Virtual Reality for Patients With Chronic Musculoskeletal Pain and Disability: An Umbrella Review of Systematic Reviews

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Abstract
Background and Aim: Virtual reality (VR) has been proposed for the management of chronic musculoskeletal pain (MSKP). This umbrella review aimed to systematically search, critically appraise, summarize, and synthesize the current systematic reviews (SRs) on delivering VR interventions to rehabilitate patients with chronic primary MSKP and disability.Method: Data were obtained from five databases. Only SRs were included. This umbrella review utilized the AMSTAR‐2 to assess the methodological quality of the included SRs and the GRADE to assess the certainty in the body of evidence.Results: Seven SRs were included. The overall confidence in the SRs ranged from low to critically low, whereas the certainty in the body of evidence ranged from moderate to very low. Whilst the majority of the SRs suggested that VR, standalone or adjunctive to other interventions, had a significant short‐term positive effect on patient‐reported outcomes for pain in patients with chronic primary MSKP, results on patient‐reported outcomes for disability and kinesiophobia were inconsistent. Adverse events included motion sickness, nausea, and vertigo.Conclusions: Although the current evidence indicates that VR may hold promise in patients with chronic primary MSKP, the included studies suffered from critical weaknesses that precluded this review from drawing a conclusive conclusion. It remains uncertain which VR interventions, including dosage, mode of delivery, supervision, frequency, duration, level of immersion, VR platform, displayed content, and mechanism of action, are more effective than the others. Future SRs should sub‐group VR based on the treatment types. Further rigorously designed studies focusing on immersive VR, standalone or adjunctive to other interventions, with long‐term follow‐up, are warranted. It is worth repeating the call for an agreed consensus on a clear definition and classification of VR within the healthcare context.

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