Metaverse technology use among patients undergoing hemodialysis: A systematic review and meta-analysis of randomized controlled trials

Aim: To synthesize the effects of metaverse-related interventions on the physical and psychological outcomes of hemodialysis in adults. Background: Owing to rapid digital healthcare development, metaverse technologies have emerged as novel approaches to patient management. Patients on hemodialysis may benefit from these technologies in terms of pain management, physical deconditioning, and psychological distress. However, evidence of their effectiveness is unclear. Methods: The study protocol was registered with PROSPERO. Following PRISMA guidelines, we searched the CINAHL, Cochrane Library Central, Embase, PubMed, and Scopus electronic databases for randomized controlled trials investigating metaverse interventions in patients on hemodialysis from inception to November 2024. Two independent reviewers screened and extracted the data, with methodological quality assessed using the Revised Cochrane Risk of Bias tool. Data were pooled using random and fixed effects approaches. Results: Fourteen studies (11 trials) met the inclusion criteria. The most common technology used among the studies was virtual-reality (VR) while the remainders used sensor-based exercise gamification. Meta-analytic findings indicated that VR significantly reduced arteriovenous fistula cannulation pain and moderately improved hemodynamics (oxygen saturation and heart rates), selected physical outcomes (6-min walk test, physical activity, and gait speed), and depressive symptoms. Conclusions: VR-based interventions appear promising for pain management and some physical improvements in patients on hemodialysis. To maximize the clinical utility of metaverse interventions in hemodialysis care settings, future studies should investigate a wider variety of metaverse modalities (such as augmented and mixed realities) and establish standardized outcome measurement periods.