A meta-analysis could not be conducted due to differences in study designs and types of controls. Pain-related Outcomes Tampa Scale for kinesiophobia (TSK) pain intensity Oswestry dysfunction index (ODI) neck disability index (NDI) were included	VR interventions may be useful for chronic pain management but was not superior to other types of interventions VR could be effective on NDI but no in RMD an TSK	Small number of included studies High heterogeneity was present in most of the outcomes No information about type of VR information A single author has conducted this study
Brea-Gómez et al. [147]	Analyze the effectiveness of VR in chronic low back pain.	2021 N Studies = 14 N participants = 765 Chronic pain (Low back pain)	4 databases Risk of bias varied between 13-27 out 28. Data from 11 studies were included in the meta-analysis Pain-related Outcomes Tampa Scale for kinesiophobia (TSK) Disability Questionnaire (RMDQ) Oswestry dysfunction index (ODI) 10-item Pain Self- Efficacy (10-PSEQ) Pain Catastrophizing Scale (PCS) isokinetic trunk flexion/extension with a dynamometer blood serum levels of stress hormones were included	A total of 2 studies used immersive VR techniques, and 12 used non-immersive techniques. VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain No significant differences were found in disability postintervention.	High heterogeneity between included Differences in the age ranges and in the clinical profile of the participants Small sample sizes on studies included High heterogeneity in VR methodology (type, frequency, and duration of VR treatment)
Gava et al. [136]	Analyze the current evidence regarding the use of games and virtual reality to improve mental health-related outcomes in patients with chronic musculoskeletal pain.	2022 N Studies = 13 N participants = 680 Chronic musculoskeletal pain (back, neck, and shoulder pain; osteoarthritis; fibromyalgia)	6 Database Risk of bias varied between 8 out of 28 and 25 out of 28 Data from 13 studies were included in the meta-analysis Pain-related Outcomes Fear-Avoidance Beliefs Questionnaire (FABQ) Tampa Kinesiophobia Scale (TSK) The Pain Catastrophizing Scale (PCS) Pain Anxiety Symptoms Scale Hospital Anxiety and Depression Scale	A total of 7 studies used immersive VR techniques, and 5 used non-immersive techniques (Exergames) VR intervention in patients with chronic musculoskeletal Pain are superior to other treatments to improve pain-related fear and superior to no treatment to improve anxiety. Gaming was not superior to other treatments or no treatment for improving pain catastrophizing, anxiety, and depression.	Very low or low quality of evidence of studies included Much heterogeneity is present in studies with VR gaming methodology (type, frequency, and duration of VR treatment) Publication bias was not assessed due to the limited number of included Studies.
Ahern et al. [148]	Evaluate effectiveness of VR technology in the management of individuals with acute, subacute, and chronic spinal pain.	2020 N Studies = 7 N participants = 469 Spinal Chronic pain (neck pain, thoracic pain, or low back pain [LBP])	5 databases All 7 of the studies included had a high risk of bias Data from 2 studies were included in the meta-analysis Pain intensity Disability specific function, general health status, future visits to healthcare professionals, return to work, patient satisfaction, adverse events, global perceived effect (GPE), balance, and fear of movement. were included	A total of 1 studies used immersive VR techniques, and 6 used non-immersive techniques. The effect of VR ranged from no statistical significance to clinical significance, depending on the area of the spine being treated, the follow-up period being assessed, and the type of VR used. Difference in effect between VR and other included interventions was often small and not clinically significant higher-quality research on efficacy and effectiveness of VR is needed	The review was limited by the low number of included studies Young population in studies included, results may not be applicable to younger or older populations. Much heterogeneity in VR methodology (type, frequency, and duration of VR treatment)
Mallari et al. [149]	Compare the effectiveness of VR in reducing acute and chronic pain in adults.	2019 N Studies = 20 N participants = No info Chronic pain (Musculoskeletal pain conditions (MSKP), four in neuropathic pain conditions (NP), one in a mixture of musculoskeletal and neuropathic pain conditions (MSKP-NP) and two in an unspecified pain condition (UnP).	3 databases All chronic pain studies had fair to high quality assessment ratings. Data from 3 studies were included in the meta-analysis Pain-related Outcomes Range of motion (ROM), strength, function, balance, and gait	A total of 18 studies used immersive VR techniques, and 2 used non-immersive techniques. VR is an effective tool in reducing chronic pain, specially while the patient is immersed in the VR environment Further research is needed to assess the extent to which one needs to be immersed and present in a virtual environment in order to reduce pain, and the dosage necessary to maintain pain reductions in chronic pain over time.	Significant heterogeneity in study population and pain conditions Much heterogeneity in VR methodology (type, frequency, and duration of VR treatment)
Gumaa et al. [150]	Analyze the effectiveness of VR in chronic low back pain.	2019 N Studies = 19 N participants = 765 Chronic pain (fibromyalgia, rheumatoid arthritis, Musculoskeletal pain conditions)	5 databases Quality Assessment varied between 22–37 out 48. Data from 3 studies were included in the meta-analysis Pain-related Outcomes Functional outcomes Functional capacity Mobility	Evidence of VR effectiveness in individuals with chronic neck pain and shoulder impingement syndrome is promising For fibromyalgia, total knee arthroplasty, and back pain, the evidence of VR effectiveness compared with more traditional exercise is absent or inconclusive	Studies assessed psychosocial outcomes were excluded Heterogeneity in VR and physical therapist interventions as well as outcome measures Small sample sizes on studies included High heterogeneity in VR methodology (type, frequency, and duration of VR treatment)
Virtual Reality (VR); Tampa Scale for kinesiophobia (TSK); Oswestry dysfunction index (ODI); neck disability index (NDI); Roland Morris Disability Questionnaire (RMDQ); 10-item Pain Self-Efficacy (10-PSEQ); Pain Catastrophizing Scale (PCS); low back pain (LBP); Musculoskeletal pain conditions (MSKP); neuropathic pain conditions (NP); Range of motion (ROM).