Shooting games and equestrian training significantly reduce pain intensity in chronic low back painVirtual reality games may help manage chronic low back pain

This network meta-analysis evaluated the efficacy of various virtual reality (VR) based training modalities for patients suffering from chronic low back pain (CLBP). The study included a total sample size of 2610 participants. The analysis compared several VR modalities, including shooting games and VR-based equestrian training, against various control groups, which included traditional exercise controls and sham interventions.

The primary outcome measured was pain intensity. The results indicated that both shooting games and VR-based equestrian training were significantly superior to all types of controls. Specifically, shooting games demonstrated a standardized mean difference (SMD) of -4.40 (95% CrI -6.80 to -2.20). VR-based equestrian training showed an SMD of -2.00 (95% CrI -3.70 to -0.57). Furthermore, a ranking analysis indicated that shooting games had the highest probability of being the most effective intervention for pain relief, with a 98% probability based on the surface under the cumulative ranking curve.

Secondary outcomes included disability, measured by the Oswestry Disability Index, and kinesiophobia, measured by the Tampa Scale of Kinesiophobia. Regarding kinesiophobia, shooting games significantly outperformed traditional exercise controls with an SMD of -3.40 (95% CrI -5.60 to -1.10). However, for the disability outcome, no specific intervention demonstrated statistically significant superiority over others. These findings suggest that while VR may impact psychological barriers like kinesiophobia and subjective pain, its impact on objective functional disability is less clear.

Safety and tolerability data were not reported in the included evidence. Consequently, the incidence of adverse events, serious adverse events, or treatment discontinuations remains unknown from this specific analysis. This lack of safety data necessitates cautious implementation when introducing new digital modalities into standard rehabilitation protocols for chronic pain.

When compared to traditional management strategies for CLBP, these results suggest that specific VR modalities may offer superior outcomes in pain reduction compared to standard exercise alone. However, it is important to note that not all VR modalities are equally effective; the efficacy appears to depend on the specific type of interaction (e.g., shooting games versus other types). The evidence quality for several outcomes was graded as ranging from very low to moderate using the GRADE framework.

Several methodological limitations were identified, including significant heterogeneity of evidence and low-quality evidence for certain outcomes. Specifically, there is limited evidence regarding improvements in disability scores. These factors suggest that while the statistical significance of pain reduction is clear, the clinical weight of these findings should be tempered by the underlying quality of the source data.

Clinical implications suggest that shooting games may be a highly effective VR therapy for reducing pain intensity and kinesiophobia in patients with CLBP. Clinicians may consider incorporating specific VR modalities as an adjunct to traditional care, particularly when patient engagement or kinesiophobia is a barrier to progress. However, clinicians should remain aware that the evidence for functional disability improvement is currently insufficient to make definitive claims regarding long-term physical outcomes. Several questions remain unanswered regarding the long-term durability of these effects and the optimal duration of VR intervention required to achieve sustained pain relief. Additionally, more research is needed to determine which specific features of shooting games or equestrian training contribute most to the observed clinical improvements.