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. 2024 Feb 26;26:e45406. doi: 10.2196/45406

Table 1.

Characteristics of the included studies.

Study (year) Country Sample size Gender Mean age (years) Pain duration (months) Intervention Exposure Outcome measures Follow-up points
Afzal et al (2022) [19] Pakistan

  • Expa: 42

  • Conb: 42

  • Male: 28

  • Female: 56

  • Exp: 38.2

  • Con: 37.5

 —c

  • Exp: Virtual reality–based exercises via kinetic exergames+physical therapy

  • Con: Back strengthening exercises+physical therapy

 12 sessions; 3 times per week VASd; ODIe 4 weeks
Eccleston et al (2022) [50] Finland

  • Exp1: 14

  • Exp2: 17

  • Con: 11

  • Male: 5

  • Female: 37

  • Exp1: 55.14

  • Exp2: 52.76

  • Con: 57.09

  • >6

  • Exp1: Virtual reality–based cognitive behavioral intervention via Oculus Quest and Touch virtual reality headset and handheld controllers

  • Exp2: Viewed text-based cognitive behavioral intervention via Oculus Quest and Touch virtual reality headset

  • Con: Standard care

 30 sessions; 5 times per week; 15-60 minutes per session NRSf; ODI; PROMISg 6b; TSKh; pain medications; EuroQoL-5D-5Li; adverse events; PGICj; Game Experience Questionnaire 9 weeks, 5 months
Garcia et al (2021) [60] United States

  • Exp: 94

  • Con: 94

  • Male: 43

  • Female: 144

  • Exp: 52.1

  • Con: 51.3

  • ≥6

  • Exp: Virtual reality–based cognitive behavioral therapy via Pico G2 4K head-mounted virtual reality device (3D visual displays)

  • Con: Sham virtual reality–based cognitive behavioral therapy via Pico G2 4K head-mounted virtual reality device

 56 sessions; 7 times per week; 2-16 minutes per session DVPRSk; DVPRS-II; PSEQl-2; PGIC; PROMIS 6b and 6a; PCSm; CPAQ-8n 8 weeks, 3 months, 6 months
Groenveld et al (2023) [61] Netherlands

  • Exp: 20

  • Con: 20

  • Male: 7

  • Female: 33

  • Exp: 51

  • Con: 52

  • Exp: 5

  • Con: 4

  • Exp: Virtual reality–based exercises via an Oculus Go head-mounted display

  • Con: Daily life routines

 60 sessions; 3 times per day; 10-30 minutes per session SF-12o; VAS; PCS; HADSp; ODI; PCCLq; NEADLr; BPIs 4 weeks, 4 months
Kim et al (2014) [20] South Korea

  • Exp: 15

  • Con: 15

  • Male: 0

  • Female: 30

  • Exp: 44.33

  • Con: 50.46

 —

  • Exp: Virtual reality–based yoga program via Wii Fit activities

  • Con: Trunk stabilizing exercise+physical therapy program

 12 sessions; 3 times per week; 30 minutes per session VAS; pressure algometry; ODI; RMDQt; FABQu 4 weeks
Kim et al (2020) [62] South Korea

  • Exp: 24

  • Con: 24

  • Male: 26

  • Female: 22

  • Exp: 26.0

  • Con: 28.79

  • Exp: 58.22

  • Con: 101.55

  • Exp: Virtual reality–based simulated horseback riding

  • Con: Stabilization exercise via suspension

 16 sessions; 2 times per week; 46 minutes per session NRS; ODI; RMDQ; FABQ 4 weeks, 8 weeks, 6 months
Li et al (2021) [51] China

  • Exp1: 11

  • Exp2: 12

  • Con: 11

  • Male: 9

  • Female: 25

  • Exp1: 21.91

  • Exp2: 23.75

  • Con: 25.36

  • Exp1: 30.18

  • Exp2: 38.83

  • Con: 49.82

  • Exp1: Virtual reality–based Fruit Ninja game via Kinect Xbox 360+magnetic therapy

  • Exp2: Ultrasound-guided abdominal drawing-in maneuver training+magnetic therapy

  • Con: Conventional thermal magnetic therapy

 10 sessions; 5 times per week; 30 minutes per session VAS; ODI; sEMGv 2 weeks
Meinke et al (2022) [63] Switzerland

  • Exp: 13

  • Con: 14

  • Male: 10

  • Female: 17

  • Exp: 40.14

  • Con: 40.85

 —

  • Exp: Virtual reality–based exergame via 2 inertial measurement units

  • Con: Daily life routines

 9 sessions; 3 times per week; 20 minutes per session NRS; TSK; RMDQ; WHOQOL-Brefw 3 weeks
Monteiro-Junior et al (2015) [57] Brazil

