Background Neck pain is a prevalent condition that causes an enormous health care burden due to the lack of efficient therapies. As a promising technology, virtual reality (VR) has shown advantages in orthopedic rehabilitation. However, there is no meta-analysis evaluating the effectiveness of VR in neck pain management. Objective This study aims to review original randomized controlled trials (RCTs) evaluating the effectiveness of VR for neck pain and to provide evidence for the clinical application of a new alternative approach for pain management. Methods A total of 9 electronic databases were systematically searched for relevant articles published from inception to October 2022. RCTs in English or Chinese that investigated VR therapy for participants with neck pain were included. The methodological quality and the evidence level were assessed using the Cochrane Back and Neck Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline, respectively. Results A total of 8 studies with 382 participants were included for the final analysis. For the pain intensity, the overall pooled effect size was 0.51, with a standardized mean difference (SMD) of −0.51 (95% CI −0.91 to −0.11; GRADE: moderate), favoring VR therapy compared with controls. Subgroups analyses revealed that significant differences in pain intensity were found in the multimodal intervention (VR in combination with other therapies) than in other interventions (SMD −0.45, 95% CI −0.78 to −0.13; GRADE: moderate), and better analgesic effects were also observed in patients with chronic neck pain receiving VR intervention (SMD −0.70, 95% CI −1.08 to −0.32; GRADE: moderate) and patients treated in the clinic or research unit (SMD −0.52, 95% CI −0.99 to −0.05; GRADE: moderate) than controls. Regarding other health outcomes, the VR experienced less disability, lower kinesiophobia, and greater kinematic function (cervical range of motion, mean and peak velocity). Nevertheless, the follow-up effects of VR therapy on pain intensity and disability were not found. Conclusions Existing moderate evidence support VR as a beneficial nonpharmacological approach to improve pain intensity in patients with neck pain, with advantages to multimodal intervention, people with chronic neck pain, and clinic or research unit–based VR therapy. However, the limited quantity and high heterogeneity of the articles limit our findings. Trial Registration PROSPERO CRD42020188635; https://tinyurl.com/2839jh8w

BACKGROUND Neck pain is a prevalent condition and causes an enormous healthcare burden due to the lacking of efficient therapies. As a promising technologies, Virtual reality (VR) had shown its advantages in orthopedic rehabilitation. However, there is no meta-analysis evaluating the effectiveness of VR in neck pain management. OBJECTIVE To review original randomized controlled trials (RCTs) evaluating the effectiveness of virtual reality for neck pain and provide evidence for the clinical application of a new alternative approach for pain management. METHODS Nine electronic databases were systematically searched for relevant articles published from inception to February 2022. Randomized controlled trials in English or Chinese that investigated VR therapy in patients with neck pain were included. The methodological quality and evidence level were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline, respectively. RESULTS Seven studies including 348 participants were included for final analysis. As for the pain intensity, the overall pooled effect size was 0.51 (standard mean difference[SMD] -0.51, 95% confidence interval[CI] -0.98 to -0.04), favouring VR therapy compared with controls. Subgroups analyses revealed that significant differences in pain intensity were found in the multimodal intervention (VR in combination with other therapies) than other interventions (SMD -0.43, 95% CI -0.81 to -0.05), and better analgesic effects were also observed in patients with chronic neck pain receiving VR intervention than controls (SMD -0.74, 95% CI -1.21 to -0.28). Regarding other health outcomes, the VR group could lead to less disability, lower level of kinesiophobia and greater kinematic function (cervical range of motion[CROM], mean and peak velocity). Nevertheless, the follow-up effects of VR therapy on pain intensity and disability was not found. CONCLUSIONS VR is a beneficial non-pharmacological approach to improve pain intensity in patients with neck pain, with advantages to multimodal intervention and subjects with chronic neck pain. However, limited quantity and high heterogeneity across articles limit our findings.