Immersive virtual reality-based interventions for chronic neck pain management: A systematic review and meta-analysis

OBJECTIVE: Chronic neck pain (CNP) is a global health problem characterized by persistent pain, functional disability, and restricted cervical range of motion (ROM). As an adjunct to conventional pharmacotherapy and physiotherapy, immersive virtual reality (IVR) interventions have emerged as a promising clinical tool for CNP management. The aim of this systematic review with meta-analysis (SRMA) was to assess the effectiveness of IVR in improving pain, disability and cervical ROM and joint position sense (JPS) in patients with CNP. Additionally, to evaluate the effectiveness of IVR in combination with physiotherapy programs or when used as a standalone intervention. METHODS: A systematic literature search was conducted in PubMed Medline, SCOPUS, WOS, CINAHL and PEDro without restrictions from inception up to November 2025. Randomized controlled trials (RCTs) including patients with CNP which a group received IVR and others conventional physiotherapy or usual care were included. Pooled effect was estimated through the Cohen's standardized mean difference in a random-effects model. RESULTS: Nine RCTs were included in this SRMA, providing data from 430 patients with CNP (41 ± 13.7 years old, 67.4% female). Our findings report that IVR is effective in reducing pain (SMD = -0.41; 95% CI -0.76 to -0.07; p = 0.02), disability (SMD = -0.38; 95% CI -0.74 to -0.02; p = 0.037), as well as increasing extension (SMD = 0.34; 95% CI 0.02 to 0.66; p = 0.037) and flexion ROM (SMD = 0.43; 95% CI 0.11 to 0.76; p = 0.01) and JPS during cervical flexion (SMD = -0.56; 95% CI -0.13 to -2.53; p = 0.011). CONCLUSION: Current evidence suggests that IVR can be effective in improving pain, disability, cervical ROM and JPS in patients with CNP. IVR can be more effective in combination with physiotherapy programs. Limitations related to sample size, performance and detection biases, and heterogeneity between IVR protocols can be considered.