Extended reality interventions for health and procedural anxiety: An overview of reviews

Background: While Extended Reality (XR) technologies are becoming increasingly prevalent across society, there is a lack of consensus around their utilisation for the management of health and medical procedure anxieties. We undertook an overview of reviews to examine the effectiveness of these technology-based interventions. Methods: Data were extracted from full-text systematic reviews of patient-directed XR interventions for health and procedural anxiety. Records from the beginning of 2013 until 30 May 2023 were obtained from searches of MEDLINE, Embase, APA PsycINFO and Epistemonikos. Narrative synthesis then examined the consistency, quality and range of eligible research evidence, and reviews were appraised using the AMSTAR-2 tool. Results: We examined 56 reviews from diverse clinical contexts (35 of which included meta-analysis). Procedural anxieties were most commonly researched, including those relating to needle insertion, acute surgery, dental operations and/or wound care. Other studies focused on more general health anxieties, relating to longer-term treatment and rehabilitation, maternity and chronic conditions. A range of interventions (e.g. distraction- and exposure-based approaches) and technologies (e.g. immersive and non-immersive devices) have been evaluated, although comparisons between different types of interventions are lacking. While XR interventions were generally found to reduce patient anxiety, AMSTAR-2 evaluations highlighted 44/46 of the appraised reviews as low or critically low in quality, and intervention reporting was often lacking in detail. Conclusions: Evidence in support of XR interventions has not reached maturity and is currently lacking. Therefore, the emerging positive consensus for these techniques should be challenged, and the rationale for adopting such techniques in practice further considered.