Virtual reality in COVID-19 rehabilitation: a systematic review and meta-analysis of randomized clinical trials

Abstract

COVID-19 is an infectious disease with a broad spectrum of symptoms. Rehabilitation is essential for COVID-19 patients. However, it can be unpleasant for those with limiting symptoms. Virtual reality (VR) could be promising in providing distraction and increasing satisfaction with the rehabilitation program. The objective was to provide a comprehensive overview of the effectiveness of VR in the rehabilitation of COVID-19 patients. A systematic review and meta-analysis was carried out according to the PRISMA. A search was conducted in 4 databases (CINAHL, Medline (Via PubMed), Scopus and Web of Science) from their inception to July 2024. Eligibility criteria were defined using PICOS. Methodological quality was assessed with the modified Downs and Black scale and risk of bias with the Revised Cochrane risk-of-bias tool. The certainty of evidence was assessed with GRADE. Meta-analysis was carried out using Review Manager 5.4. Four studies were included in the systematic review and the meta-analysis. We observed that the combination of standard rehabilitation + VR reduced fatigue (SMD = -0.04; 95% CI = -0.43, 0.34; p = 0.82; n = 118), dyspnea (SMD = -0.07; 95% CI = -0.46, 0.32; p = 0.71; n = 102), anxiety (SMD = -0.28; 95% CI = -0.75, 0.19; p = 0.25; n = 70), and depression (SMD = -0.05; 95% CI = -0.53, 0.42; p = 0.82; n = 70) more than standard rehabilitation alone in COVID-19 patients. Significant level was not reached. The level of evidence ranged from very low to low. The results of this systematic review and meta-analysis suggested that VR in addition to standard rehabilitation, appears to be effective in the rehabilitation of COVID-19 patients because it shows a tendency to reduce fatigue, dyspnea, anxiety and depression more than standard rehabilitation alone. Nevertheless, more studies are needed to obtain significant results.