Patients' use of virtual reality technology for pain reduction during outpatient hysteroscopy: A meta-analysis of randomized controlled trials

Objective: To summarize evidence from Randomized Controlled Trials (RCTs) on the effectiveness of Virtual Reality Technology (VRT), as used by patients, for reducing pain during outpatient hysteroscopy. Data sources: Electronic databases and clinical registers were searched until 21th June 2023. The review protocol was registered in PROSPERO before the data extraction (CRD42023434340). Methods of study selection: We included RCTs of patients receiving VRT compared with controls receiving routine care during outpatient hysteroscopy. Tabulation, integration and results: The primary outcome was average pain during hysteroscopy. Pooled results were expressed as mean differences (MD) with 95% confidence interval (95% CI). Sources of heterogeneity were investigated through sensitivity and subgroups analysis. 5 RCTs were included (435 participants). The comparison between the intervention and control groups showed a borderline difference in perceived pain during hysteroscopy (MD -0.88, 95%CI -1.77, 0.01). Subgroup analysis based on the type of VRT (Active or Passive) indicated that Active VRT potentially reduced the perception of pain (MD -1.42, 95%CI -2.21, -0.62), while Passive VRT had no effect (MD -0.06, 95%CI -1.15, 1.03). Conclusion: Patients' use of active VRT may be associated with a reduction in pain during outpatient hysteroscopy (evidence GRADE 2/4). Future research should focus on conducting methodologically robust studies with larger sample sizes and more homogeneous populations.