Effectiveness of Virtual Reality-Complemented Pulmonary Rehabilitation on Lung Function, Exercise Capacity, Dyspnea, and Health Status in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis.

Summary

Across 16 RCTs (1052 participants), VR-complemented PR significantly improved FEV1 (MD 0.25 L), FEV1/FVC (MD 6.12), FVC (MD 0.28 L), 6MWD (MD 23.49 m), dyspnea (mMRC MD −0.28), CAT score (MD −2.95), and SpO2 (MD 1.35%). Benefits were larger vs nonactive controls, with optimal 6MWD gains in 5–12-week programs. Adherence and engagement were higher with VR.

Key Findings

• VR-complemented PR improved lung function (FEV1, FEV1/FVC, FVC), exercise capacity (6MWD), dyspnea, health status (CAT), and SpO2.
• 6MWD improvement (23.49 m) was statistically significant but just below common MCID thresholds (≈26 m).
• Greatest gains occurred vs nonactive controls and in 5–12-week interventions; adherence and engagement were higher with VR.

Clinical Implications

VR components can be added to PR to boost adherence and modestly improve function and symptoms, especially in programs of 5–12 weeks; implementation should consider standardization and long-term outcomes.

Limitations

• Heterogeneity in VR interventions, PR protocols, and comparators; limited long-term follow-up
• Clinical significance for 6MWD borderline; potential publication bias not fully excluded

Future Directions

Standardize VR-PR protocols, assess cost-effectiveness and remote delivery, and conduct longer follow-up trials focusing on exacerbations and hospitalizations.