- Design
- Systematic review and meta-analysis of randomised trials
- Population
- 20 trials, 1,551 adult ICU patients
- Primary outcome
- Anxiety, depression and post-traumatic stress
- Effect
- Anxiety SMD −0.67 (−1.00 to −0.35); depression SMD −0.46 (−0.72 to −0.21)
A meta-analysis pooled 20 randomised trials with 1,551 adult intensive care patients receiving immersive or non-immersive virtual reality.
Virtual reality was associated with less anxiety (SMD −0.67, 95% CI −1.00 to −0.35) and depression (SMD −0.46), lower post-traumatic stress scores, better sleep and better lower-limb function scores. Pain and bedside balance did not differ significantly.
Most trials had some risk of bias and certainty ranged from very low to moderate. Blinding is impossible, and outcomes were mostly self-reported. It is a reasonable adjunct where equipment exists, not an analgesic or a substitute for delirium prevention.
- Consider virtual reality as an adjunct for anxiety and sleep in alert ICU patients where available.
- Do not rely on it for pain control; no significant analgesic effect was shown.
- Keep established delirium and sleep measures in place.
- Screen ICU survivors for anxiety, depression and post-traumatic stress at follow-up.
Why it matters
The psychological after-effects of intensive care are common and have few tested non-drug options.
Don't overread it
Evidence certainty was very low to moderate, with unblinded trials and self-reported outcomes.
The statistics, in plain English
An SMD of −0.67 is a moderate effect. With self-reported outcomes and no blinding, some of it may be expectation.
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