Effectiveness of virtual reality interventions on physiological and psychological outcomes of adults with cardiovascular disease: A systematic review and meta-analysis

Purpose: The aim of this study was to provide evidence of the effectiveness of virtual reality interventions on the physiological and psychological outcomes of adults with cardiovascular disease. Design: A systematic review and meta-analysis. Methods: Database searches were carried out in CINAHL, Cochrane Central, Web of Science, PubMed, Scopus, Science Direct, and Ovid without restriction of year up to December 2021. The study was carried out in accordance with PRISMA 2020 and Cochrane 2021 recommendations. The intervention effects were pooled using the random effects model. The Risk of Bias 2 tool was' used to assess the risk of bias. Heterogeneity and publication bias were also assessed. Findings: In total, 14 trials were included. The included studies found a significantly higher effect on anxiety (Hedge's g = -0.85, 95% Cl: -1.55 to -0.14, p = 0.01) and a medium effect on physical functional capacity (Hedge's g = 0.54,95% Cl: 0.01 to 1.08, p = 0.05), stress (Hedge's g = -0.36,95% Cl: -0.60 to -0.11, p = 0.01), and depression (Hedge's g = -0.39, 95% Cl: -0.68 to -0.11, p = 0.01) compared to the control group. The Cochrane GRADE approach showed low level evidence for the effect of virtual reality on anxiety and moderate level evidence for stress, depression, and physical functional capacity. Conclusions: The effect size and grade evaluation results showed that virtual reality may be an effective intervention to reduce anxiety, stress, and depression and to increase physical functional capacity in patients with cardiovascular disease. However, more study is necessary in order to establish evidence. Registration: Registered in the PROSPERO database: PROSPERO international prospective register of systematic reviews Registration number: CRD42022296578.