Virtual reality exposure and distraction are recent novel technologies for reducing preoperative anxiety symptoms. However, the effectiveness of virtual reality-enhanced interventions in adults is still controversial and has yet to be evaluated in a systematic review. The study aimed to (1) evaluate the effectiveness of virtual reality-enhanced interventions on preoperative anxiety symptoms in adults compared to comparators; and (2) identify the factors affecting the effectiveness of interventions. Systematic review, meta-analysis, and meta-regression analysis of randomised controlled trials. We conducted a three-step systematic search from inception until May 1, 2024, using (1) eleven databases, (2) two clinical registries, and (3) citation and grey literature searches in either English or Chinese. The package of R software version 4.3.1 was used to perform the meta-analysis, subgroup analysis, and meta-regression analyses. We adopted the restricted maximum likelihood estimator for random-effects meta-analysis and univariate random-effects meta-regression analyses. The Cochrane risk-of-bias tool version 2 and the Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to examine quality assessment and the certainty of evidence. We selected 26 randomised controlled trials with 2357 participants from 12 different countries. Random-effects meta-analyses showed that virtual reality-enhanced interventions had a statistically significant reduction in preoperative anxiety symptoms ( = −5.58, < 0.001) with a moderate to large effect size (Hedges' = −0.76, 95 % confidence interval: −1.03 to −0.48) compared to usual care. Statistically significant subgroup differences were found for the nature of the intervention, geographical region, country, and type of surgery. The improvement in preoperative anxiety symptom outcomes was greater when the virtual reality-enhanced interventions were chosen by patients ( = −2.55, 95 % CI: −3.08 to −2.02) when compared to virtual reality exposure interventions with educational content ( = −0.72, 95%CI: −1.07 to −0.38) or virtual reality distraction interventions ( = −0.64, 95 % CI: −1.04 to −0.23). Trials conducted in Asia had a greater effect on preoperative anxiety symptom outcomes ( = −0.98, 95 % CI: −1.33 to −0. 62) in comparison with those conducted in non-Asia ( = −0.23, 95 % CI: −0.54 to 0.07). The random-effects meta-regression identified sample size ( = −0.008, = 0.031) as a statistically significant covariate of preoperative anxiety symptoms. The overall certainty of the evidence was very low. Virtual reality-enhanced interventions can be considered supplementary interventions for adults undergoing elective surgery. Future trials on a large scale with follow-up assessments are needed. PROSPERO registration ID: CRD42024486343.

中文翻译：

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虚拟现实增强干预对接受择期手术的成人术前焦虑症状：荟萃分析和荟萃回归


虚拟现实暴露和分散注意力是减轻术前焦虑症状的最新新技术。然而，虚拟现实增强干预措施对成人的有效性仍然存在争议，并且尚未通过系统评价进行评估。该研究的目的是（1）与对照组相比，评估虚拟现实增强干预措施对成人术前焦虑症状的有效性； (2) 确定影响干预措施有效性的因素。随机对照试验的系统评价、荟萃分析和荟萃回归分析。我们从一开始到 2024 年 5 月 1 日进行了三步系统检索，使用 (1) 11 个数据库，(2) 两个临床登记，以及 (3) 英文或中文的引文和灰色文献检索。使用R软件4.3.1版软件包进行荟萃分析、亚组分析和荟萃回归分析。我们采用限制最大似然估计进行随机效应荟萃分析和单变量随机效应荟萃回归分析。使用 Cochrane 偏倚风险工具版本 2 和建议分级、评估、制定和评估标准来检查质量评估和证据的确定性。我们选择了 26 项随机对照试验，共有来自 12 个不同国家的 2357 名参与者。随机效应荟萃分析显示，虚拟现实增强干预措施在术前焦虑症状方面具有统计学显着性降低（= -5.58，< 0.001），且效应大小为中等到大（Hedges'= -0.76，95%置信区间： −1.03 至 −0.48）与常规护理相比。 在干预性质、地理区域、国家和手术类型方面发现了统计学上显着的亚组差异。与具有教育内容的虚拟现实暴露干预措施 (= -0.72, 95% CI：-1.07 至 -0.38）或虚拟现实分心干预（= -0.64，95 % CI：-1.04 至 -0.23）。与非亚洲地区进行的试验（= -0.23，95 % CI：-0.54）相比，在亚洲进行的试验对术前焦虑症状结果的影响更大（= -0.98，95 % CI：-1.33至-0. 62）至 0.07）。随机效应荟萃回归将样本量（= -0.008，= 0.031）确定为术前焦虑症状的统计显着协变量。证据的总体确定性非常低。虚拟现实增强干预措施可以被视为对接受择期手术的成人的补充干预措施。未来需要进行大规模试验并进行后续评估。 PROSPERO 注册 ID：CRD42024486343。