Effectiveness of Virtual Reality for Pain Management in Musculoskeletal Disorders Across Anatomical Regions: A Systematic Review and Meta-Analysis

Abstract

Introduction: The use of virtual reality (VR) in physiotherapy is expanding across various fields; however, while extensively researched in neurology, its application in musculoskeletal (MSK) disorders remains underexplored. This review aims to evaluate the effectiveness of VR in pain management across different anatomical regions. Materials and Methods: The research was conducted using the MEDLINE (via PubMed), Cochrane Library, Scopus, Web of Science, and Embase databases, including randomized controlled trials that evaluated the effectiveness of VR interventions, encompassing immersive VR, specialised non-immersive VR, and gaming platforms. The primary outcomes focused on pain reduction. Data were extracted from the included studies, and methodological quality was assessed using the Revised Cochrane risk-of-bias tool for Randomized Trials (RoB 2). A meta-analysis was conducted using both fixed- and random-effects models to synthesise the findings. Results: From 1265 records, 27 articles met the eligibility criteria, comprising a total of 1191 participants. Of these, 20 studies contributed data to the meta-analyses. Significant findings were observed for pain relief in the knee region (SMD = − 0.33; 95% CI: − 0.55 to − 0.10; I2 = 13%, p < 0.004), with particularly notable effects within the subgroup utilising specialised non-immersive VR (SMD = − 0.32; 95% CI: − 0.62 to − 0.03; I2 = 10%, p < 0.003). For other anatomical regions, the heterogeneity was substantial, limiting the strength of recommendations for these areas. Conclusions: VR shows potential for managing pain in MSK disorders, particularly knee conditions, with significant effectiveness using specialised non-immersive VR. However, high heterogeneity across other regions limits broader recommendations.