Effect of immersive virtual reality as a therapeutic strategy in university students with neck pain
DOI:
https://doi.org/10.56294/mr2025195Keywords:
Immersive Virtual Reality, Virtual Reality, Neck Pain, Pain, Range of MotionAbstract
Introduction: imersive virtual reality as been shown to have analgesic effects by facilitating attentional distraction and altering pain perception. Its implementation in therapeutic settings could result in significant functional improvements, particularly for college students suffering from neck pain. Objective: the purpose of this study is to evaluate the impact of immersive virtual reality as a therapeutic strategy for pain management and cervical range of motion among university students through a systematic review with meta-analysis. Methods: a systematic review was conducted following the PRISMA guidelines, exploring the PubMed and ScienceDirect. Research published in the last five years that applied interventions using virtual reality in young adults with neck pain was included. Methodological quality was assessed using the PEDro scale. In addition, a meta-analysis was performed on three selected studies that reported information related to cervical range of motion, using standardized effect size and a random effects model. Results: The meta-analysis revealed a significant improvement in cervical ROM after virtual reality-based interventions, especially during rotational movements. The combined effect size was moderate to large (SMD: 0,70–2,47), showing statistically significant results in all studies analyzed. Overall, the methodological quality was considered good (PEDro ≥6). Conclusions: Immersive virtual reality appears to be an effective tool for improving cervical range of motion among students with clinically relevant neck pain; therefore, its integration into university rehabilitation programs is suggested, as well as further clinical research using larger samples.
References
1. Chechet EA, Parfenov VA. Management of patients with neck pain. Neurology, Neuropsychiatry, Psychosomatics [Internet]. 2016 Mar 21 [cited 2025 Jul 28];8(1):4–8. Available from: https://nnp.ima-press.net/nnp/article/view/575
2. Tabeeva GR. Neck pain: a clinical analysis of causes and therapy priorities. Neurology, Neuropsychiatry, Psychosomatics [Internet]. 2019 Jun 20 [cited 2025 Jul 28];11(2S):69–75. Available from: https://nnp.ima-press.net/nnp/article/view/1123
3. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015 Feb 1;90(2):284–99.
4. Aringer M. Remission Possible: New Era of SLE Treatment with Biologics Involvement. Journal of Clinical Rheumatology and Immunology. 2024 Jan;24(supp01):9–9.
5. Hammer HB. Pain in Inflammatory and Degenerative Joint Diseases. https://doi.org/101142/S2661341724740109 [Internet]. 2024 Nov 8 [cited 2025 Jul 28];24(supp01):10–10. Available from: /doi/pdf/10.1142/S2661341724740109?download=true
6. Kratter C. Therapeutic management of the painful nerve: a narrative review of common rehabilitation interventions. Plast Aesthet Res 2024;11:1 [Internet]. 2024 Jan 18 [cited 2025 Jul 28];11(0):N/A-N/A. Available from: https://www.oaepublish.com/articles/2347-9264.2023.78
7. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain [Internet]. 2020 Sep 1 [cited 2025 Jul 28];161(9):1976–82. Available from: https://journals.lww.com/pain/fulltext/2020/09000/the_revised_international_association_for_the.6.aspx
8. Styazhkina EM, Otvetchikova DI, Marchenkova LA. Virtual reality in the rehabilitation of motor disorders in diseases and injuries of the musculoskeletal system. Fizioterapevt (Physiotherapist). 2024 Nov 12;(5):101–9.
9. Bhise S, Rathi M, Dabadghav R, Atre J. Use of virtual reality in physical rehabilitation: A narrative review. Curr Med Res Pract [Internet]. 2024 May [cited 2025 Jul 28];14(3):122–7. Available from: https://journals.lww.com/cmre/fulltext/2024/14030/use_of_virtual_reality_in_physical_rehabilitation_.6.aspx
10. Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ (Online). 2017;358.
11. Guo Q, Zhang Lim, Gui C, Chen G, Chen Y, Tan H, et al. Virtual Reality Intervention for Patients with Neck Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res [Internet]. 2023 Apr 3 [cited 2025 Jul 28];25(1):e38256. Available from: https://www.jmir.org/2023/1/e38256
12. Opara M, Kozinc Ž. Virtual reality training for management of chronic neck pain: a systematic review with meta-analysis. Eur J Physiother [Internet]. 2024 [cited 2025 Jul 28];26(3):135–47. Available from: https://www.tandfonline.com/doi/pdf/10.1080/21679169.2023.2215831
13. Sánchez López JD, Cambil Martín J, Luque Martínez F. Belmont report. A theorical and practical reviewed. J Healthc Qual Res. 2021 May 1;36(3):179–80.
