Does a digital "distraction" strategy during exercise reduce pain response? A systematic review and meta-analysis

Background: Exercise and "distraction" are useful pain management options. Virtual reality has demonstrated its potential as a "distraction" technology for pain management. Many studies have explored the use of virtual reality-assisted movements for pain management. However, there are no meta-analyses to assess the effectiveness of virtual reality-assisted exercise for pain management.
Aim: This study aims to provide an overview of original randomized controlled trials(RCTs) evaluating the effectiveness of virtual reality-assisted exercise programs for pain management and provide evidence for applying new pain management alternatives in exercise or physical therapy.
Method: A total of 3 electronic databases (PubMed, Web of Science, and SPORTDiscus ) were systematically searched for relevant articles published from their inception to June 2024. The meta-analysis followed PRISMA and PERSiST guidelines. Two authors independently screened the studies identified in the search. Any differences of opinion regarding the screening of studies followed the opinion of the third author.
Result: A total of 13 studies with a total of 961 participants were ultimately included. For the pain intensity, the overall pooled effect size was 0.66, with a standardized mean difference of -0.66 (95% CI -1.15 to -0.18), which favored the results for the virtual reality-assisted exercise intervention compared to the control group. Subgroup analyses showed that the intervention pain intensity for exercise with VR (SMD -1.30, 95% CI -2.04 to -0.55) was significantly lower than that of virtual reality training or digital physical therapy. Meanwhile, compared to receiving a multimodal intervention (virtual reality-assisted movement intervention combined with other interventions), the unimodal intervention was more effective in reducing pain intensity (SMD -1.66, 95% CI -3.26 to -0.07). Considering other health outcomes, the virtual reality-assisted movement intervention had less kinesiophobia and lower perceived exertion. However, there was no identified effect of the virtual reality-assisted exercise intervention on range of motion(ROM) or chronic pain management.
Conclusion: The extant evidence provides support for the notion that virtual reality-assisted exercise programs can serve as an effective combined approach to further ameliorate pain intensity in comparison to conventional physical therapy or exercise. Nevertheless, our study was constrained by the restricted quantity of literature available and the markedly heterogeneous nature of the research.