Psychological interventions using virtual reality for pain associated with medical procedures: a systematic review and meta-analysis

AbstractBackgroundVirtual reality (VR) may enhance the effectiveness of psychological interventions for acute pain. We conducted a meta-analysis to assess the efficacy and safety of VR-based interventions for pain associated with medical procedures.MethodsWe searched PubMed, EMBASE, the Cochrane Library, and PsycINFO until June 17th 2018. We identified randomized controlled trials (RCTs), comparing VR-based psychological interventions to usual care, for pain intensity (primary outcome) or affective and cognitive components of pain (secondary outcomes), assessed real-time or retrospectively. Two independent reviewers performed study selection and data extraction. Risk of bias was independently evaluated by three raters using the revised Cochrane Collaboration tool. A random-effects model using the Paule and Mandel estimator was used for pooling effect sizes.Results27 RCTs (1452 patients) provided enough data for meta-analysis. Compared to usual care, VR-based interventions reduced pain intensity both real-time (9 RCTs, Hedges' g = 0.95, 95% CI 0.32–1.57) and retrospectively (22 RCTs, g = 0.87, 95% CI 0.54–1.21). Results were similar for cognitive (8 RCTs, g = 0.82, 95% CI 0.39–1.26) and affective pain components (14 RCTs, g = 0.55, 95% CI 0.34–0.77). There was marked heterogeneity, which remained similarly high in sensitivity analyses. Across domains, few trials were rated as low risk of bias and there was evidence of publication bias. Adverse events were rare.ConclusionsThough VR-based interventions reduced pain for patients undergoing medical procedures, inferring clinical effectiveness is precluded by the predominance of small trials, with substantial risk of bias, and by incomplete reporting.

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Psychological interventions using virtual reality for pain associated with medical procedures: A systematic review and meta-analysis

10.31234/osf.io/fxa8h ◽

2019 ◽

Author(s):

Ioana Cristea ◽

Raluca Georgescu ◽

Liviu Andrei Fodor

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Pain Intensity ◽

Real Time ◽

Randomized Trials ◽

Meta Analysis ◽

Procedural Pain ◽

Psychological Interventions ◽

Medical Procedures ◽

Treatment As Usual

In a meta-analysis of twenty-seven randomized trials, VR-based distraction interventions for procedural pain demonstrated reductions in pain intensity, assessed either real-time or retrospectively, compared to treatment as usual. Though effects appeared generally large, they were associated by high heterogeneity, with all predictive intervals including zero.

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Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000662 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000662 ◽

Cited By ~ 1

Author(s):

Nick Brown ◽

Antti Juhani Kukka ◽

Andreas Mårtensson

Keyword(s):

Systematic Review ◽

Treatment Failure ◽

Low Income ◽

Meta Analysis ◽

Severe Pneumonia ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries

BackgroundDespite advances in vaccination and case management, pneumonia remains the single largest contributor to early child mortality worldwide. Zinc has immune-enhancing properties, but its role in adjunctive treatment of pneumonia in low-income and middle-income countries (LMICs) is controversial and research still active.MethodsSystematic review and meta-analysis of randomised controlled trials of zinc and placebo in pneumonia in children aged 2 to 60 months in LMICs. Databases included MEDLINE, the Cochrane Library, EMBASE, LILACS, SciELO, the WHO portal, Scopus, Google Scholar and ClinicalTrials.gov. Inclusion criteria included accepted signs of pneumonia and clear measure of outcome. Risk of bias was independently assessed by two authors. ORs with 95% CI were used for calculating the pooled estimate of dichotomous outcomes including treatment failure and mortality. Time to recovery was expressed as HRs. Sensitivity analyses considering risk of bias and subgroup analyses for pneumonia severity were performed.ResultsWe identified 11 trials published between 2004 and 2019 fulfilling the a priori defined criteria, 7 from South Asia and 3 from Africa and 1 from South America. Proportional treatment failure was comparable in both zinc and placebo groups when analysed for all patients (OR 0.95 (95% CI 0.80 to 1.14)) and only for those with severe pneumonia (OR 0.93 (95% CI 0.75 to 1.14)). No difference was seen in mortality between zinc and placebo groups (OR 0.64 (95% CI 0.31 to 1.31)). Time to recovery from severe pneumonia did not differ between the treatment and control groups for patients with severe pneumonia (HR 1.01 (95% CI 0.89 to 1.14)). Removal of four studies with high risk of bias made no difference to the conclusions.ConclusionThere is no evidence that adjunctive zinc treatment improves recovery from pneumonia in children in LMICs.Trial registration numberCRD42019141602.

