Table 1.
Study characteristics.
| Author, citation | Study design | Study goals | N of patients included in MA | Total number of studies included in MA | Diagnosis | VR programs | Surgery, procedure, or pain condition | Study conclusions |
|---|---|---|---|---|---|---|---|---|
| Ahern (9) | SR + MA of RCTs | Primary – pain, secondary – function, doctor visits, return to work, patient satisfaction, AEs | 311 | 7 | Chronic spinal and neck Pain | Nintendo Wii sports program, VR-based computer game, airplane flight via headset, kinematic training via head-mounted laser, horse-riding simulation | Spinal and neck Pain | VR improves spinal pain |
| Baradwan (14) | SR + MA of RCTs | Primary – pain (VAS) Secondary – anxiety, satisfaction | 466 | 8 | Pregnant | NG | Labor | VR decreases anxiety and pain and improves satisfaction |
| Bordeleau (1) | SR + MA of RCTs and observational studies | Pain (VAS, NRS) | 900 | 24 | Chronic low back pain | VR-based exercises program, VR-based horse-riding simulator, VR-based graded exposure, CBT using SnowWorld, PlayMancer progressive exergame, ValedoMotion exercise system, Nintendo Wii exercise, Kinect games, ProKin 252 balance training, dodgeball games, VR-based motor imagery | Back pain | VR improves back pain and function |
| Chan (15) | SR + MA of RCTs and crossovers | Pain | 656 | 16 | Burns, wounds | HMD via PC, joystick; HMD via laptop, inertial tracking; HMD-mounted phone, gaze tracking; HMD via PC, trackball; HMD via DVD player; HMD via PC, mouse; HMD, keyboard/mouse. Interactive games and non-interactive videos | Port access, peripheral IV cannula, Venepuncture, Episiotomy repair, LP, cystoscopy, burns and wound care | VR can improve pain |
| Czech (16) | SR + MA of RCTs and crossovers | Pain, ROM, fear, anxiety | 587 | 17 | Burns, wounds | Ditto non-interactive video, immersive VR game, non-immersive VR relaxation, smartphone VR | Burns and wound care | VR improves pain |
| Eijlers (17) | SR + MA | Pain, anxiety | 859 | 17 | Burns, elective surgery, oncology | i-glasses, nVisor SX, ProView, eMagin Z800 3DVisor, VR-1280, Virtual IO, i-O Display Systems, HMD with tracker, Oculus Rift, Samsung Gear VR, Google Pixel, Merge VR | venous access, chemotherapy, LP, port access | VR improves pain and anxiety |
| Gao (18) | SR + MA of RCTs | Pain, anxiety, fear | 2,224 | 27 | - | NG | LP, IV, plastic surgery, port access, laceration repair | VR improves pain and anxiety |
| Gates (19) | SR + MA of RCTs, cross-sectional, and other observational studies | Pain | 7,820 | 106 | Burns, wounds | NG | IV, dental anesthesia, immunization | VR improves pain |
| Grassini (20) | SR + MA of RCTs | Pain (VAS), disability | 524 | 9 | Neck and low back pain | VR Dodgeball, Kinect Xbox 360: Fruit Ninja game, Cervi game, Video of walking down the Ireland forest, VR: kinematic training, VR multimedia with audio, VR Vox Play glass with HMD and smartphone, VR shooting game. | Neck and low back pain | VR improves chronic pain |
| He (21) | SR + MA of RCTs | Pain (VAS), BP | 1,258 | 13 | Burns, wounds, hemorrhoids, vascular ulcer, war blast wound, abdominal surgery | Ditto, Sony VR Play-station, 3D glasses, headphones, eMagin Z800 3DVISOR, headset. | Dressing change, hemorrhoids, abdominal surgery | VR improves pain |
| Huang (22) | SR + MA of RCTs | Pain (VAS) | 1947 | 31 | Breast cancer, hemorrhoids, fibromyalgia, injury, burns | Immersive VR, Snow World, Google Pixel XL/Google Daydream, iWear Video Headphones, Oculus DK2 HMD, ezVision X4 VR goggles, Virtual Gorilla program, Samsung Galaxy S6 mobile-based Gear VR goggles, Nintendo Wii eMagin Z800 3D VISOR HMD, Ditto | Hemorrhoidectomy, needle and dental procedures, lower limb amputation, low back pain, TKR, fibromyalgia | VR improves pain |
| Li (6) | SR + MA of RCTs | Pain, AEs | 273 | 4 | Wounds, burns | HMD, glasses | IV, dressing change | VR improves pain |
| Luo (23) | SR + MA of RCTs | Pain, anxiety, ROM, AEs | 362 | 13 | Burns | Immersive games | Dressing change, physical therapy | VR improves pain |
| Rajendram (24) | SR + MA | Pain (VAS) | 300 (214/86) (mirror/VR) | 15 (8/7) (mirror/VR) | phantom limb pain | NG | phantom limb pain | Mirror therapy and VR decrease pain |
| Simonetti (25) | SR + MA of RCTs | Anxiety, pain | 602 | 7 | - | HTC Vive visor, Oculus Rift Headset, Oculus Rift Headset, Samsung Gear VR headset | Before surgery | VR improves anxiety |
| Suleiman-Martos (26) | SR + MA of RCTs | Pain, anxiety | 2,525 | 26 | Hernia, rheumatology, ophthalmology, orthopedic | VR eyeglasses | Dental, ENT, circumcision, abdominal, urology, elective minor or major surgeries | VR improves anxiety |
| Tas (27) | SR + MA of RCTs, crossovers, and non-RCTs | Pain, anxiety | 1,695 | 13 | Burns, cancer | i-glasses; nVisor; ProView eMagin 3DVisor; Kaiser Optical; 5DT HMD; Oculus Rift DK2; Samsung Gear VR; Google Pixel; Merge VR | IV, port access, dressing change, physical therapy, dental, nasal endoscopy | VR improves pain and anxiety |
| Tran (28) | SR + MA of RCTs | Pain | 438 | 10 | Cancer | NG | IV, LP | VR improves pain |
| Zeng (29) | SR + MA of RCT, case–control, and other observational studies | Anxiety, pain | 225 | 6 | Cancer | Nintendo Wii Fit Plus, goggles | Cancer pain | VR improves pain and anxiety |
| Zhang (30) | SR + MA of RCTs and observational studies | Pain, anxiety, ROM | 529 | 8 | Breast cancer | Forearm support, HMD and headphones, movement tracking system, VR exploration on Second Life platform, Xbox360 Kinect video game, VERT system | Surgery, chemotherapy | VR improves pain |
AE, adverse event; BP, blood pressure; HMD, head-mounted display; IV, intravenous; LP, lumbar puncture; MA, meta-analysis; NRS, numerical rating scale; RCT, randomized controlled trial; ROM, range of motion; SR, systematic review; TKR, total knee replacement; VAS, visual analogue scale; VR, virtual reality.