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Effectiveness of Virtual Reality Versus Exercise-Based Interventions in the Management of Chronic Spinal Pain: A
Julián Peralta-Álvarez1, Francisco Nieto-Escámez2, Remedios López-Liria1
1Department of Nursing, Physiotherapy and Medicine, University of Almería, Health Research Centre, Humanidades-498 Research Group, Almería, Spain.
Background/Purpose:
This systematic review and meta-analysis assessed the comparative effectiveness of virtual reality (VR) versus exercise-based interventions for pain, disability, fear of movement, and quality of life in patients with chronic spinal pain.
Methods:
Five databases were searched for randomized control trials (RCTs) in the last 10 years, comparing VR versus exercise-based interventions (with or without passive adjunct modalities) for adults (≥ 18 years) with chronic spinal pain. Risk of bias and certainty of evidence were assessed using the Cochrane RoB 2.0 tool and GRADE framework, followed by random-effect meta-analyses.
Results:
Fifteen RCTs comprising 659 participants were included, with most presenting a high risk of bias. Based on very low-certainty evidence, VR showed statistically significant superiority over exercise-based interventions for pain (VAS: MD -1.05, 95% CI -1.92 to -0.18; p = 0.02; I2 = 94%; NPRS: MD -0.95, 95% CI -1.59 to -0.31; p = 0.003; I2 = 14%) and kinesiophobia (MD -3.52, 95% CI -6.08 to -0.96; p = 0.007; I2 = 0%). None of these statistically significant reductions met the commonly established thresholds for Minimal Clinically Important Difference (MCID) for chronic spinal pain populations. Very low-certainty evidence found no significant differences for functional disability (MD -1.38, 95% CI -5.43 to 2.67; p = 0.50; I2 = 0%), and results on quality of life were heterogeneous and inconclusive.
Discussion:
Although VR may offer statistical advantages over exercise-based interventions for pain and kinesiophobia, the overall certainty of the evidence remains very low. The non-attainment of the MCID thresholds, coupled with high risk of bias and substantial statistical heterogeneity, underscores the need for strict caution.
Trial Registration:
PROSPERO (CRD420251101584).
