Effects of Virtual Reality Interventions on Anxiety and Depression in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

BACKGROUND

The effectiveness of virtual reality (VR) technology in reducing anxiety and depression among patients with chronic obstructive pulmonary disease (COPD) remains uncertain. This study aimed to evaluate the impact of VR-based interventions on psychological outcomes in patients with COPD through a systematic review and meta-analysis.

METHODS

A systematic search was conducted in 11 databases, including PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, PsycINFO, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, the Chinese Medical Journal Full-text Database (CMJD), and SinoMed, from database inception to February 11, 2026. Randomized controlled trials (RCTs) assessing the effects of VR interventions on anxiety or depression in patients with COPD were included. Two reviewers independently performed study screening, data extraction, and quality assessment, and the risk of bias was evaluated using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model in RevMan 5.4, and the certainty of evidence was assessed using the GRADE approach. The primary outcomes were changes in anxiety and depression symptoms.

RESULTS

A total of 1,767 records were identified, of which 10 studies involving 673 patients with COPD met the inclusion criteria, and 9 studies were included in the meta-analysis. Because of substantial between-study heterogeneity, a random-effects model was used. Meta-analysis showed that, compared with control groups, VR interventions significantly reduced anxiety levels in patients with COPD [SMD = -1.63, 95% CI (-2.49, -0.78), P = 0.0002, I2 = 95%] and reduced depressive symptoms [SMD = -0.90, 95% CI (-1.28, -0.53), P < 0.00001, I2 = 77%].

CONCLUSION

VR-based interventions show potential for improving anxiety and depressive symptoms in patients with COPD and may serve as a valuable adjunct to conventional pulmonary rehabilitation. Nevertheless, the substantial heterogeneity observed across studies limits the certainty of the available evidence. Consequently, the findings should be interpreted with caution, and further rigorously designed, large-scale RCTs are needed to verify the long-term effectiveness of VR interventions and inform their optimal clinical implementation.