The Effectiveness of Virtual Reality–Based Interventions in Rehabilitation Management of Breast Cancer Survivors: Systematic Review and Meta-analysis

Abstract

Background Breast cancer survivors (BCSs) can present with various physical and psychological symptoms and functional deficits that impact their quality of life. Virtual reality (VR) technology is being used in breast cancer rehabilitation management to improve the emotional, cognitive, and physical well-being of BCSs. Objective This systematic review aimed to examine the effectiveness of VR-based interventions on health-related outcomes in BCSs. A meta-analysis was conducted to evaluate the effectiveness of VR-based interventions in the rehabilitation management of BCSs. Methods A systematic search was conducted on PubMed, Web of Science, EMBASE, CINAHL with Full Text, the Cochrane Central Register of Controlled Trials, CNKI, WanFang, VIP, and CBM, from inception to May 25, 2021. The inclusion criteria of the selected studies were as follows: (1) adults diagnosed with breast cancer; (2) any type of VR-based interventions (immersive and nonimmersive virtual environment); (3) comparison of traditional rehabilitation methods; (4) outcomes including pain, depression, anxiety, fatigue, cognitive function, shoulder range of motion (ROM), hand grip strength, lymphedema, cybersickness symptoms, fear of movement, bleeding, effusion, and flap necrosis, both during and after treatment; and (5) randomized controlled trials (RCTs), case-controlled trials, and quasi-experimental studies. The Cochrane Collaboration Tool was used to evaluate the risk of bias. Review Manager version 5.3 (Cochrane Collaboration) was used to conduct the meta-analysis. The mean difference (MD) and SDs with 95% CIs were used to calculate continuous variables. Results Twelve articles were included in this systematic review, of which 10 contributed information to the meta-analysis. A total of 604 participants were analyzed. The statistical analysis showed significant results for flexion (standard mean difference [SMD] 1.79; 95% CI 0.55 to 3.03; P=.005), extension (SMD 1.54; 95% CI 0.83 to 2.25; P<.001), abduction (MD 17.53; 95% CI 14.33 to 20.72; P<.001), adduction (MD 15.98; 95% CI 14.02 to 17.94; P<.001), internal rotation (MD 7.12; 95% CI 5.54 to 8.70; P<.001), external rotation (SMD 0.96; 95% CI 0.62 to 1.29; P<.001), anxiety (MD −6.47; 95% CI −7.21 to −5.73; P<.001), depression (MD −4.27; 95% CI −4.64 to −3.91; P<.001), pain (MD −1.32; 95% CI −2.56 to −0.09; P=.04), and cognitive function (MD 8.80; 95% CI 8.24 to 9.36; P<.001). The meta-analysis indicated little to no difference in hand grip strength (MD 1.96; 95% CI –0.93 to 4.85; P=.18). Conclusions Findings of this review noted a weak but consistent positive association between VR-based interventions and outcomes. However, these results must be interpreted with caution due to the limited number of controlled trials analyzed, small sample sizes, and poor methodological quality. Well‐designed, large, high‐quality trials may have a significant impact on our confidence in the results. Future studies should identify specific aspects that improve the clinical impact of VR-based interventions on major outcomes in BCSs in the clinical setting. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021250727; https://tinyurl.com/2p89rmnk

Digital and Interactive Health Interventions Minimize the Physical and Psychological Impact of Breast Cancer, Increasing Women’s Quality of Life: A Systematic Review and Meta-Analysis

“…Our subgroup analysis revealed that the practice of exercise using VRBT may have been better than SABT at reducing depression symptoms in comparison to conventional therapies. Our findings were in agreement with previous reviews [ 34 , 36 ], and although we included the same number of studies, our studies all included research on two groups of patients; thus, they may be more accurate.…”

“…Our findings suggest that DIHIs, especially non-immersive VRBT, are effective at increasing flexion, abduction, and external rotation shoulder range of motion. These results are in concordance with previous reviews, although Zhang H et al only assessed abduction shoulder ROM [ 35 ], and the work of Bu X et al, which included four studies, included one study that only examined one group of patients [ 36 ]. In comparison, we included more studies that considered this outcome.…”

“…This result is very interesting because VRBT was four times more effective than the MCID for VAS assessment (expected change of 10%) [ 79 ]. Our study, in addition to confirming the results of the meta-analysis by Bu X et al [ 36 ], provided results with greater levels of evidence, accuracy, and generalization due to including a greater number of studies and participants. None of the subsequent reviews have discussed the effect of VRBT on pain.…”

“…To date, previous reviews have assessed the effect of DIHIs (VRBT [ 34 , 35 , 36 ] and SABT [ 32 , 37 ]) with promising results. However, the large heterogeneity in the design of the studies included and the fact that studies with only one group were combined with those with two or more groups may have minimized the impact of the results.…”

Impact of virtual reality on cardiac rehabilitation-related anxiety: a protocol for systematic review and meta-analysis

“…The use of VR has been adopted in a variety of therapeutic ways such as physical rehabilitation in neurological diseases, rehabilitation for various psychiatric illnesses and postcancer rehabilitation in breast cancer survivors. [10][11][12][13][14] Our subject of interest is the application of VR technology in the field of cardiac rehabilitation. It has been used during both aerobic exercises and relaxation exercises separately.…”