Effectiveness of virtual reality in cardiac rehabilitation: A systematic review and meta-analysis of randomized
Yanya Chen1, Li Cao2, Yinuo Xu2
1School of Nursing, Jinan University, Guangzhou, China; Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, China.
Insights
Virtual reality (VR) may enhance cardiac rehabilitation by improving exercise capacity and reducing psychological distress. Further research is needed to confirm these benefits for patients undergoing cardiac rehabilitation.
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Digital Health
Background:
- Cardiovascular disease (CVD) is a leading cause of premature death and a significant economic burden.
- Virtual reality (VR) is emerging as a potential tool in cardiac rehabilitation.
- The effectiveness of VR in cardiac rehabilitation requires further investigation.
Purpose of the Study:
- To systematically review and synthesize evidence on the effects of VR for individuals undergoing cardiac rehabilitation.
- To appraise the quality of research and certainty of evidence regarding VR interventions in cardiac rehabilitation.
Main Methods:
- A comprehensive systematic literature search was conducted across multiple databases (PubMed, Embase, Web of Science, CINAHL, Cochrane, PEDro) up to May 2022.
- Included studies were randomized controlled trials (RCTs) assessed for risk of bias using the Cochrane Risk of Bias Tool.
- Meta-analysis was performed where feasible; otherwise, narrative summaries were used. Certainty of evidence was assessed using GRADE methodology.
Main Results:
- Ten studies were included in the review.
- VR likely improves exercise capacity (moderate-certainty evidence).
- VR may reduce emotional tension and intrapsychic stress (low-certainty evidence), and potentially depression (very low-certainty evidence). Evidence for other outcomes like anxiety, stress, and lipid profiles was uncertain.
Conclusions:
- Virtual reality interventions show promise for improving exercise capacity and psychological outcomes in cardiac rehabilitation.
- Further large-scale, well-designed studies with tailored VR interventions are necessary to confirm these findings and optimize application in cardiac rehabilitation programs.
Background:
Cardiovascular disease has risen sharply and causes more premature deaths than cancer, while it represents a major economic burden for healthcare systems and impacts patients' quality of life negatively. Virtual reality has captured the attention of researchers in the field of cardiac rehabilitation. However, the efficacy of virtual reality among individuals undergoing cardiac rehabilitation remains inconclusive.
Objective:
To appraise research evidence on the effects of virtual reality for individuals undergoing cardiac rehabilitation.
Design:
Systematic review and meta-analysis.
Methods:
A systematic search of publications was conducted using Pubmed, Embase, Web of science, Cumulative Index to Nursing and Allied Health Literature database (CINAHL), Cochrane Central Register of Controlled trials and Physiotherapy Evidence Database (PEDro) from inception to 15 May 2022, without language restriction. The Cochrane Risk of Bias Tool was used to examine the methodological quality of the included randomized controlled studies. When feasible, a meta-analysis was performed to calculate the pooled effects using Review Manager (Version 5.4). Otherwise, narrative summaries were performed. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of the evidence.
Results:
A total of ten studies were included. Virtual reality probably increases exercise capacity for individuals undergoing cardiac rehabilitation (the pooled mean difference 49.55, 95% confidence interval 30.59 ~ 68.52, P < 0.00001, moderate-certainty evidence) and might result in a reduction in emotional tension (mean difference -6.43, 95% confidence interval -9.02 ~ -3.84, P < 0.00001, low-certainty evidence) and intrapsychic stress (mean difference -4.25, 95% confidence interval -6.83 to -1.67, P = 0.001, low-certainty evidence). It also seemed to have a positive effect on quality of life, although meta-analysis could not be conducted to pool the results. Virtual reality might reduce depression (standardised mean difference -0.48, 95% confidence interval -0.84 ~ -0.12, P = 0.009,very low- certainty evidence), but the evidence was uncertain, with similar results of anxiety, general level of stress, external stress, total cholesterol, and low-density lipoprotein. The evidence was uncertain about the effect of virtual reality on high-density lipoprotein (mean difference -1.79, 95% confidence interval -8.96 ~ 5.38, P = 0.62, very low-certainty evidence), with similar results of triglycerides and BMI.
Conclusions:
Individuals undergoing cardiac rehabilitation may benefit from virtual reality since it can improve exercise capacity and psychological outcomes. More large, and well-designed studies with tailored virtual reality intervention are warranted to confirm the effects of virtual reality on individuals undergoing cardiac rehabilitation.
Tweetable Abstract:
Virtual reality may benefit individuals undergoing cardiac rehabilitation since it can improve exercise capacity and psychological outcomes.
