International journal of nursing studies · 2025
Effects of virtual reality-based interventions on symptom management among adult patients in the intensive care unit: A systematic review and meta-analysis of randomized controlled trials.
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Song Yuan-Yuan, Zhang Yao-Dan, Jiang Bian-Tong, Liu Huan, Du Ai-Ping, Xu Yu, Tian Yong-Ming
Аннотация
BACKGROUND: Critical illness and its management in the intensive care unit (ICU) place a significant burden on patients, leading to symptoms such as pain, sleep disorders, fatigue, dyspnea, thirst, anxiety, depression, and post-traumatic stress disorder. Virtual reality has emerged as a promising intervention for symptom management across various patient populations. However, the effects of virtual reality-based interventions on symptom management among adult ICU patients are unclear.
AIM: This review aims to critically synthesize evidence evaluating the effects of virtual reality-based interventions on symptoms in adult ICU patients.
METHODS: A systematic search of PubMed, Embase, Web of Science, Cochrane Library, CINAHL, PsycINFO, CNKI, Wanfang Data, ProQuest Dissertations & Theses Global, ClinicalTrials.gov, and the Chinese Clinical Trial Registry (ChiCTR) from inception to 5 June 2025 was performed. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. The effect of the intervention was estimated as the standard mean difference (SMD) with 95 % confidence interval (CI) using random-effects models in Review Manager 5.4, with heterogeneity assessed by the I2 statistic. Narrative syntheses were adopted when meta-analysis was inappropriate. The overall certainty of the evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The protocol was registered in PROSPERO (ID: CRD42023487828).
RESULTS: Out of 6517 identified records, 9 studies were eligible, and 8 were included in the meta-analysis. Virtual reality-based interventions significantly reduced anxiety levels (k = 6, SMD = -0.50, 95 % CI [-0.94, -0.06], P = 0.02, I2 = 86 %, low certainty of evidence) and improve sleep quality in ICU patients (k = 4, SMD = 0.91, 95 % CI [0.62, 1.20], P < 0.00001, I2 = 32 %, low certainty of evidence). Exploratory subgroup analyses suggested a difference based on intervention frequency (P for subgroup difference = 0.04). Sensitivity analysis showed unstable results for anxiety but stable for sleep quality. Narrative analyses indicated that virtual reality-based interventions may reduce depression and short-term mental health-related quality of life but did not show significant effects on fatigue, thirst, dyspnea, post-traumatic stress disorder, or physical health-related quality of life. Effects on pain and overall discomfort were inconsistent. No severe adverse events were reported.
CONCLUSIONS: Preliminary evidence suggests that virtual reality-based interventions may alleviate anxiety, improve sleep quality, reduce depression, and enhance short-term mental health-related quality of life in adult ICU patients. Manageable safety concerns support their feasibility. Additional rigorous trials are needed to further confirm these findings.
AIM: This review aims to critically synthesize evidence evaluating the effects of virtual reality-based interventions on symptoms in adult ICU patients.
METHODS: A systematic search of PubMed, Embase, Web of Science, Cochrane Library, CINAHL, PsycINFO, CNKI, Wanfang Data, ProQuest Dissertations & Theses Global, ClinicalTrials.gov, and the Chinese Clinical Trial Registry (ChiCTR) from inception to 5 June 2025 was performed. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. The effect of the intervention was estimated as the standard mean difference (SMD) with 95 % confidence interval (CI) using random-effects models in Review Manager 5.4, with heterogeneity assessed by the I2 statistic. Narrative syntheses were adopted when meta-analysis was inappropriate. The overall certainty of the evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The protocol was registered in PROSPERO (ID: CRD42023487828).
RESULTS: Out of 6517 identified records, 9 studies were eligible, and 8 were included in the meta-analysis. Virtual reality-based interventions significantly reduced anxiety levels (k = 6, SMD = -0.50, 95 % CI [-0.94, -0.06], P = 0.02, I2 = 86 %, low certainty of evidence) and improve sleep quality in ICU patients (k = 4, SMD = 0.91, 95 % CI [0.62, 1.20], P < 0.00001, I2 = 32 %, low certainty of evidence). Exploratory subgroup analyses suggested a difference based on intervention frequency (P for subgroup difference = 0.04). Sensitivity analysis showed unstable results for anxiety but stable for sleep quality. Narrative analyses indicated that virtual reality-based interventions may reduce depression and short-term mental health-related quality of life but did not show significant effects on fatigue, thirst, dyspnea, post-traumatic stress disorder, or physical health-related quality of life. Effects on pain and overall discomfort were inconsistent. No severe adverse events were reported.
CONCLUSIONS: Preliminary evidence suggests that virtual reality-based interventions may alleviate anxiety, improve sleep quality, reduce depression, and enhance short-term mental health-related quality of life in adult ICU patients. Manageable safety concerns support their feasibility. Additional rigorous trials are needed to further confirm these findings.