Open Access

Ana Izabela Sobral de Oliveira Souza, Johannes Outzen, Amanda Rodrigues, Rieke Büscher, Sine Schriewer, Liz Dennett, Harry von Piekartz, Susan Armijo-Olivo

• Background: Virtual reality (VR) has been defined as a computer-generated display that allows the user to have a sense of being present and interacting in an environment other than the one they are actually in.[1] VR has been used to relieve and improve function in several musculoskeletal disorders (MSKD) [2-4], including neck pain (NP). However, there is still a lack of evidence on the effectiveness of VR for the management of NP. Several systematic reviews (SR) have been published regarding the effectiveness of VR on MSK disorders,[2-6] but none of these SRs looked specifically at the effectiveness of VR on NP-associated disorders. Based on these statements, this SR has some specific aims: (1) summarizing the evidence from randomized controlled trials (RCTs) and controlled trials (CTs) that examined the effectiveness of active VR used in the treatment of patients with NP, and (2) to determine the clinical effectiveness and the magnitude of the effect of active VR in the management of NP. Methods: This is a SR with meta-analysis that performed a literature search of five electronic databases (Ovid Medline, Embase, Cinahl, Scopus, and Cochrane Library) in September 2023 in partnership with a health science librarian without restriction in terms of publication year and language. It included RCTs and CT with adults (>18 years old) with NP, and the evaluation of the effectiveness of active VR or augmented VR. VR could be implemented by using off-the-shelf or custom-made devices, in combination with a display allowing a multisensory experience and active interaction with the virtual world. [7,8] First (abstract and title) and second (full text) screening, data extraction, and risk of bias (Cochrane RoB-2 tool) assessments were performed by two independent reviewers. The results were presented qualitatively and quantitatively. When possible, the data from the included studies were pooled in a meta-analysis. The certainty of evidence was assessed using the GRADE approach. Results: In the first screening, 8.208 studies were selected, and nine studies were included. All studies revealed a significant pain reduction in all interventions (either VR or control groups) after the end of the treatment. The VR group performed better results on pain intensity after treatment compared to conventional exercises (SMD [95%CI]: 0.43 [0.04, 0.83]) but it was not statistically different from kinematic exercise (SMD [95%CI]: 0.43 [0.50 [-0.06, 1.06]), and control group (waiting list) (SMD [95%CI]: 0.27 [-0.13, 0.66]). Although VR had positive results in all outcomes analyzed within group, no statistically or clinically significant differences were found between the VR and other interventions, in other outcomes (fear of movement, neck ROM, balance, and quality of life). Most of the studies (5 studies) presented some concerns and four studies presented a high RoB based on the RoB-2 tool. The overall quality of the evidence was considered as “very low” by the GRADE approach. Conclusion: Although the evidence is still limited for the VR treatment in patients with NP, the results found in this SR bring an important indication that the implementation of VR in existing rehabilitation for patients with neck pain appears to be a potentially safe and promising treatment approach to relieve pain and could be an alternative more effective to conventional exercise treatments that normally are employed in clinical practice.