The Efficacy of Virtual Reality on the Rehabilitation of Musculoskeletal Diseases: Umbrella Review

Abstract

BackgroundMusculoskeletal disorders cause pain, disability, and financial burdens, with rising prevalence. Virtual reality (VR) offers immersive, digital rehabilitation potential, improving motor functions and pain management. ObjectiveTo evaluate the impact of VR on the rehabilitation of musculoskeletal disorders and to assess the consistency of evidence provided by existing systematic reviews and meta-analyses, this study focuses on musculoskeletal disorders, which encompass conditions affecting the locomotor system, such as arthritis, joint deformities, and injuries. VR therapy leverages immersive digital environments to enhance rehabilitation through digital exercises and simulations. MethodsThe PubMed or MEDLINE, Embase, and Cochrane Library databases were systematically searched for relevant papers published up to April 2024. Literature screening, quality assessment, and data extraction were conducted according to predefined inclusion and exclusion criteria. The methodological quality of the included meta-analyses was evaluated using the Measurement Tool to Assess Systematic Reviews 2. The Grading of Recommendations Assessment, Development, and Evaluation system was used to classify the evidence level for each outcome as high, moderate, low, or very low. Additionally, the evidence was categorized into 5 levels based on classification criteria: I (convincing), II (highly suggestive), III (suggestive), IV (weak), and nonsignificant. ResultsThis umbrella review synthesized data from 14 meta-analyses published between 2019 and 2024, involving a total of 13,184 patients. In total, 7 meta-analyses received high Measurement Tool to Assess Systematic Reviews 2 ratings, 7 were rated moderate, and the remainder were rated low. VR demonstrated promising results in musculoskeletal rehabilitation, significantly reducing knee pain (mean difference [MD] –1.38, 95% CI –2.32 to –0.44; P=.004; I2=94%) and improving balance. For patients with fibromyalgia syndrome, VR effectively reduced pain (standardized mean difference [SMD] –0.45, 95% CI –0.70 to –0.20; P<.001), fatigue (SMD –0.58, 95% CI –1.01 to –0.14; P=.01), anxiety (SMD –0.50, 95% CI –0.908 to –0.029; P=.04), and depression (SMD –0.62, 95% CI –0.76 to –0.15; P=.003) while also enhancing quality of life. In individuals with back pain, VR alleviated pain-related fears (MD –5.46, 95% CI –9.40 to –1.52; P=.007; I2=90%) and reduced pain intensity (MD –1.43, 95% CI –1.86 to –1.00; P<.001; I2=95%). After arthroplasty, VR improved knee functionality (MD 8.30, 95% CI 6.92-9.67; P<.001; I2=24%) and decreased anxiety (MD –3.95, 95% CI –7.76 to –0.13; P=.04; I2=0%). ConclusionsVR demonstrates significant potential in the rehabilitation of various musculoskeletal conditions. It effectively alleviates pain, enhances psychological well-being, and facilitates the recovery of motor function in patients. Trial RegistrationPROSPERO CRD42024538469; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024538469