Adesão a intervenções de realidade virtual na dor crónica: uma revisão sistemática
DOI:
https://doi.org/10.47197/retos.v80.119312Palavras-chave:
Adesão ao tratamento, dor crónica, reabilitação, realidade virtualResumo
Introdução: A dor crónica é uma condição altamente prevalente e persistente, caracterizada pela baixa adesão às intervenções terapêuticas, o que compromete a eficácia clínica e os resultados funcionais. Neste contexto, a realidade virtual surge como uma estratégia inovadora para otimizar a participação do doente.
Objectivo: Examinar como a adesão a intervenções baseadas na realidade virtual é definida, medida e reportada em pessoas com dor crónica, e descrever os níveis observados e as abordagens metodológicas utilizadas.
Metodologia: Foi realizada uma revisão sistemática seguindo as guidelines PRISMA, incluindo ensaios clínicos randomizados identificados em bases de dados internacionais. A adesão foi analisada através de uma síntese narrativa estruturada, organizando os indicadores de acordo com a taxonomia ABC: frequência, implementação e persistência.
Resultados: Foram incluídos sete estudos, demonstrando heterogeneidade na definição e medição da adesão. Os níveis reportados variaram entre 64% a 94%, com maior consistência nas intervenções domiciliárias. Os métodos incluíram registos objetivos, percentagem de exercícios realizados, conclusão da sessão e retenção, revelando falta de padronização.
Discussão: A realidade virtual demonstrou níveis de adesão iguais ou superiores aos das intervenções convencionais, embora estes pareçam depender mais de fatores contextuais e de acessibilidade do que do nível de imersão. A variabilidade metodológica limita a comparabilidade entre estudos e a identificação dos limiares ótimos.
Conclusões: A realidade virtual demonstra níveis de adesão favoráveis, mas o seu impacto depende da uniformização da sua medição e do planeamento das intervenções em contextos clínicos reais.
Referências
Aderinto, N., Olatunji, G., Abdulbasit, M. O., Edun, M., Aboderin, G., & Egbunu, E. (2023). Exploring the efficacy of virtual reality-based rehabilitation in stroke: A narrative review of current evidence. Annals of Medicine, 55(2), 2285907.
Al-Sharman, A., Ismaiel, I. A., Khalil, H., & El-Salem, K. (2021). Exploring the relationship between sleep quality, sleep-related biomarkers, and motor skill acquisition using virtual reality in people with Parkinson’s disease: A pilot study. Frontiers in Neurology, 12, 582611.
Bargeri, S., Scalea, S., Agosta, F., Banfi, G., Corbetta, D., Filippi, M., Sarasso, E., Turolla, A., Castellini, G., & Gianola, S. (2023). Effectiveness and safety of virtual reality rehabilitation after stroke: An overview of systematic reviews. EClinicalMedicine, 64.
Bhatia, A., Kara, J., Janmohamed, T., Prabhu, A., Lebovic, G., Katz, J., & Clarke, H. (2021). User Engagement and Clinical Impact of the Manage My Pain App in Patients With Chronic Pain: A Real-World, Multi-site Trial. JMIR Mhealth Uhealth, 9(3), e26528. https://doi.org/10.2196/26528
Cerda, I. H., Therond, A., Moreau, S., Studer, K., Donjow, A. R., Crowther, J. E., Mazzolenis, M. E., Lang, M., Tolba, R., Gilligan, C., Ashina, S., Kaye, A. D., Yong, R. J., Schatman, M. E., & Robinson, C. L. (2024). Telehealth and Virtual Reality Technologies in Chronic Pain Management: A Narrative Review. Current Pain and Headache Reports, 28(3), 83–94. https://doi.org/10.1007/s11916-023-01205-3
Cetin, H., Kose, N., Gurses, E., Turkmen, C., Aksoy, S., & Oge, H. K. (2023). Effects of virtual reality for postural control in chronic neck pain: A single-blind, randomized controlled study. Journal of Manipulative and Physiological Therapeutics, 46(4), 191–200.
