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

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

Psychological Medicine ◽

10.1017/s0033291719001855 ◽

2019 ◽

Vol 50 (11) ◽

pp. 1795-1807 ◽

Cited By ~ 1

Author(s):

Raluca Georgescu ◽

Liviu A. Fodor ◽

Anca Dobrean ◽

Ioana A. Cristea

Keyword(s):

Virtual Reality ◽

Usual Care ◽

Pain Intensity ◽

Real Time ◽

Meta Analysis ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Psychological Interventions ◽

Medical Procedures

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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The Effects of Virtual Reality on Procedural Pain and Anxiety in Pediatrics: A Systematic Review and Meta-Analysis

Frontiers in Virtual Reality ◽

10.3389/frvir.2021.699383 ◽

2021 ◽

Vol 2 ◽

Author(s):

Rikke Nordgård ◽

Torstein Låg

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Treatment Effects ◽

Meta Analysis ◽

Effect Sizes ◽

Procedural Pain ◽

Medical Procedures ◽

Pain Outcomes ◽

Technical Specifications ◽

Preparation Techniques

Distraction and procedural preparation techniques are frequently used to manage pain and anxiety in children undergoing medical procedures. An increasing number of studies have indicated that Virtual Reality (VR) can be used to deliver these interventions, but treatment effects vary greatly. The present study is a systematic review and meta-analysis of studies that have used VR to reduce procedural pain and anxiety in children. It is the first meta-analytic assessment of the potential influence of technical specifications (immersion) and degree of user-system interactivity on treatment effects. 65 studies were identified, of which 42 reported pain outcomes and 35 reported anxiety outcomes. Results indicate large effect sizes in favor of VR for both outcomes. Larger effects were observed in dental studies and studies that used non-interactive VR. No relationship was found between the degree of immersion or participant age and treatment effects. Most studies were found to have a high risk of bias and there are strong indications of publication bias. The results and their implications are discussed in context of these limitations, and modified effect sizes are suggested. Finally, recommendations for future investigations are provided.

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Adjunctive virtual reality for procedural pain management of burn patients during dressing change or physical therapy: A systematic review and meta-analysis of randomized controlled trials

Wound Repair and Regeneration ◽

10.1111/wrr.1 ◽

2018 ◽

Vol 27 (1) ◽

pp. 90-101 ◽

Cited By ~ 7

Author(s):

Huaxiu Luo ◽

Chang Cao ◽

Jian Zhong ◽

Junjie Chen ◽

Ying Cen

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Pain Management ◽

Physical Therapy ◽

Meta Analysis ◽

Procedural Pain ◽

Controlled Trials ◽

Burn Patients ◽

Randomized Controlled ◽

Dressing Change

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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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Clinical efficacy of virtual reality for acute procedural pain management: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0200987 ◽

2018 ◽

Vol 13 (7) ◽

pp. e0200987 ◽

Cited By ~ 30

Author(s):

Evelyn Chan ◽

Samantha Foster ◽

Ryan Sambell ◽

Paul Leong

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Pain Management ◽

Clinical Efficacy ◽

Meta Analysis ◽

Procedural Pain

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Psychological interventions for people with psychotic experiences: A systematic review and meta-analysis of controlled and uncontrolled effectiveness and economic studies

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867420913118 ◽

2020 ◽

Vol 54 (7) ◽

pp. 673-695

Author(s):

Emma Soneson ◽

Debra Russo ◽

Jan Stochl ◽

Margaret Heslin ◽

Julieta Galante ◽

...

Keyword(s):

Systematic Review ◽

Cognitive Behavioural Therapy ◽

Psychotic Disorders ◽

Meta Analysis ◽

Behavioural Therapy ◽

Economic Evaluations ◽

Psychological Interventions ◽

Psychotic Experiences ◽

Treatment As Usual ◽

Cognitive Behavioural

Objective: Many people with psychotic experiences do not develop psychotic disorders, yet those who seek help demonstrate high clinical complexity and poor outcomes. In this systematic review and meta-analysis, we evaluated the effectiveness and cost-effectiveness of psychological interventions for people with psychotic experiences. Method: We searched 13 databases for studies of psychological interventions for adults with psychotic experiences, but not psychotic disorders. Our outcomes were the proportion of participants remitting from psychotic experiences (primary); changes in positive and negative psychotic symptoms, depression, anxiety, functioning, distress, and quality of life; and economic outcomes (secondary). We analysed results using multilevel random-effects meta-analysis and narrative synthesis. Results: A total of 27 reports met inclusion criteria. In general, there was no strong evidence for the superiority of any one intervention. Five studies reported on our primary outcome, though only two reports provided randomised controlled trial evidence that psychological intervention (specifically, cognitive behavioural therapy) promoted remission from psychotic experiences. For secondary outcomes, we could only meta-analyse trials of cognitive behavioural therapy. We found that cognitive behavioural therapy was more effective than treatment as usual for reducing distress (pooled standardised mean difference: −0.24; 95% confidence interval = [−0.37, −0.10]), but no more effective than the control treatment for improving any other outcome. Individual reports indicated that cognitive behavioural therapy, mindfulness-based cognitive therapy, sleep cognitive behavioural therapy, systemic therapy, cognitive remediation therapy, and supportive treatments improved at least one clinical or functional outcome. Four reports included economic evaluations, which suggested cognitive behavioural therapy may be cost-effective compared with treatment as usual. Conclusion: Our meta-analytic findings were primarily null, with the exception that cognitive behavioural therapy may reduce the distress associated with psychotic experiences. Our analyses were limited by scarcity of studies, small samples and variable study quality. Several intervention frameworks showed preliminary evidence of positive outcomes; however, the paucity of consistent evidence for clinical and functional improvement highlights a need for further research into psychological treatments for psychotic experiences. PROSPERO protocol registration number: CRD42016033869

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