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Changes in apical base sagittal relationship in Class II malocclusion treatment with and without premolar extractions: A systematic review and meta-analysis

The Angle Orthodontist ◽

10.2319/030716-198.1 ◽

2016 ◽

Vol 87 (2) ◽

pp. 338-355 ◽

Cited By ~ 1

Author(s):

Guilherme Janson ◽

Aron Aliaga-Del Castillo ◽

Ana Niederberger

Keyword(s):

Meta Analysis ◽

Cochrane Collaboration ◽

Class Ii ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Control Group ◽

Qualitative Synthesis ◽

Class Ii Treatment ◽

Apical Base

ABSTRACT Objective: To evaluate the changes in apical base sagittal relationship in Class II treatment with and without premolar extractions. Materials and Methods: Controlled studies evaluating ANB angle changes after Class II Division 1 malocclusion treatment with or without premolar extractions were considered. Electronic databases (PubMed, Embase, Web of Science, Scopus, The Cochrane Library, Lilacs, and Google Scholar) without limitations regarding publication year or language were searched. Risk of bias was assessed with Risk Of Bias in Non-randomized Studies—of Interventions tool of the Cochrane Collaboration. Mean difference (MD) and 95% confidence interval (CI) were calculated from the random-effects meta-analysis. Subgroup and sensitivity analyses were also performed. Results: Twenty-five studies satisfied the inclusion criteria and were included in the qualitative synthesis. Eleven nonextraction and only one extraction Class II treatment studies presented untreated Class II control group. Therefore, meta-analysis was performed only for the nonextraction protocol. In treated Class II nonextraction patients, the average of the various effects was a reduction in the ANB angle of 1.56° (95% CI: 1.03, 2.09, P < .001) compared with untreated Class II subjects. Class II malocclusions treated with two maxillary-premolar extractions and four-premolar extractions produced estimated mean reductions in ANB of −1.88° and −2.55°, respectively. However, there is a lack of low-risk-of-bias studies. Conclusions: According to the existing low quality evidence, the apical base sagittal relationship in nonextraction, two-maxillary and four-premolar extractions Class II treatments decreases −1.56°, 1.88° and 2.55°, respectively. Further studies are necessary to obtain more robust information.

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Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182211806 ◽

2021 ◽

Vol 18 (22) ◽

pp. 11806

Author(s):

Beatriz Brea-Gómez ◽

Irene Torres-Sánchez ◽

Araceli Ortiz-Rubio ◽

Andrés Calvache-Mateo ◽

Irene Cabrera-Martos ◽

...

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Chronic Low Back Pain ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Low Back

Virtual reality (VR) can present advantages in the treatment of chronic low back pain. The objective of this systematic review and meta-analysis was to analyze the effectiveness of VR in chronic low back pain. This review was designed according to PRISMA and registered in PROSPERO (CRD42020222129). Four databases (PubMed, Cinahl, Scopus, Web of Science) were searched up to August 2021. Inclusion criteria were defined following PICOS recommendations. Methodological quality was assessed with the Downs and Black scale and the risk of bias with the Cochrane Risk of Bias Assessment Tool. Fourteen studies were included in the systematic review and eleven in the meta-analysis. Significant differences were found in favor of VR compared to no VR in pain intensity postintervention (11 trials; n = 569; SMD = −1.92; 95% CI = −2.73, −1.11; p < 0.00001) and followup (4 trials; n = 240; SDM = −6.34; 95% CI = −9.12, −3.56; p < 0.00001); and kinesiophobia postintervention (3 trials; n = 192; MD = −8.96; 95% CI = −17.52, −0.40; p = 0.04) and followup (2 trials; n = 149; MD = −12.04; 95% CI = −20.58, −3.49; p = 0.006). No significant differences were found in disability. In conclusion, VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain after the intervention and at followup. However, high heterogeneity exists and can influence the consistency of the results.

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Do virtual reality games improve mobility skills and balance measurements in community-dwelling older adults? Systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215517694677 ◽

2017 ◽

Vol 31 (10) ◽

pp. 1292-1304 ◽

Cited By ~ 35

Author(s):

Silvia GR Neri ◽

Jefferson R Cardoso ◽

Lorena Cruz ◽

Ricardo M Lima ◽

Ricardo J de Oliveira ◽

...

