Virtual Reality

The Virtual Reality recommendation has been downgraded one level because of feasibility and inconsistent evidence.

Two moderate quality studies (Jin 2018 and Gianola 2020) addressed use of virtual reality.  Jin et al utilized psychologic interventions, along with VR (simulated rowing), and found lower WOMAC scores up to 6 months and lower VAS scores up to 7 days among patients in the intervention group.  However, the use of 2 modalities makes the effect of VR alone difficult to discern.  Gianola found no differences in VAS, WOMAC, opioid use, knee range of motion, strength, or QoL but improve proprioception among patients who utilized VR, but the authors did not describe the intervention used. 

Benefits/Harms of Implementation

No benefits or harms were noted in either of the cited studies.  However, there is insufficient evidence with this relatively new technology to understand potential risks. 

Cost Effectiveness/Resource Utilization

The cost of VR was not discussed in either cited study.  This will need additional evaluation, to assure that the cost of VR is offset by savings in terms of patient outcome (and length of stay) and opioid use. 

Acceptability

While VR is used for recreation, its use in a medical setting is not widely discussed at this point.  The acceptance of use of this technology among patients and surgeons will need additional input and research.   

Feasibility

While VR is becoming more accessible, use may be limited in rural/frontier and smaller hospitals.  In addition, training of healthcare professionals regarding the appropriate use of this technology may limit its translation into routine patient care. 

Future Research

Virtual reality may prove to be an effective non-pharmacologic intervention to improve patient pain and function after musculoskeletal surgery.  However, there is currently insufficient evidence to recommend its use.  Further research is needed to identify the benefits, potentials harms, and associated costs with this modality.  Research should include patients with a spectrum of genders and racial/ethnic backgrounds, to reflect the patient population in the US.