沉浸式和非沉浸式虚拟现实辅助主动训练治疗慢性肌肉骨骼疼痛：系统评价和荟萃分析。

BACKGROUND: Virtual reality (VR) in different immersive conditions has been increasingly used as a nonpharmacological method for managing chronic musculoskeletal pain. OBJECTIVE: We aimed to assess the effectiveness of VR-assisted active training versus conventional exercise or physiotherapy in chronic musculoskeletal pain and to analyze the effects of immersive versus nonimmersive VR on pain outcomes. METHODS: This systematic review of randomized control trials (RCTs) searched PubMed, Scopus, and Web of Science databases from inception to June 9, 2024. RCTs comparing adults with chronic musculoskeletal pain receiving VR-assisted training were included. The primary outcome was pain intensity; secondary outcomes included functional disability and kinesiophobia. Available data were pooled in a meta-analysis. Studies were graded using the Cochrane Risk-of-Bias Tool version 2. RESULTS: In total, 28 RCTs including 1114 participants with some concerns for a high risk of bias were identified, and 25 RCTs were included in the meta-analysis. In low back pain, short-term outcomes measured post intervention showed that nonimmersive VR is effective in reducing pain (standardized mean difference [SMD] -1.79, 95% CI -2.72 to -0.87; P<.001), improving disability (SMD -0.44, 95% CI -0.72 to -0.16; P=.002), and kinesiophobia (SMD -2.94, 95% CI -5.20 to -0.68; P=.01). Intermediate-term outcomes measured at 6 months also showed that nonimmersive VR is effective in reducing pain (SMD -8.15, 95% CI -15.29 to -1.01; P=.03), and kinesiophobia (SMD -4.28, 95% CI -8.12 to -0.44; P=.03) compared to conventional active training. For neck pain, immersive VR reduced pain intensity (SMD -0.55, 95% CI -1.02 to -0.08; P=.02) but not disability and kinesiophobia in the short term. No statistical significances were detected for knee pain or other pain regions at all time points. In addition, 2 (8%) studies had a high risk of bias. CONCLUSIONS: Both nonimmersive and immersive VR-assisted active training is effective in reducing back and neck pain symptoms. Our study findings suggest that VR is effective in alleviating chronic musculoskeletal pain. TRIAL REGISTRATION: PROSPERO CRD42022302912; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302912.

背景：虚拟现实（VR）在不同的沉浸式条件下已被越来越多地用作管理慢性肌肉骨骼疼痛的非药物方法。

目的：我们旨在评估 VR 辅助主动训练与传统运动或物理疗法在慢性肌肉骨骼疼痛中的效果，并分析沉浸式与非沉浸式 VR 对疼痛结果的影响。

方法：本系统评价对随机对照试验（RCT）进行了检索，检索了 PubMed、Scopus 和 Web of Science 数据库，检索时间截至 2024 年 6 月 9 日。纳入了比较接受 VR 辅助训练的慢性肌肉骨骼疼痛成年人的 RCT。主要结局为疼痛强度；次要结局包括功能障碍和运动恐惧症。对可获得的数据进行了荟萃分析。使用 Cochrane 风险偏倚工具 2 版对研究进行了分级。

结果：共确定了 28 项 RCT，包括 1114 名存在高偏倚风险的参与者，其中 25 项 RCT 被纳入荟萃分析。在腰痛方面，短期干预后测量的结果表明，非沉浸式 VR 在减轻疼痛方面是有效的（标准化均数差[SMD]-1.79，95%CI-2.72 至-0.87；P<.001），改善了残疾（SMD-0.44，95%CI-0.72 至-0.16；P=.002）和运动恐惧症（SMD-2.94，95%CI-5.20 至-0.68；P=.01）。6 个月时的中期结果也表明，与传统主动训练相比，非沉浸式 VR 在减轻疼痛（SMD-8.15，95%CI-15.29 至-1.01；P=.03）和运动恐惧症（SMD-4.28，95%CI-8.12 至-0.44；P=.03）方面也有效。对于颈部疼痛，沉浸式 VR 在短期内减轻了疼痛强度（SMD-0.55，95%CI-1.02 至-0.08；P=.02），但在短期和中期都没有改善残疾和运动恐惧症。在所有时间点，对于膝关节疼痛或其他疼痛部位，均未检测到统计学意义。此外，有 2（8%）项研究存在高偏倚风险。

结论：非沉浸式和沉浸式 VR 辅助主动训练均能有效减轻背部和颈部疼痛症状。我们的研究结果表明，VR 在缓解慢性肌肉骨骼疼痛方面是有效的。

试验注册：PROSPERO CRD42022302912；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302912。