Effectiveness of Virtual Reality Versus Exercise-Based Interventions in the Management of Chronic Spinal Pain: A Systematic Review and Meta-Analysis.

BACKGROUND/PURPOSE: This systematic review and meta-analysis assessed the comparative effectiveness of virtual reality (VR) versus exercise-based interventions for pain, disability, fear of movement, and quality of life in patients with chronic spinal pain.

METHODS

Five databases were searched for randomized control trials (RCTs) in the last 10 years, comparing VR versus exercise-based interventions (with or without passive adjunct modalities) for adults (≥ 18 years) with chronic spinal pain. Risk of bias and certainty of evidence were assessed using the Cochrane RoB 2.0 tool and GRADE framework, followed by random-effect meta-analyses.

RESULTS

Fifteen RCTs comprising 659 participants were included, with most presenting a high risk of bias. Based on very low-certainty evidence, VR showed statistically significant superiority over exercise-based interventions for pain (VAS: MD -1.05, 95% CI -1.92 to -0.18; p = 0.02; I2 = 94%; NPRS: MD -0.95, 95% CI -1.59 to -0.31; p = 0.003; I2 = 14%) and kinesiophobia (MD -3.52, 95% CI -6.08 to -0.96; p = 0.007; I2 = 0%). None of these statistically significant reductions met the commonly established thresholds for Minimal Clinically Important Difference (MCID) for chronic spinal pain populations. Very low-certainty evidence found no significant differences for functional disability (MD -1.38, 95% CI -5.43 to 2.67; p = 0.50; I2 = 0%), and results on quality of life were heterogeneous and inconclusive.

DISCUSSION: Although VR may offer statistical advantages over exercise-based interventions for pain and kinesiophobia, the overall certainty of the evidence remains very low. The non-attainment of the MCID thresholds, coupled with high risk of bias and substantial statistical heterogeneity, underscores the need for strict caution.

TRIAL REGISTRATION: PROSPERO (CRD420251101584).