To Örebro University

BACKGROUND AND OBJECTIVE: Virtual reality (VR) is a rapidly evolving technology that is currently utilized in hospital settings for various types of surgical procedures. The extent to which VR is evident in improving patient outcomes is unknown. This systematic review assesses the impact of VR on adult patients undergoing elective surgical procedures.

DATABASES AND DATA TREATMENT: The following databases were sought: CENTRAL, MEDLINE, EMBASE, and CINAHL. All studies published after 2017 were included. The risk of bias was assessed using the ROB2 and ROBINS-I. Meta-analyses and Trial Sequential Analyses were performed, and the quality of evidence was evaluated using the GRADE approach for the randomised controlled trials.

RESULTS: A total of 37 full-text studies (n = 3152) were included. VR significantly reduced anxiety measured by the Numeric Rating Scale (p < 0.0001) and the State-Trait Anxiety Inventory (p = 0.008). Furthermore, Numeric Rating Scale pain was significantly reduced (p < 0.00005), with a significantly shorter recovery time and a non-significant improvement in patient satisfaction. Adverse events were infrequent and mild, with no serious adverse events reported. The risk of bias was primarily "some concerns", and the certainty of evidence ranged from moderate to low.

CONCLUSIONS: VR appears effective in reducing pain and anxiety in adult patients in an in-hospital setting. It offers a relatively safe adjunct to standard care with minimal side effects. However, heterogeneity in outcomes and the risk of bias suggest a need for more standardised, high-quality trials.

SIGNIFICANCE STATEMENT: This systematic review with meta-analysis and trial sequential analysis provides updated evidence that virtual reality can significantly reduce anxiety and pain in patients undergoing surgical procedures. Through combining recent RCTs and cohort studies with robust methodological approaches, this review strengthens the evidence for VR as an effective non-pharmacological intervention. With minimal adverse events and significant improvements in recovery time, VR represents a scalable tool that can strengthen multimodal strategies and promote safer and more comfortable patient experiences.