Effectiveness of Virtual Reality Interventions on Perioperative Anxiety, Depression, Blood Pressure, and Heart Rate: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Perioperative stress hinders patient recovery and poses significant challenges for clinical nursing. It triggers a vicious cycle of negative psychological emotions and adverse physiological stress responses. Immersive virtual reality (VR), an innovative nonpharmacological intervention, has been gradually incorporated into perioperative care, showing promise in alleviating patient stress. However, comprehensive evaluations of its multidimensional efficacy remain lacking. Objective: This study aims to systematically evaluate the dual regulatory effects of VR interventions on both psychological emotions and objective physiological stress in adult patients undergoing perioperative care. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we comprehensively searched 9 electronic databases for randomized controlled trials (RCTs) published from January 2000 to March 2026. Eligible RCTs evaluated VR combined with routine care vs routine care alone in adult patients (≥18 years). The risk of bias was assessed using the Cochrane Risk of Bias 2 tool (Cochrane Collaboration). Meta-analyses were performed using a random-effects model based on the Hartung-Knapp-Sidik-Jonkman method. We reported 95% CIs and 95% prediction intervals (PIs) to interpret clinical heterogeneity and evaluated evidence certainty using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: We included 42 RCTs involving 4648 participants. Compared to routine care, VR significantly reduced anxiety (standardized mean difference -1.17, 95% CI -1.50 to -0.85; 95% PI -3.16 to 0.81) and depression (standardized mean difference -1.26, 95% CI -1.71 to -0.81; 95% PI -2.39 to -0.13). Physiologically, VR effectively decreased systolic blood pressure (mean difference [MD] -5.12, 95% CI -7.21 to -3.03; 95% PI -11.73 to 1.49), diastolic blood pressure (MD -3.45, 95% CI -5.18 to -1.73; 95% PI -8.63 to 1.72), and heart rate (MD -4.45, 95% CI -5.94 to -2.97; 95% PI -10.15 to 1.24). Subgroup analyses revealed that the anxiolytic effect was more pronounced in Asian populations. Conclusions: VR serves as a safe and effective adjunctive intervention that exhibits a dual regulatory mechanism, simultaneously mitigating psychological distress and stabilizing hemodynamic parameters in perioperative adults. Unlike existing systematic reviews that are predominantly limited to a single psychological metric (eg, anxiety) or focused on pediatric populations, this review integrates both psychological (anxiety and depression) and objective physiological (blood pressure and heart rate) dimensions into a unified evaluation framework. While average benefits are robust, the wide PIs suggest that true effects may vary across individuals due to clinical heterogeneity. Future standardized, large-scale RCTs with strict blinding are warranted to elevate the certainty of evidence.