  • Exp: 16

  • Con: 14

  • Male: 0

  • Female: 30

  • 68

 —

  • Exp: Virtual reality–based physical training via Nintendo Wii-motion and WBBx+core and strength training

  • Con: Core and strength training

 24 sessions; 3 times per week; 90 minutes per session NRS; WBB; sit-to-stand test; POMSy 8 weeks
Nambi et al (2020) [54] Saudi Arabia

  • Exp1: 15

  • Exp2: 15

  • Con: 15

  • Male: 45

  • Female: 0

  • Exp1: 21.25

  • Exp2: 20.23

  • Con: 20.78

  • Exp1: 4.1

  • Exp2: 4.1

  • Con: 4.3

  • Exp1: Virtual reality–based-balance training via Pro-Kin system PK 252 N

  • Exp2: Balance training via Swiss ball

  • Con: Conventional balance training via active isotonic and isometric exercise

 20 sessions; 5 times per week; 30 minutes per session VAS; player wellness; sprint performance; jump performance 4 weeks, 8 weeks, 6 months
Nambi et al (2021) [55] Saudi Arabia

  • Exp1: 20

  • Exp2: 20

  • Con: 20

  • Male: 60

  • Female: 0

  • Exp1: 21.45

  • Exp2: 21.39

  • Con: 20.97

  • Exp1: 4.8

  • Exp2: 5.2

  • Con: 4.9

  • Exp1: Virtual reality training via firing game

  • Exp2: Core stabilization training via therapeutic ball

  • Con: Traditional active balance exercise

 20 sessions; 5 times per week; 30 minutes per session NRS; physical fitness index; sprint performance; jump performance 4 weeks, 8 weeks, 6 months
Nambi et al (2021) [53] Saudi Arabia

  • Exp1: 18

  • Exp2: 18

  • Con: 18

  • Male: 54

  • Female: 0

  • Exp1: 22.3

  • Exp2: 21.4

  • Con: 21.9

  • Exp1: 5.4

  • Exp2: 5.3

  • Con: 5.5

  • Exp1: Virtual reality training+hot pack therapy+ultrasound

  • Exp2: Isokinetic training+hot pack therapy+ultrasound

  • Con: Conventional core training+hot pack therapy+ultrasound

 20 sessions; 5 times per week; 30 minutes per session VAS; TSK; blood serum level of stress hormones 4 weeks, 6 months
Nambi et al (2021) [52] Saudi Arabia

  • Exp1: 20

  • Exp2: 20

  • Con: 20

  • Male: 60

  • Female: 0

  • Exp1: 23.2

  • Exp2: 22.8

  • Con: 23.3

  • Exp1: 5.8

  • Exp2: 5.2

  • Con: 5.4

  • Exp1: Virtual reality training+hot pack therapy+ultrasound

  • Exp2: Isokinetic training+hot pack therapy+ultrasound

  • Con: Conventional core training+hot pack therapy+ultrasound

 20 sessions; 5 times per week; 30 minutes per session VAS; TSK; blood serum level of stress hormones 4 weeks, 6 months
Oh et al (2014) [56] South Korea

  • Exp1: 9

  • Exp2: 9

  • Exp3: 10

  • Con: 9

  • Male: 37

  • Female: 0

  • Exp1: 20.7

  • Exp2: 20.56

  • Exp3: 20.33

  • Con: 20.44

  • Exp1: 6.38

  • Exp2: 6.21

  • Exp3: 7.57

  • Con: 6.75

  • Exp1: Virtual reality training via horse simulator machine for 10 minutes

  • Exp2: Virtual reality training via horse simulator machine for 20 minutes

  • Exp3: Virtual reality training via horse simulator machine for 30 minutes

  • Con: Daily life routines

 40 sessions; 5 times per week; 15-35 minutes per session VAS; body composition; isokinetic trunk and hip extension or flexion and hip abduction or adduction 8 weeks
Park et al (2013) [21] South Korea

  • Exp1: 8

  • Exp2: 8

  • Con: 8

 —

  • Exp1: 44.12

  • Exp2: 43.37

  • Con: 44.12

  • Exp1: 17.0

  • Exp2: 16.0

  • Con: 18.75

  • Exp1: Virtual reality–based training via Nintendo Wii program+physical therapy

  • Exp2: Lumbar stabilization exercise+physical therapy

  • Con: Physical therapy (eg, hot pack, interferential current therapy, and deep heat with ultrasound)