14. Sampieri R, Collado C, Lucio P. Metodologia de la investigaci6n. Edici6n McGraw-Hill. 1996.
15. Zúñiga PIV, Cedeño RJC, Palacios IAM. Metodología de la investigación científica: guía práctica. Ciencia Latina Revista Científica Multidisciplinar [Internet]. 2023 Sep 27 [cited 2024 Jan 14];7(4):9723–62. Available from: https://www.ciencialatina.org/index.php/cienciala/article/view/7658/11620
16. Steinsaltz D, Dahl A, Wachter KW. Statistical properties of simple random-effects models for genetic heritability * HHS Public Access. Electron J Stat. 2018;12(1):321–56.
17. Araújo A, Nathália I, Vieira U, Nayara J, Da Silva F, Pereira De Faria S, et al. tick: a Python Library for Statistical Learning, with an emphasis on Hawkes Processes and Time-Dependent Models. Journal of Machine Learning Research [Internet]. 2018 [cited 2025 Jul 17];18(214):1–5. Available from: http://jmlr.org/papers/v18/17-381.html
18. Sarkar S, Baidya DK. Meta analysis interpretation of forest plots: A wood for the trees. Indian J Anaesth [Internet]. 2025 Jan 1 [cited 2025 Jul 17];69(1):147–52. Available from: https://journals.lww.com/ijaweb/fulltext/2025/01000/meta_analysis___interpretation_of_forest_plots__a.18.aspx
19. Cetin H, Aydogdu S, Onal B, Dulger E, Bilgin S, Oge HK, et al. Immersive virtual reality versus cervical mobilization: The effects on joint position sense and pain for chronic neck pain - a randomized controlled trial. Braz J Phys Ther [Internet]. 2025 Sep 1 [cited 2025 Jul 27];29(5):101228. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1413355525000577
20. Kragting M, Voogt L, Coppieters MW, Pool-Goudzwaard AL. Visual feedback manipulation in virtual reality to influence pain-free range of motion. Are people with non-specific neck pain who are fearful of movement more susceptible? PLoS One [Internet]. 2023 Jul 1 [cited 2025 Jul 27];18(7 July). Available from: https://pubmed.ncbi.nlm.nih.gov/37406021/
21. Gavish L, Weissberger O, Barzilay Y. Gamification of Cervical Spine Physiotherapy by Virtual Reality Software: Is This Real Rehabilitation? Games Health J [Internet]. 2023 Dec 1 [cited 2025 Jul 27];12(6):468–71. Available from: https://pubmed.ncbi.nlm.nih.gov/37486726/
22. Santos-Paz JA, Sánchez-Picot Á, Rojo A, Martín-Pintado-Zugasti A, Otero A, Garcia-Carmona R. A novel virtual reality application for autonomous assessment of cervical range of motion: development and reliability study. PeerJ [Internet]. 2022 Sep 14 [cited 2025 Jul 27];10. Available from: https://pubmed.ncbi.nlm.nih.gov/36124134/
23. Tejera DM, Beltran-Alacreu H, Cano-De-la-cuerda R, Hernández JVL, Martín-Pintado-zugasti A, Calvo-Lobo C, et al. Effects of virtual reality versus exercise on pain, functional, somatosensory and psychosocial outcomes in patients with non-specific chronic neck pain: A randomized clinical trial. Int J Environ Res Public Health [Internet]. 2020 Aug 2 [cited 2025 Jul 27];17(16):1–19. Available from: https://pubmed.ncbi.nlm.nih.gov/32824394/
24. Emedoli D, Alemanno F, Iannaccone S, Houdayer E, Castellazzi P, Zangrillo F, et al. Sensory-motor training with virtual reality as a complementary intervention to manual therapy for persistent non-specific neck pain: a randomized controlled trial. Eur J Phys Rehabil Med [Internet]. 2024 Aug 1 [cited 2025 Jul 27];60(4):680–90. Available from: https://pubmed.ncbi.nlm.nih.gov/38922315/
25. Nusser M, Kramer M, Knapp S, Krischak G. Effects of virtual reality-based neck-specific sensorimotortraining in patients with chronic neck pain: A randomized controlled pilot trial. J Rehabil Med [Internet]. 2021 Feb 1 [cited 2025 Jul 27];53(2). Available from: https://pubmed.ncbi.nlm.nih.gov/33369684/
