International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania.
Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, Cluj-Napoca, Romania.
Psychol Med. 2020 Aug;50(11):1795-1807. doi: 10.1017/S0033291719001855. Epub 2019 Aug 28.
Virtual reality (VR) may enhance the effectiveness of psychological interventions for acute pain. We conducted a meta-analysis to assess the efficacy and safety of VR-based interventions for pain associated with medical procedures.
We searched PubMed, EMBASE, the Cochrane Library, and PsycINFO until June 17th 2018. We identified randomized controlled trials (RCTs), comparing VR-based psychological interventions to usual care, for pain intensity (primary outcome) or affective and cognitive components of pain (secondary outcomes), assessed real-time or retrospectively. Two independent reviewers performed study selection and data extraction. Risk of bias was independently evaluated by three raters using the revised Cochrane Collaboration tool. A random-effects model using the Paule and Mandel estimator was used for pooling effect sizes.
27 RCTs (1452 patients) provided enough data for meta-analysis. Compared to usual care, VR-based interventions reduced pain intensity both real-time (9 RCTs, Hedges' g = 0.95, 95% CI 0.32-1.57) and retrospectively (22 RCTs, g = 0.87, 95% CI 0.54-1.21). Results were similar for cognitive (8 RCTs, g = 0.82, 95% CI 0.39-1.26) and affective pain components (14 RCTs, g = 0.55, 95% CI 0.34-0.77). There was marked heterogeneity, which remained similarly high in sensitivity analyses. Across domains, few trials were rated as low risk of bias and there was evidence of publication bias. Adverse events were rare.
Though VR-based interventions reduced pain for patients undergoing medical procedures, inferring clinical effectiveness is precluded by the predominance of small trials, with substantial risk of bias, and by incomplete reporting.
虚拟现实（VR）可能会提高急性疼痛心理干预的效果。我们进行了一项荟萃分析，以评估基于 VR 的干预措施在与医疗程序相关的疼痛中的疗效和安全性。
我们检索了 PubMed、EMBASE、Cochrane 图书馆和 PsycINFO，检索时间截至 2018 年 6 月 17 日。我们确定了比较基于 VR 的心理干预与常规护理的随机对照试验（RCT），以评估疼痛强度（主要结局）或疼痛的情感和认知成分（次要结局），评估实时或回顾性。两名独立的审查员进行了研究选择和数据提取。三位评分者独立评估偏倚风险，使用修订的 Cochrane 协作工具。使用 Paule 和 Mandel 估计量的随机效应模型用于汇总效应大小。
27 项 RCT（1452 名患者）提供了足够的数据进行荟萃分析。与常规护理相比，基于 VR 的干预措施在实时（9 项 RCT，Hedges' g = 0.95，95%置信区间 0.32-1.57）和回顾性（22 项 RCT，g = 0.87，95%置信区间 0.54-1.21）时均降低了疼痛强度。认知（8 项 RCT，g = 0.82，95%置信区间 0.39-1.26）和情感疼痛成分（14 项 RCT，g = 0.55，95%置信区间 0.34-0.77）的结果也相似。各领域的试验数量较少，被评为低偏倚风险，且存在发表偏倚的证据。不良事件很少发生。
尽管基于 VR 的干预措施可减轻接受医疗程序的患者的疼痛，但由于小型试验居多、存在较大的偏倚风险以及报告不完整，推断临床效果受到限制。