 24 sessions; 3 times per week; 80 minutes per session VAS; isometric lifting strength for back strength; 1-legged Stand Test for balance ability; RAND-36z; SF-36aa 8 weeks
Park et al (2020) [58] South Korea

  • Exp: 40

  • Con: 40

  • Male: 0

  • Female: 80

  • Exp: 71.35

  • Con: 72.05

  • Exp: 23.61

  • Con: 22.10

  • Exp: Virtual reality–based training via equestrian simulator

  • Con: Sitting on the equestrian simulator

 36 sessions; 3 times per week; 30 minutes per session VAS; ODI; body composition; isokinetic trunk extension and flexion; spinal alignment 12 weeks
Yalfani et al (2022) [22] Japan

  • Exp: 13

  • Con: 12

  • Male: 0

  • Female: 25

  • Exp: 68

  • Con: 67.08

  • >6

  • Exp: Virtual reality–based training via Xbox Kinect headset

  • Con: Daily life routines

 24 sessions; 3 times per week; 30 minutes per session VAS; SF-36; FRIab; BBSac 2 weeks
Yilmaz Yelvar et al (2017) [64] Iran

  • Exp: 22

  • Con: 22

  • Male: 16

  • Female: 28

  • Exp: 46.27

  • Con: 52.81

  • Exp: 5.27

  • Con: 7.45

  • Exp: Virtual walking task via Vita Digital Productions+physical therapy

  • Con: Physical therapy (eg, hot pack, TENSad, deep heat with ultrasound, and therapeutic exercises)

 10 sessions; 5 times per week VAS; TSK; ODI; Nottingham Health Profile; TUGae; 6MWTaf; single-leg balance test 2 weeks
Yoo et al (2014) [59] South Korea

  • Exp: 24

  • Con: 23

  • Male: 47

  • Female: 0

  • Exp: 20.44

  • Con: 20.7

  • Exp: 9.41

  • Con: 8.35

  • Exp: Virtual reality–based training via horse simulator

  • Con: Daily life routines

 24 sessions; 3 times per week; 20-50 minutes per session VAS; body composition; isokinetic trunk strength 8 weeks
Zadro et al (2019) [65] Turkey

  • Exp: 30

  • Con: 30

  • Male: 29

  • Female: 31

  • Exp: 68.8

  • Con: 67.8

  • >3

  • Exp: Video game home-based exercise via Nintendo Wii U console

  • Con: Daily life routines

 24 sessions; 3 times per week; 60 minutes per session NRS; TSK; PSEQ; 3-item questionnaire; Rapid Assessment of Physical Activity questionnaire; PSFSag; RMDQ; 16-item Falls Efficacy Scale-International Questionnaire 8 weeks

aExp: experimental group.

bCon: control group.

cNot available.

dVAS: Visual Analog Scale.

eODI: Oswestry Disability Index.

fNRS: Numerical Rating Scale.

gPROMIS: Patient-Reported Outcomes Measurement Information System.

hTSK: Tampa Scale of Kinesiophobia.

iEuroQoL-5D-5L: European Quality of Life 5-dimension, 5-level scale.

jPGIC: Patient’s Global Impression of Change.

kDVPRS: Defense and Veterans Pain Rating Scale.

lPSEQ: Pain Self-Efficacy Questionnaire.

mPCS: Pain Catastrophizing Scale.

nCPAQ-8: Chronic Pain Acceptance Questionnaire.

oSF-12: 12-item Short-Form Health Survey.

pHADS: Hospital Anxiety and Depression Scale.

qPCCL: Pain Coping and Cognition List.

rNEADL: Nottingham Extended Activities of Daily Living.

sBPI: Brief Pain Inventory.

tRMDQ: Roland Morris Disability Questionnaire.

uFABQ: Fear Avoidance Beliefs Questionnaire.

vsEMG: surface electromyography.

wWHOQOL-Brief: World Health Organization Quality of Life Questionnaire-short version.

xWBB: Wii Balance Board.

yPOMS: Profile of Mood States.

zRAND-36: RAND-36 Health Status Inventory.

aaSF-36: 36-item Short-Form Health Survey.

abFRI: Fall Risk Index.

acBBS: Biodex Balance System.

adTENS: transcutaneous electrical nerve stimulation.

aeTUG: Timed Up and Go Test.

af6MWT: 6-Minute Walk Test.

agPSFS: Patient-Specific Functional Scale.