26. Cioeta M, Pournajaf S, Goffredo M, Giovannico G, Franceschini M. Improving Adherence to a Home Rehabilitation Plan for Chronic Neck Pain through Immersive Virtual Reality: A Case Report. J Clin Med [Internet]. 2023 Mar 1 [cited 2025 Jul 27];12(5). Available from: https://pubmed.ncbi.nlm.nih.gov/36902713/
27. Hoffman HG, Seibel EJ, Richards TL, Furness TA, Patterson DR, Sharar SR. Virtual Reality Helmet Display Quality Influences the Magnitude of Virtual Reality Analgesia. Journal of Pain [Internet]. 2006 Nov [cited 2025 Jul 27];7(11):843–50. Available from: https://pubmed.ncbi.nlm.nih.gov/17074626/
28. Beck DB, Ferrada MA, Sikora KA, Ombrello AK, Collins JC, Pei W, et al. Somatic Mutations in UBA1 and Severe Adult-Onset Autoinflammatory Disease. N Engl J Med [Internet]. 2020 Oct 27 [cited 2020 Nov 3];NEJMoa2026834. Available from: http://www.ncbi.nlm.nih.gov/pubmed/33108101
29. Gray ML, Goldrich DY, McKee S, Schaberg M, Del Signore A, Govindaraj S, et al. Virtual Reality as Distraction Analgesia for Office-Based Procedures: A Randomized Crossover-Controlled Trial. Otolaryngology - Head and Neck Surgery (United States) [Internet]. 2021 Mar 1 [cited 2025 Jul 27];164(3):580–8. Available from: https://pubmed.ncbi.nlm.nih.gov/32746734/
30. Pandrangi VC, Shah SN, Bruening JD, Wax MK, Clayburgh D, Andersen PE, et al. Effect of Virtual Reality on Pain Management and Opioid Use among Hospitalized Patients after Head and Neck Surgery: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg [Internet]. 2022 Aug 1 [cited 2025 Jul 27];148(8):724–30. Available from: https://pubmed.ncbi.nlm.nih.gov/35679057/
31. Slatman S, Heesink L, Achterkamp R, Broeks J, Lemans B, de Oliveira NM, et al. Cluster-Randomised Controlled Trial of At-Home Virtual Reality for People With Chronic Musculoskeletal Pain on the Waiting List. European Journal of Pain [Internet]. 2025 Jul 1 [cited 2025 Jul 27];29(6). Available from: https://pubmed.ncbi.nlm.nih.gov/40616335/
32. Hoffman HG. Interacting with virtual objects via embodied avatar hands reduces pain intensity and diverts attention. Sci Rep [Internet]. 2021 Dec 1 [cited 2025 Jul 28];11(1):10672. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8140079/
33. Luc A, Lambricht N, Aujoulat I, Detrembleur C, Pitance L. Experiences of People with Persistent Nonspecific Neck Pain Who Used Immersive Virtual Reality Serious Games in the Home Setting: A Qualitative Study. Phys Ther [Internet]. 2025 Mar 1 [cited 2025 Jul 28];105(3). Available from: https://pubmed.ncbi.nlm.nih.gov/39388230/
34. Zizolfi B, Foreste V, Trinchillo MG, Borrelli D, Gallo A, De Angelis MC, et al. The impact of virtual reality technology in the era of See & Treat hysteroscopy: a randomised controlled trial. Facts Views Vis Obgyn [Internet]. 2025 Jun 23 [cited 2025 Jul 27];17(2). Available from: https://pubmed.ncbi.nlm.nih.gov/40546021/
35. Harvie DS, Smith RT, Moseley GL, Meulders A, Michiels B, Sterling M. Illusion-enhanced Virtual Reality Exercise for Neck Pain: A Replicated Single Case Series. Clinical Journal of Pain [Internet]. 2020 Feb 1 [cited 2025 Jul 27];36(2):101–9. Available from: https://pubmed.ncbi.nlm.nih.gov/31714324/.
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Copyright (c) 2025 Paola Gabriela Ortiz Villalba, Víctor Santiago Manzano Villafuerte, María Belén Eugenio Arias, Mateo Josué Mayorga Zaldaña, Alexander Josué Monge Roque, Fabricio Alejandro Vásquez de la Bandera Cabezas, Jeannette Mercedes Acosta Nuñez, Melany Katherine Defaz Rea, Josselyn Gabriela Bonilla Ayala, Christopher Hilario Acosta Nuñez (Author)
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