Keyword(s):

Virtual Reality ◽

Fear Of Falling ◽

Random Sequence ◽

Meta Analysis ◽

Risk Of Bias ◽

Community Dwelling ◽

Cochrane Library ◽

Clinical Effects ◽

Large Variability ◽

Positive Effects

Objective: To summarize evidence on the effectiveness of virtual reality games and conventional therapy or no-intervention for fall prevention in the elderly. Data sources: An electronic data search (last searched December 2016) was performed on 10 databases (Web of Science, EMBASE, PUBMED, CINAHL, LILACS, SPORTDiscus, Cochrane Library, Scopus, SciELO, PEDro) and retained only randomized controlled trials. Review method: Sample characteristics and intervention parameters were compared, focusing on clinical homogeneity of demographic characteristics, type/duration of interventions, outcomes (balance, reaction time, mobility, lower limb strength and fear of falling) and low risk of bias. Based on homogeneity, a meta-analysis was considered. Two independent reviewers assessed the risk of bias. Results: A total of 28 studies met the inclusion criteria and were appraised ( n: 1121 elderly participants). We found that virtual reality games presented positive effects on balance and fear of falling compared with no-intervention. Virtual reality games were also superior to conventional interventions for balance improvements and fear of falling. The six studies included in the meta-analysis demonstrated that virtual reality games significantly improved mobility and balance after 3–6 and 8–12 weeks of intervention when compared with no-intervention. The risk of bias revealed that less than one-third of the studies correctly described the random sequence generation and allocation concealment procedures. Conclusion: Our review suggests positive clinical effects of virtual reality games for balance and mobility improvements compared with no-treatment and conventional interventions. However, owing to the high risk of bias and large variability of intervention protocols, the evidence remains inconclusive and further research is warranted.

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Prognostic and therapeutic role of vitamin D in COVID-19: systematic review and meta-analysis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab892 ◽

2021 ◽

Author(s):

Harsha Anuruddhika Dissanayake ◽

Nipun Lakshitha de Silva ◽

Manilka Sumanatilleke ◽

Sawanawadu Dilantha Neomal de Silva ◽

Kavinga Kalhari Kobawaka Gamage ◽

...

Keyword(s):

Vitamin D ◽

High Risk ◽

Vitamin D Deficiency ◽

Observational Studies ◽

Meta Analysis ◽

Severe Disease ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Cochrane Library

Abstract Purpose Vitamin D deficiency/insufficiency may increase the susceptibility to COVID-19. We aimed to determine the association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, its severity, mortality and role of vitamin D in its treatment. Methods We searched CINHAL, Cochrane library, EMBASE, PubMED, Scopus, and Web of Science up to 30.05.2021 for observational studies on association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, severe disease and death among adults, and, randomized controlled trials (RCTs) comparing vitamin D treatment against standard care or placebo, in improving severity or mortality among adults with COVID-19. Risk of bias was assessed using Newcastle-Ottawa scale for observational studies and AUB-KQ1 Cochrane tool for RCTs. Study-level data were analyzed using RevMan 5.3 and R (v4∙1∙0). Heterogeneity was determined by I 2 and sources were explored through pre-specified sensitivity analyses, subgroup analyses and meta-regressions. Results Of 1877 search results, 76 studies satisfying eligibility criteria were included. Seventy-two observational studies were included in the meta-analysis (n=1976099). Vitamin D deficiency/insufficiency increased the odds of developing COVID-19 (OR 1∙46, 95% CI 1∙28–1∙65, p<0∙0001, I 2=92%), severe disease (OR 1∙90, 95% CI 1∙52–2∙38, p<0.0001, I 2=81%) and death (OR 2∙07, 95% CI 1∙28–3∙35, p=0.003, I 2=73%). 25-hydroxy vitamin D (25(OH)D) concentration were lower in individuals with COVID-19 compared to controls (mean difference [MD] -3∙85 ng/mL, 95% CI -5∙44,-2∙26, p=<0.0001), in patients with severe COVID-19 compared to controls with non-severe COVID19 (MD -4∙84 ng/mL, 95% CI -7∙32,-2∙35, p=0∙0001) and in non-survivors compared to survivors (MD -4∙80 ng/mL, 95%-CI -7∙89,-1∙71, p=0∙002). The association between vitamin D deficiency/insufficiency and death was insignificant when studies with high risk of bias or studies reporting unadjusted effect estimates were excluded. Risk of bias and heterogeneity were high across all analyses. Discrepancies in timing of vitamin D testing, definitions of severe COVID-19 and vitamin D deficiency/insufficiency partly explained the heterogeneity. Four RCTs were widely heterogeneous precluding meta-analysis. Conclusion Multiple observational studies involving nearly two million adults suggest vitamin D deficiency/insufficiency increases susceptibility to COVID-19 and severe COVID-19, although with a high risk of bias and heterogeneity. Association with mortality was less robust. Heterogeneity in RCTs precluded their meta-analysis.

