The effect of virtual reality on anxiety and pain in patients undergoing totally implantable venous access port: a systematic review and meta-analysis

Abstract

Background The totally implantable venous access port (TIVAP) is the preferred venous access device for patients requiring long-term chemotherapy or intravenous nutrition. However, as an invasive procedure, TIVAP implantation often induces considerable anxiety and pain. Virtual reality (VR), a non-pharmacological distraction technique, provides an immersive audio-visual experience that redirects patients' attention away from noxious stimuli, and has been proven to effectively alleviate pain and anxiety across various medical procedures. Randomized controlled trials (RCTs) have reported that VR interventions significantly reduce pain and anxiety levels during TIVAP implantation. Nevertheless, a comprehensive synthesis of evidence on the effectiveness of VR intervention in this specific setting is currently lacking. Therefore, this study aimed to evaluate, through a meta-analysis, the effects of VR intervention on anxiety and pain in patients undergoing TIVAP implantation, with the goal of providing evidence-based guidance for clinical practice. Methods We systematically searched PubMed, Cochrane Library, Web of Science, and Embase for RCTs examining the effects of VR intervention on anxiety and pain in patients receiving TIVAP implantation, from inception to June 2026. Two researchers independently screened the literature, extracted data, and assessed the methodological quality of included studies using the Cochrane Risk of Bias 2.0 (RoB2) tool. The primary outcomes were anxiety and pain scores. A meta-analysis was conducted using RevMan 5.3 software, and the quality of evidence for each outcome was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results Five studies involving 452 participants were included. The meta-analysis revealed no no statistically significant difference between VR group and the control group in improving pain scores [SMD = −0.84, 95% CI (−1.89, 0.22), P = 0.119; Evidence level: Very low]. However, VR intervention was associated with a statistically significant reduction in anxiety scores, albeit with low-quality evidence and uncertain clinical significance [SMD = −1.89, 95% CI (−3.42, −0.36), P = 0.015; Evidence level: Low]. Subgroup analyses indicated that, for pain scores, studies with a sample size of <100 showed a significant pain-reducing effect of VR intervention, whereas those with ≥100 participants did not. When stratified by control group type, VR intervention did not significantly reduce pain scores compared with either standard care or music intervention. For anxiety scores, VR intervention significantly alleviated anxiety in both sample-size subgroups (<100 and ≥100). Stratified by control type, VR intervention demonstrated a significant anxiety-reducing effect when the control group received music intervention, but the difference did not reach statistical significance when compared with standard care. Conclusions Current evidence is insufficient to support a definitive clinical benefit of VR intervention in alleviating anxiety and pain among patients undergoing TIVAP implantation. Although VR intervention offers theoretical advantages as a non-pharmacological approach, its efficacy appears to be influenced by multiple factors, including device characteristics, content, duration, and application context. Given the low strength of available evidence, routine adoption of VR intervention as an adjunctive measure cannot be strongly recommended at this time. Future research should involve larger sample sizes, rigorous designs, standardized VR intervention protocols, and unified outcome assessment tools to provide more robust evidence for clinical decision-making. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261430609, identifier CRD420261430609.