Volume 49, Issue 2, February 2024, 102231Author links open overlay panel, , AbstractObjective

This paper aims to provide a review of the use of virtual reality in cardiac rehabilitation.

Background

Can virtual reality technology improve outcomes in patients with cardiovascular disease? The question is still open.

Methods

A literature search was conducted in the Embase, the Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure Database, Wanfang Database, and China Biological Medicine Database. Databases were searched to July 2023. The inclusion criteria were as follows: the nature of the studies was set as a systematic review; the research participants were patients with cardiovascular diseases undergoing cardiac rehabilitation; the research content was a comparison of virtual reality effects between other care approaches. A Measurement Tool to Assess Systematic Reviews was employed to evaluate the quality of included studies and judge the overall certainty of evidence by using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. When there were differences between the outcomes, we used the RevMan 5.3 to recalculate.

Results

A total of 7 reviews were included in our synthesis, including 3 low-quality articles and 4 very low-quality articles. Virtual reality was effective in improving patients' depression symptoms, anxiety, stress, and improving athletic ability, but it remains unknown whether virtual reality is effective for other outcomes or not.

Conclusions

Virtual reality can effectively improve the mental health of patients with cardiovascular disease. However, its role in improving other health indicators such as adherence, satisfaction, and quality of life has not been shown.

Section snippetsBackground

Cardiovascular disease (CVD) is characterized by high morbidity and mortality rates.1 From 1990 to 2019, the prevalence of CVD increased from 271 million to 523 million cases, and the number of CVD deaths increased from 12.1 million to 18.6 million cases.2 This leads to a substantial burden on individuals, their families, and the whole society.2 Cardiac rehabilitation (CR) is a comprehensive program aimed at improving the physical and mental well-being of individuals with CVD.3 CR includes

Design

This overview of systematic reviews was registered with PROSPERO under registration number CRD42023445040, to conduct research in strict adherence to the original systematic evaluation protocol. We adhered to following the Cochrane Handbook for Systematic Reviews of Interventions (Chapter V—Overviews) recommendations and the Preferred Reporting Items for Overviews of Reviews (PRIOR).27,28

Search strategy

The research team comprehensively searched Embase, the Cochrane Library, PubMed, Web of Science, China

Study selection

308 pieces of related literature were initially detected, 7 pieces of literature were finally included after layer-by-layer screening, and the specific screening process is shown in Fig. 1.12,18,21, 22, 23, 24, 25

Basic characteristics

These literature were published between 2021 and 2023, and the number of randomized controlled studies included in the original review ranged from 7 to 14. The risk of bias evaluation for the inclusion of randomized controlled studies mainly used the Cochrane risk of bias assessment

Virtual reality improves patients' mental status and exercise levels to varying degrees

In this overview of systematic reviews, 7 systematic reviews were included to describe the effect of the VR impact of CR. Depression and anxiety are common and persistent in patients with CVD, and they are strongly associated with poor patient prognosis.32 Studies have found that CVD increases the risk of anxiety and depression, and anxiety and depression exacerbate the symptoms and progression of CVD.32,33 It is therefore crucial to improve the mood of patients with CVD promptly. VR enables

Conclusion

VR-based CR can effectively improve patients' mental health, together with the level of exercise. However, the methodological quality of existing VR-based CR studies needs to be improved, and more high-quality, large-sample randomized controlled trials are needed to elucidate the effectiveness of VR in CR.

Clinical relevance

Based on the available evidence, we encourage patients with CVD to participate actively in VR-based CR and consider VR as an effective adjunct tool. However, the impact of VR technology on patients' quality of life, triglycerides, and other health indicators still requires high-quality evidence for validation.

Ethical considerations

This study relied on secondary data; therefore, no ethics approval or patient consent was required.

Data availability statement

In regards to data availability, the corresponding author can provide the data that substantiate the results of this investigation when requested in a reasonable manner.

CRediT authorship contribution statement

Ying Ying Jia: Conceptualization, Methodology, Writing – original draft, Writing – review & editing, Funding acquisition. Jian Ping Song: Methodology, Investigation, Supervision, Writing – review & editing, Funding acquisition. Li Yang: Methodology, Investigation.

Declaration of Competing Interest

All authors declare no conflict of interest.

Funding information

This work received financial support from A Project Supported by Scientific Research Fund of Zhejiang Provincial Education Department [Y202352490].

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