Effectiveness of Virtual Reality Interventions for Perioperative Anxiety in Adults: A Systemic Review With Meta-Analysis

BackgroundSurgery often causes anxiety in adults due to various factors, including fear of anaesthesia and loss of independence. This anxiety can lead to higher anaesthesia requirements and more postoperative complications. Virtual Reality (VR) is increasingly used as a non-pharmacological intervention to decrease perioperative anxiety. This systematic review and meta-analysis aim to evaluate the effectiveness of VR to decrease perioperative anxiety in adult patients undergoing elective surgery.DesignA systematic review was conducted according to the Joanna Briggs Institute (JBI) method for systematic reviews of effectiveness. This paper complies with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement.MethodsFour electronic databases were searched from inception to July 2024. Inclusion criteria were experimental and quasi-experimental studies using VR preoperatively to reduce perioperative anxiety as the primary outcome, with no language or date restrictions. Two independent reviewers screened and critically appraised the studies using the JBI appraisal tool. Randomised controlled trials (RCTs) were synthesised, and data were pooled in a statistical meta-analysis. A random effects meta-analysis was used due to heterogeneity. For studies that could not be meta-analysed, a narrative synthesis was performed.Results11 studies met the inclusion criteria, including eight RCTs and three quasi-experimental studies. Overall, the majority of studies demonstrated that VR effectively reduced anxiety and increased patient satisfaction. The meta-analysis revealed a small, non-significant reduction in preoperative anxiety, favouring VR (Standardised Mean Difference - 0.29, 95% Confidence Interval - 0.83 to 0.24), with moderate heterogeneity (I2 = 47%). However, findings regarding secondary outcomes including VR side effects, stress levels, preparedness levels, patients' satisfaction and length of hospital stay were inconsistent.ConclusionsThe evidence is limited to support the use of VR in reducing perioperative anxiety among adults. Larger sample sizes, high-quality RCTs and standardised anxiety measures are required to determine the effectiveness of VR on perioperative anxiety.Trial RegistrationPROSPERO CRD42020158529 .Patient or Public ContributionNo patient or public contribution was required to design or undertake this review.