BACKGROUND Nursing education is facing various challenges. Virtual reality(VR) is an innovative type of simulation, providing the possibility for practical nurses and other health care providers with repeated skill exercises. OBJECTIVE The purpose of this study was to meta-analyze the efficacy of VR for nursing education. METHODS We used an electronic (the Cochrane Library, Web of Science, PubMed, Embase, CINAHL) and manual search up to December, 2019 to identify studies reporting knowledge, skills, satisfaction, confidence and performance time. Two independent reviewers carried out the study selection and data extraction. Cochrane criteria for risk of bias was applied to assess the methodological quality of the studies. RESULTS Twelve studies, including 821 participants, were included in the final review. VR had a superior effect on improving knowledge when compared with control groups[SMD = 0.58, 95%CI (0.41, 0.75), p<0.00001, I2 = 47%]. But there’s no difference between experimental and control groups in skills[SMD= 0.01, 95%CI (-0.24, 0.26), p=0.93, I2 = 37%], satisfaction[SMD = 0.01, 95%CI (-0.79, 0.80), p=0.99, I2 = 86%], confidence[SMD = 0.00, 95%CI (-0.28, 0.27), p=0.99, I2 = 0%], and performance time[SMD = -0.55, 95%CI (-2.04, 0.94), p=0.47, I2 = 97%]. CONCLUSIONS The results of this study suggests that VR can effectively improve knowledge in nursing education, but it had no better effects on skills, satisfaction, confidence and performance time when compared with other education methods. But further meticulous studies with large sample size are warranted to prove the existing results.

Background. Low back pain (LBP) is considered the leading cause of people living with years of disability worldwide. Notably, thunder-fire moxibustion (TFM) is a new type of moxibustion, which has been widely applied to treat pain syndromes for thousands of years. This study aims to provide evidence to evaluate the effect and safety of TFM in treating LBP. Methods. A systematic search of PubMed, Web of Science, the Cochrane Library, Embase, EBSCO, CNKI, Wanfang Data, CBM, and VIP (until April 2021) was used to identify studies reporting pain intensity, disability, Japanese Orthopedic Association (JOA) score, and quality of life in patients with LBP. Randomized controlled trials (RCTs), which compared TFM and other therapies in LBP, were included. Meanwhile, methodological quality was evaluated using the Cochrane criteria for risk of bias, and the level of evidence was rated utilizing the GRADE approach. Results. Twenty-one RCTs, including 2198 patients, satisfied the inclusion criteria. Compared with other therapies, the effect of TFM was statistically significant, pain intensity decreased (SMD = 0.94; 95% CI (0.74, 1.14); p < 0.00001 ), disability improved (SMD = 1.39; 95% CI (0.19, 2.59); p = 0.02 ), and the JOA score increased (SMD = −1.34; 95% CI (−1.88, −0.80); p < 0.00001 ). It was also reported that the patient’s quality of life improved after treatment for a period of 4 weeks (SMD = −0.29; 95% CI (−0.42, −0.16); p < 0.0001 ) and after a follow-up of 1 month (SMD = −0.20; 95% CI (−0.34, −0.07); p = 0.003 ). The evidence level of the results was determined to be very low to low. Conclusions. Based on the existing evidence, it can be concluded that TFM may have a better effect than other treatments on LBP. However, it is not yet possible to assess the safety level of TFM therapy. Due to the universal low quality of the eligible trials and low evidence level, rigorously designed large-scale RCTs must be conducted in order to further confirm the results in this review.