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Effectiveness of telephone-based interventions for managing osteoarthritis and spinal pain: a systematic review and meta-analysis

PeerJ ◽

10.7717/peerj.5846 ◽

2018 ◽

Vol 6 ◽

pp. e5846 ◽

Cited By ~ 9

Author(s):

Kate M. O’Brien ◽

Rebecca K. Hodder ◽

John Wiggers ◽

Amanda Williams ◽

Elizabeth Campbell ◽

...

Keyword(s):

Usual Care ◽

Pain Intensity ◽

Meta Analysis ◽

Spinal Pain ◽

Risk Of Bias ◽

Educational Materials ◽

Face To Face ◽

Randomised Controlled ◽

Meta Analyses ◽

Reduce Pain Intensity

Background Osteoarthritis and spinal pain are common and burdensome conditions; however, the majority of patients with these conditions do not receive care that is consistent with clinical practice guidelines. Telehealth models of care have the potential to improve care for osteoarthritis and spinal pain patients. The aim of this review was to assess the effectiveness of verbal real-time telehealth interventions, including telephone-based and videoconferencing interventions to reduce pain intensity and disability in patients with osteoarthritis of the knee or hip and spinal pain (back or neck pain). Methods We searched seven electronic databases from inception to May 2018. Randomised controlled trials (RCTs), cluster-RCTs, and non-randomised controlled trials were included. Two review authors independently extracted data for each included study. Primary outcomes were pain intensity and disability. We conducted primary meta-analyses combining all conditions with similar interventions and comparators. Standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated using random effects models. We used the Cochrane Risk of Bias tool to assess risk of bias, and GRADE to evaluate the quality of evidence. Results We included 23 studies with 56 trial arms and 4,994 participants. All studies utilised telephone-based interventions. Only two studies used a telephone only approach and the remainder included educational materials and/or face-to-face components. We found no studies utilising videoconferencing. Meta-analysis showed telephone-based interventions (with educational materials) for osteoarthritis and spinal pain improved pain intensity (n = 5 trials, n = 1,357 participants, SMD −0.27, 95% CI [−0.53, −0.01], Tau2 = 0.06, I2 = 74%; moderate-quality evidence) and disability (n = 7 trials, n = 1,537 participants, SMD −0.21, 95% CI [−0.40, −0.02], Tau2 = 0.03, I2 = 56%; moderate-quality evidence) compared to usual care. Meta-analyses found telephone with face-to-face interventions does not improve pain and disability compared to usual care or face-to-face care alone. Discussion We are moderately confident that telephone-based interventions reduce pain intensity and disability in patients with osteoarthritis and spinal pain compared to usual care, but telephone plus face-to-face interventions are no more effective than usual care or face-to-face interventions alone.

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Opioid versus opioid-free analgesia after surgical discharge: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-035443 ◽

2020 ◽

Vol 10 (1) ◽

pp. e035443

Author(s):

Charbel El-Kefraoui ◽

Ghadeer Olleik ◽

Marc-Aurele Chay ◽

Araz Kouyoumdjian ◽

Philip Nguyen-Powanda ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Pain Intensity ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Major Surgery ◽

Manuscript Submission ◽

Health Crisis ◽

Study Results

IntroductionExcessive prescribing after surgery has contributed to a public health crisis of opioid addiction and overdose in North America. However, the value of prescribing opioids to manage postoperative pain after surgical discharge remains unclear. We propose a systematic review and meta-analysis to assess the extent to which opioid analgesia impact postoperative pain intensity and adverse events in comparison to opioid-free analgesia in patients discharged after surgery.Methods and analysisMajor electronic databases (MEDLINE, Embase, Cochrane Library, Scopus, AMED, BIOSIS, CINAHL and PsycINFO) will be searched for multi-dose randomised-trials examining the comparative effectiveness of opioid versus opioid-free analgesia after surgical discharge. Studies published from January 1990 to July 2019 will be targeted, with no language restrictions. The search will be re-run before manuscript submission to include most recent literature. We will consider studies involving patients undergoing minor and major surgery. Teams of reviewers will, independently and in duplicate, assess eligibility, extract data and evaluate risk of bias. Our main outcomes of interest are pain intensity and postoperative vomiting. Study results will be pooled using random effects models. When trials report outcomes for a common domain (eg, pain intensity) using different scales, we will convert effect sizes to a common standard metric (eg, Visual Analogue Scale). Minimally important clinical differences reported in previous literature will be considered when interpreting results. Subgroup analyses defined a priori will be conducted to explore heterogeneity. Risk of bias will be assessed according to the Cochrane Collaboration's Risk of Bias Tool 2.0. The quality of evidence for all outcomes will be evaluated using the GRADE rating system.Ethics and disseminationEthical approval is not required since this is a systematic review of published studies. Our results will be published in a peer-reviewed journal and presented at relevant conferences. Further knowledge dissemination will be sought via public and patient organisations focussed on pain and opioid-related harms.

