The overall effects of virtual reality interventions on ICU patients

Abstract

Background: Adult intensive care unit (ICU) patients frequently experience psychological distress, pain, sleep disruption, and motor impairments. Virtual reality (VR) has emerged as a promising nonpharmacological adjunct to improve these outcomes, yet existing evidence remains fragmented and inconsistent. This systematic review and meta-analysis synthesized recent clinical trials to evaluate the effectiveness of VR on mental health, pain, sleep, functional outcomes, and delirium in adult ICU patients. Methods: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (2020) guidance and was registered in International Prospective Register of Systematic Reviews (CRD42023482529). Eight databases were searched for randomized controlled trials published between January 2000 and September 2025. Eligible studies included adult ICU patients receiving immersive or non-immersive VR interventions. Primary outcomes were anxiety, depression, and post-traumatic stress disorder (PTSD); secondary outcomes included pain, sleep quality, lower-limb function, and bedside balance. Risk of bias was assessed using the Cochrane RoB tool, and certainty of evidence was graded using Grading of Recommendations Assessment, Development and Evaluation. Results: Twenty randomized controlled trials were identified, involving a total of 1551 patients. This meta-analysis showed that VR intervention helped improve anxiety (standardized mean difference [SMD] = −0.67, 95% confidence interval [CI: −1.00 to −0.35], P < .0001), depression (SMD = −0.46, 95% CI [−0.72 to −0.21], P = .0004), PTSD [mean difference = −5.48, 95% CI (−9.36 to −1.59), P = .006], lower-limb function score [mean difference = 2.83, 95% CI (1.99 to 3.67), P < .001] and sleep quality (SMD = 0.70, 95% CI [0.47 to 0.92], P < .0001), but had no significant effect on pain score (SMD = −0.57, 95% CI [−1.49 to 0.36], P = .23) and bedside balance score (SMD = 0.61, 95% CI [−0.44 to 1.66], P = .25). Most studies were assessed as having varying degrees of risk of bias. All evidence was rated from very low to moderate. Conclusion: VR interventions may confer meaningful benefits for anxiety, depression, PTSD, and sleep quality in adult ICU patients, and may improve lower-limb function in selected populations. However, evidence for analgesic effects and bedside balance remains inconclusive. Standardized VR protocols, objective outcome assessment, and adequately powered multicenter trials are needed to clarify the clinical value of VR in ICU care.