Effectiveness of Virtual Reality-Based Early Rehabilitation Strategies on Pain, Sleep, Anxiety, Balance, Cognition, and Quality of Life in Adult ICU Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (Preprint)

BACKGROUND Early rehabilitation strategies based on virtual reality (VR) technology offer a new perspective for the physical, psychological, and cognitive rehabilitation of critically ill patients, yet there are still discrepancies in the effectiveness of related interventions. OBJECTIVE To explore evidence regarding the effectiveness of early VR-based interventions on physical, psychological, and cognitive function indicators in critically ill patients during ICU treatment, as well as during short-term (within 3 months) and long-term (6-12 months) follow-up. METHODS We searched 10 international and Chinese databases, including PubMed, Embase, and Cochrane Library, for randomized controlled trials (RCTs) published up to May 11, 2025, that applied VR technology for early rehabilitation (within 72 hours of ICU admission). The Cochrane Risk of Bias tool was used to assess the methodological quality of the studies. RevMan 5.3 software was employed for meta-analysis, sensitivity analysis, and subgroup analysis, with standardized mean difference (SMD) and 95% confidence interval (CI) as the combined effect sizes. Stata 17.0 software was used to evaluate the risk of publication bias for relevant indicators. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was applied to grade the quality of evidence for outcome measures. RESULTS Fourteen RCTs involving 1,259 critically ill patients were included. Compared with conventional measures, VR therapy reduced anxiety levels during ICU treatment (SMD = -1.79, 95% CI -3.24 to -0.33; P =.02) and at short-term follow-up (SMD = -0.66, 95% CI -1.17 to -0.15; P =.01). It also improved sleep quality during ICU treatment (SMD = 2.20, 95% CI 0.74 to 3.65; P =.003) and at short-term follow-up (SMD = 0.51, 95% CI 0.15 to 0.88; P =.006), with subgroup analysis showing a better effect on improving sleep during ICU treatment (P =.03). Additionally, VR therapy enhanced balance ability (SMD = 0.88, 95% CI 0.53 to 1.24; P <.01) and quality of life (SMD = 1.27, 95% CI 0.09 to 2.44; P =.03) at short-term follow-up. No significant publication bias was observed for the outcome measures. Due to the lack of blinding of interveners and participants in the studies and substantial heterogeneity among them, the relevant evidence was of moderate to low quality. CONCLUSIONS Our results preliminarily suggest that early VR-based intervention strategies have positive impacts on relevant outcome measures in critically ill patients during ICU treatment and at short-term follow-up. However, the findings of this review are limited by the small number of included studies, small sample sizes, and substantial heterogeneity among studies. High-quality long-term follow-up studies are still needed to further validate the intervention effects. CLINICALTRIAL PROSPERO CRD420251114439.