Effectiveness and Safety of Virtual Reality Interventions for Symptom Management in Adults Undergoing Hemodialysis: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Journal of Medical Internet Research ·
Background: Adults receiving long-term hemodialysis often experience a multidimensional symptom burden that affects their functional status and daily activities. Effective symptom management may help reduce this burden, preserve functional status, and improve the overall treatment experience. However, evidence remains limited for nonpharmacological interventions that are safe, acceptable, and easy to integrate into routine hemodialysis care. Virtual reality (VR) may be a promising approach for symptom relief and supportive management, but its overall effectiveness and safety in adults receiving hemodialysis remain unclear. Objective: This review aims to determine whether VR-based interventions improve symptom-related outcomes and are safe for adults receiving hemodialysis. Methods: A comprehensive search was conducted across 12 electronic databases and trial registries from inception to January 2026. Eligible studies were randomized controlled trials evaluating VR-based interventions for symptom-related outcomes in adult patients receiving hemodialysis. The methodological quality of the included trials was appraised using the Cochrane Risk of Bias 2 tool for randomized trials (RoB 2). Quantitative synthesis was conducted in RevMan 5.4 (Cochrane) when appropriate. For continuous variables, treatment effects were summarized as mean differences (MDs) or standardized mean differences (SMDs) according to outcome measurement consistency. Statistical heterogeneity was examined using the chi-square test and value, and the choice between fixed-effect and random-effects models was based on the degree of heterogeneity. Outcomes unsuitable for meta-analysis were summarized descriptively. Results: Of the 11,192 records identified, 19 randomized controlled trials from 10 countries were included, involving 1228 participants. Thirteen studies used immersive VR and 6 used nonimmersive VR. Compared with usual care or no VR intervention, moderate-certainty evidence showed that VR reduced pain during arteriovenous fistula cannulation (MD −2.44, 95% CI −2.91 to −1.97; <.001; ²=66%), improved gait speed (SMD 0.46, 95% CI 0.11-0.81; =.01; ²=0%), increased 6-minute walk distance (MD 74.77, 95% CI 40.55-108.99; <.001; ²=43%), and reduced depressive symptoms (MD −3.48, 95% CI −6.77 to −0.18; =.04; ²=33%). Evidence for trait anxiety was of very low certainty (MD −7.72, 95% CI −13.72 to −1.71; =.01; ²=61%). No serious VR-related adverse events were reported. Conclusions: Preliminary evidence suggests that VR-based interventions may reduce arteriovenous fistula cannulation pain and depressive symptoms and may improve selected physical function outcomes, including gait speed and 6-minute walk distance, in adults receiving hemodialysis. No serious VR-related adverse events were reported, although safety evidence remains limited. Further high-quality studies are warranted to confirm and refine these findings. Trial Registration: PROSPERO CRD420261341833; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261341833
Background: Adults receiving long-term hemodialysis often experience a multidimensional symptom burden that affects their functional status and daily activities. Effective symptom management may help reduce this burden, preserve functional status, and improve the overall treatment experience. However, evidence remains limited for nonpharmacological interventions that are safe, acceptable, and easy to integrate into routine hemodialysis care. Virtual reality (VR) may be a promising approach for symptom relief and supportive management, but its overall effectiveness and safety in adults receiving hemodialysis remain unclear. Objective: This review aims to determine whether VR-based interventions improve symptom-related outcomes and are safe for adults receiving hemodialysis. Methods: A comprehensive search was conducted across 12 electronic databases and trial registries from inception to January 2026. Eligible studies were randomized controlled trials evaluating VR-based interventions for symptom-related outcomes in adult patients receiving hemodialysis. The methodological quality of the included trials was appraised using the Cochrane Risk of Bias 2 tool for randomized trials (RoB 2). Quantitative synthesis was conducted in RevMan 5.4 (Cochrane) when appropriate. For continuous variables, treatment effects were summarized as mean differences (MDs) or standardized mean differences (SMDs) according to outcome measurement consistency. Statistical heterogeneity was examined using the chi-square test and value, and the choice between fixed-effect and random-effects models was based on the degree of heterogeneity. Outcomes unsuitable for meta-analysis were summarized descriptively. Results: Of the 11,192 records identified, 19 randomized controlled trials from 10 countries were included, involving 1228 participants. Thirteen studies used immersive VR and 6 used nonimmersive VR. Compared with usual care or no VR intervention, moderate-certainty evidence showed that VR reduced pain during arteriovenous fistula cannulation (MD −2.44, 95% CI −2.91 to −1.97; <.001; ²=66%), improved gait speed (SMD 0.46, 95% CI 0.11-0.81; =.01; ²=0%), increased 6-minute walk distance (MD 74.77, 95% CI 40.55-108.99; <.001; ²=43%), and reduced depressive symptoms (MD −3.48, 95% CI −6.77 to −0.18; =.04; ²=33%). Evidence for trait anxiety was of very low certainty (MD −7.72, 95% CI −13.72 to −1.71; =.01; ²=61%). No serious VR-related adverse events were reported. Conclusions: Preliminary evidence suggests that VR-based interventions may reduce arteriovenous fistula cannulation pain and depressive symptoms and may improve selected physical function outcomes, including gait speed and 6-minute walk distance, in adults receiving hemodialysis. No serious VR-related adverse events were reported, although safety evidence remains limited. Further high-quality studies are warranted to confirm and refine these findings. Trial Registration: PROSPERO CRD420261341833; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261341833