The efficacy of VR in the application of musculoskeletal diseases: An umbrella review (Preprint)

Abstract

Musculoskeletal disorders are the leading cause of disability in people, and managing them can be challenging. Virtual reality (VR) technology has been recognized as a promising simulation tool in the field of medicine and rehabilitation, and is an important part of the rehabilitation care of patients in the field of orthopedics. The efficacy of VR interventions for musculoskeletal disorders remains to be determined.

To analyze the impact of the virtual reality on musculoskeletal diseases rehabilitation and assess the consistency of evidence from existing systematic reviews and meta-analyses.

The PubMed/Medline, Embase, and Cochrane Library databases were searched for relevant articles published up to April 2024. Literature screening, quality evaluation, and data extraction were performed based on predefined inclusion and exclusion criteria. The Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 was used to evaluate the methodological quality of the included meta-analyses. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to rate the evidence level for each outcome as high, moderate, low, or very low. Furthermore, the ratings were classified into four categories based on the evidence classification criteria: I (convincing); II (highly suggestive); III (suggestive); IV (weak); and non-significant.

Results from 15 meta-analyses were synthesized. Seven meta-analyses had high, eight had moderate, and the remaining had low AMSTAR 2 ratings. Virtual reality (VR) shows promising results in musculoskeletal rehabilitation, significantly reducing knee pain (MD=-1.38, 95%CI: -2.32, -0.44, P=.004, I²=94%) and enhancing balance. In Fibromyalgia Syndrome, VR effectively decreases pain (SMD=-0.45, 95%CI: -0.70, -0.20, P<.01), fatigue (SMD=-0.58, 95%CI: -1.01, -0.14, P=.01), anxiety (SMD=0.50, 95%CI: -0.908, -0.029, P=.04), and depression (SMD=0.02, 95%CI: -0.76, -0.15, P=.003), also improving life quality. For back pain sufferers, VR lessens pain-related fears (MD=-5.46, 95%CI: -9.40, -1.52, P=.007, I²=90%) and pain itself (MD=-1.43, 95%CI: -1.86, -1.00, P<.01, I²=95%). Post-arthroplasty, it positively impacts knee functionality (MD=8.30, 95%CI: 6.92, 9.67, P<.01, I²=24%) and lowers anxiety (MD=-3.95, 95%CI: -7.76, -0.13, P=.04, I²=0%).

Virtual reality has shown potential value in rehabilitating various musculoskeletal conditions. It can reduce pain, improve psychological state, and promote patient motor function recovery.