Virtual Reality–Based Training in Chronic Low Back Pain: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Low back pain is one of the most prevalent pain conditions worldwide. Virtual reality–based training has been used for low back pain as a new treatment strategy. Present evidence indicated that the effectiveness of virtual reality–based training for people with chronic low back pain is inconclusive. Objective: This study conducted a meta-analysis to evaluate the immediate- and short-term effects of virtual reality–based training on pain, pain-related fear, and disability in people with chronic low back pain. Methods : We searched the PubMed, Embase, Web of Science, PEDro, CENTRAL, and CINAHL databases from inception until January 2024. Only randomized controlled trials assessing the effects of virtual reality–based training on individuals with chronic low back pain were selected. The outcomes were focused on pain, pain-related fear measured by the Tampa Scale of Kinesiophobia, and disability measured by the Oswestry Disability Index. The immediate term was defined as the immediate period after intervention, and the short term was defined as 3 to 6 months after intervention. The Cochrane Risk of Bias tool and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach were used to evaluate the quality of the methodology and evidence, respectively. Results : In total, 20 randomized controlled trials involving 1059 patients were eligible for analysis. Virtual reality–based training showed significant improvements in pain (mean difference [MD] –1.43; 95% CI –1.86 to –1.00; I2=95%; P