Chikaka, T., & Keller, M. M. (2024). Low back pain treatment adherence barriers in Eswatini private physiotherapy practices: A pilot study. The South African Journal of Physiotherapy, 80(1), 2077. https://doi.org/10.4102/sajp.v80i1.2077
Cochrane Handbook for Systematic Reviews of Interventions. (n.d.). Wiley Online Library. https://doi.org/10.1002/9781119536604
Da Cruz, M. M. A., Ricci-Vitor, A. L., Borges, G. L. B., Da Silva, P. F., Turri-Silva, N., Takahashi, C., Grace, S. L., & Vanderlei, L. C. M. (2021a). A randomized, controlled, crossover trial of virtual reality in maintenance cardiovascular rehabilitation in a low-resource setting: Impact on adherence, motivation, and engagement. Physical Therapy, 101(5), pzab071.
Da Cruz, M. M. A., Ricci-Vitor, A. L., Borges, G. L. B., Da Silva, P. F., Turri-Silva, N., Takahashi, C., Grace, S. L., & Vanderlei, L. C. M. (2021b). A randomized, controlled, crossover trial of virtual reality in maintenance cardiovascular rehabilitation in a low-resource setting: Impact on adherence, motivation, and engagement. Physical Therapy, 101(5), pzab071.
Darnall, B. D., Krishnamurthy, P., Tsuei, J., & Minor, J. D. (2020a). Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study. JMIR Formative Research, 4(7), e17293. https://doi.org/10.2196/17293
Darnall, B. D., Krishnamurthy, P., Tsuei, J., & Minor, J. D. (2020b). Self-administered skills-based virtual reality intervention for chronic pain: Randomized controlled pilot study. JMIR Formative Research, 4(7), e17293.
de Zambotti, M., Barresi, G., Colrain, I. M., & Baker, F. C. (2020). When sleep goes virtual: The potential of using virtual reality at bedtime to facilitate sleep. Sleep, 43(12), zsaa178.
Ehrler, F., Guebey, J., Rochat, J., Gosetto, L., Rehberg, B., Lovis, C., & Molinard-Chenu, A. (2025). Dolodoc, an App to Leverage Self-Management of Chronic Pain: Design, Development, and Implementation Report. JMIR Medical Informatics, 13, e71597. https://doi.org/10.2196/71597
Elkeblawy, M. M., Wahid, A. R. A., Allah, W. A. A., Sarhan, E. E., Mohammed, A. H., & Yousef, A. M. (2026). Estimulación eléctrica nerviosa transcutánea vs realidad virtual en trastorno temporomandibular tras cirugía maxilofacial. Retos, 76, 923–930. https://doi.org/10.47197/retos.v77.118506
Elor, A., Powell, M., Mahmoodi, E., Teodorescu, M., & Kurniawan, S. (2021). Gaming beyond the novelty effect of immersive virtual reality for physical rehabilitation. IEEE Transactions on Games, 14(1), 107–115.
Ferche, O.-M., Moldoveanu, A., Moldoveanu, F., Voinea, A., Asavei, V., & NEGOI, I. (2015). CHALLENGES AND ISSUES FOR SUCCESSFULLY APPLYING VIRTUAL REALITY IN MEDICAL REHABILITATION. eLearning & Software for Education, (1).
Fusco, A., & Tieri, G. (2022). Challenges and perspectives for clinical applications of immersive and non-immersive virtual reality. Journal of Clinical Medicine, 11(15), 4540.
Garcia, L. M., Birckhead, B. J., Krishnamurthy, P., Sackman, J., Mackey, I. G., Louis, R. G., Salmasi, V., Maddox, T., & Darnall, B. D. (2021a). An 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality Program for Chronic Low Back Pain: Double-Blind, Randomized, Placebo-Controlled Trial Conducted During COVID-19. J Med Internet Res, 23(2), e26292. https://doi.org/10.2196/26292
Garcia, L. M., Birckhead, B. J., Krishnamurthy, P., Sackman, J., Mackey, I. G., Louis, R. G., Salmasi, V., Maddox, T., & Darnall, B. D. (2021b). An 8-week self-administered at-home behavioral skills-based virtual reality program for chronic low back pain: Double-blind, randomized, placebo-controlled trial conducted during COVID-19. Journal of Medical Internet Research, 23(2), e26292.
