Impact of extended reality technology on shoulder function and pain in patients with shoulder disorders: a systematic review and meta-analysis.

Background

Shoulder disorders are common musculoskeletal conditions causing pain and functional limitation. Extended reality (XR) technology offers immersive and interactive rehabilitation, but evidence of its effectiveness remains inconclusive.

Objective

To evaluate the effects of XR-based interventions versus conventional rehabilitation on function and pain in patients with shoulder disorders, and to explore potential effects of XR type, country income level, and intervention duration.

Methods

Four English and three Chinese databases were searched from inception to July 25, 2026, for randomized controlled trials (RCTs) comparing XR-based rehabilitation with conventional care. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Meta-analyses and subgroup analyses were performed using Stata 18.0.

Results

Nine RCTs involving 613 participants were included. The XR intervention significantly improved shoulder function compared with conventional rehabilitation (SMD = 0.75, 95% CI 0.30, 1.20), with substantial heterogeneity (I2 = 85.1%). The XR intervention did not significantly reduce pain (SMD =  -0.18, 95% CI - 0.43, 0.08). Subgroup analyses showed that the study groupings based on XR type and national economic development level were completely identical; therefore, the observed between-group differences could not be attributed to either variable independently and should be interpreted only as exploratory findings. No significant difference was observed between subgroups based on intervention duration. Sensitivity analyses showed that the direction of the primary results remained generally consistent after sequentially excluding individual studies. According to the GRADE assessment, the certainty of evidence was very low for shoulder function and low for pain.

Conclusion

The XR intervention may improve overall shoulder function, but evidence certainty is very low; it should not replace conventional rehabilitation and provides no additional pain benefit. This review defines the current evidence boundary, supports cautious clinical use of XR as an adjunct, and highlights key issues for future research, including confounding, protocol standardization, and long-term follow-up.