Virtual reality in adults with respiratory diseases experiencing dyspnoea: a systematic review and meta-analysis

Abstract

Objectives: Our aim was to evaluate virtual reality’s effects in dyspnoea’s management. Methods: Information sources: Trials were identified through a systematic search carried out on MEDLINE, Web of Science, Scopus and CINAHL until 17 March 2025. Eligibility criteria: Eligible studies were controlled trials including adults with dyspnoea associated with respiratory diseases, for whom virtual reality was implemented and compared with another intervention. Risk of bias: Risk of bias (ROB) was assessed using the ROB 2 tool. Synthesis of results: The primary outcome was dyspnoea. Secondary outcomes included exercise capacity, healthrelated quality of life (HRQOL) and muscle function. Effect size was expressed using standardised mean difference (SMD) or MD for primary and secondary outcomes, respectively (random-effects model). We used the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence. Results: Included studies: 13 studies were selected, including 483 adults and using non-immersive tools (n=7) or immersive tools (n=6). Risk of bias in these studies was low (n=1), some concerns (n=8) and high risk (n=4). Synthesis of results: No difference was found in dyspnoea (8 studies, 224 participants; SMD 0.02, 95%CI −0.82 to 0.86, I2 =88.2%), exercise capacity (5 studies, 183 participants; MD 3.62, 95%CI −19.39 to 26.63, I2 =39.8%) and in HRQOL (4 studies, 127 participants; MD −11.81, 95%CI −42.95 to 19.33, I2 =98.9%). The data available were insufficient to conduct a pooled analysis for muscle function. Conclusions: Limitations of evidence: The evidence is very uncertain about virtual reality’s effects on dyspnoea due to risk of bias, imprecision and heterogeneity. Interpretation: Further studies are needed and should explore various aspects of the application of immersive virtual reality