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Effects of Immersive and Non-Immersive Virtual Reality on the Static and Dynamic Balance of Stroke Patients: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10194473 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4473

Author(s):

Aitor Garay-Sánchez ◽

Carmen Suarez-Serrano ◽

Mercedes Ferrando-Margelí ◽

Jose Jesus Jimenez-Rejano ◽

Yolanda Marcén-Román

Keyword(s):

Virtual Reality ◽

New Technologies ◽

Therapeutic Option ◽

Dynamic Balance ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Static Balance ◽

Immersive Virtual Reality ◽

Stroke Patients

(1) Background: The development of new technologies means that the use of virtual reality is increasingly being implemented in rehabilitative approaches for adult stroke patients. Objective: To analyze the existing scientific evidence regarding the application of immersive and non-immersive virtual reality in patients following cerebrovascular incidents and their efficacy in achieving dynamic and static balance. (2) Data sources: An electronic search of the databases Medline, Cochrane Library, PEDro, Scopus, and Scielo from January 2010 to December 2020 was carried out using the terms physiotherapy, physical therapy, virtual reality, immersive virtual reality, non-immersive virtual reality, stroke, balance, static balance, and dynamic balance. Selection of studies: Randomized controlled trials in patients older than 18 developed with an adult population (>18 years old) with balance disorders as a consequence of suffering a stroke in the previous six months before therapeutic intervention, including exercises harnessing virtual reality in their interventions and evaluations of balance and published in English or Spanish, were included. A total of two hundred twenty-seven articles were found, ten of which were included for review and of these, nine were included in the subsequent meta-analysis. (3) Data extraction: Two authors selected the studies and extracted their characteristics (participants, interventions, and validation instruments) and results. The methodological quality of the studies was evaluated using the PEDro scale, and the risk of bias was determined using the Cochrane risk-of-bias tool. Data synthesis: Of the selected studies, three did not show significant improvements and seven showed significant improvements in the intervention groups in relation to the variables. (4) Conclusions: Non-immersive virtual reality combined with conventional rehabilitation could be considered as a therapeutic option.

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Efficacy of Mobile Health in Patients with Low Back Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials (Preprint)

10.2196/preprints.26095 ◽

2020 ◽

Author(s):

Mingrong Chen ◽

Tingting Wu ◽

Meina Lv ◽

Zongwei Fang ◽

Zhiwei Zeng ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

Pain Intensity ◽

Mobile Health ◽

Rating Scale ◽

Meta Analysis ◽

Numeric Rating Scale ◽

Cochrane Library ◽

Low Back

BACKGROUND Low back pain is one of the most common health problems and a main cause of disability, which imposes a great burden on patients. Mobile health (mHealth) affects many aspects of people's lives, and it has progressed rapidly, showing promise as an effective intervention for patients with low back pain. However, the efficacy of mHealth interventions for patients with low back pain remains unclear; thus, further exploration is necessary. OBJECTIVE The purpose of this study was to evaluate the efficacy of mHealth interventions in patients with low back pain, compared to usual care. METHODS We searched for studies published in English before October 2020 in PubMed, EMBASE, Web of Science, and the Cochrane Library. Two researchers independently scanned the literature, extracted data, and assessed the methodological quality of the included studies. We used RevMan 5.4 software to perform the meta-analysis. RESULTS A total of 10 studies with 1003 participant, met the inclusion criteria. The simultaneous use of mHealth and usual care showed a greater reduction in pain intensity than usual care alone, as measured by the Numeric Rating Scale (mean difference [MD] -0.85, 95% CI -1.29 to -0.40; P<.001), and greater efficacy in reducing disability, as measured by the Rolland-Morris Disability Questionnaire (MD -1.58, 95% CI -2.33 to -0.83; P<.001). CONCLUSIONS The simultaneous interventions of mHealth and usual care has greater efficacy than usual care alone in reducing pain intensity and disability in patients with low back pain.

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