Garrett, B., Taverner, T., Gromala, D., Tao, G., Cordingley, E., & Sun, C. (2018). Virtual reality clinical research: Promises and challenges. JMIR Serious Games, 6(4), e10839.
Giacomelli, L., Martin Sölch, C., & Ledermann, K. (2024). The effect of virtual reality interventions on reducing pain intensity in chronic pain patients: A systematic review. Virtual Real., 28(3). https://doi.org/10.1007/s10055-024-00994-1
Glegg, S. M. N., & Levac, D. E. (2018). Barriers, facilitators and interventions to support virtual reality implementation in rehabilitation: A scoping review. PM&R, 10(11), 1237-1251. e1.
Huang, J., Wei, Y., Zhou, P., He, X., Li, H., & Wei, X. (2025). Effect of Home-Based virtual reality training on upper extremity recovery in patients with stroke: Systematic review. Journal of Medical Internet Research, 27, e69003.
Janela, D., Costa, F., Molinos, M., Moulder, R. G., Lains, J., Francisco, G. E., Bento, V., Cohen, S. P., & Correia, F. D. (2022).
Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study
. Journal of Pain Research, 15, 53–66. https://doi.org/10.2147/JPR.S343308Kenney, M. P., & Milling, L. S. (2016). The effectiveness of virtual reality distraction for reducing pain: A meta-analysis. Psychology of Consciousness: Theory, Research, and Practice, 3(3), 199.
Kraśnik, W., Jankowska, O., Kurzeja, J., Piotrowicz, K., Piotrowicz, H., Bajkacz, A., Rogala, A., & Osmólska, J. (2024). The benefits and challenges of virtual reality application in rehabilitation for chronic conditions. Journal of Education, Health and Sport, 75, 56379–56379.
Kravitz, R. L., Schmid, C. H., Marois, M., Wilsey, B., Ward, D., Hays, R. D., Duan, N., Wang, Y., MacDonald, S., Jerant, A., Servadio, J. L., Haddad, D., & Sim, I. (2018). Effect of Mobile Device–Supported Single-Patient Multi-crossover Trials on Treatment of Chronic Musculoskeletal Pain: A Randomized Clinical Trial. JAMA Internal Medicine, 178(10), 1368–1377. https://doi.org/10.1001/jamainternmed.2018.3981
Li, A., Montaño, Z., Chen, V. J., & Gold, J. I. (2011). Virtual reality and pain management: Current trends and future directions. Pain Management, 1(2), 147–157. https://doi.org/10.2217/pmt.10.15
Liao, K.-L., Huang, M., Shi, J., Chen, M., & Yang, R. (2025). Focus-driven augmented feedback: Enhancing focus and maintaining engagement in upper limb virtual reality rehabilitation. IEEE Transactions on Visualization and Computer Graphics.
Lim, D. Z., Newby, J. M., Gardner, T., Haskelberg, H., Schultz, R., Faux, S. G., & Shiner, C. T. (2021). Evaluating Real-World Adherence and Effectiveness of the “Reboot Online” Program for the Management of Chronic Pain in Routine Care. Pain Medicine (Malden, Mass.), 22(8), 1784–1792. https://doi.org/10.1093/pm/pnaa458
Lo, H. H. M., Ng, M., Fong, P. Y. H., Lai, H. H. K., Wang, B., Wong, S. Y., & Sit, R. W. S. (2024). Examining the Feasibility, Acceptability, and Preliminary Efficacy of an Immersive Virtual Reality–Assisted Lower Limb Strength Training for Knee Osteoarthritis: Mixed Methods Pilot Randomized Controlled Trial. JMIR Serious Games, 12, e52563.
Maddox, T., Oldstone, L., Sackman, J., Judge, E., Maddox, R., Adair, T., Ffrench, K., Sparks, C. Y., & Darnall, B. D. (2024). Sociodemographic Predictors of Clinical Effectiveness, Therapeutic Program Engagement, and Device Usability for an In-Home Virtual Reality Program for Chronic Low Back Pain: Secondary Analysis of a Randomized Controlled Trial. Journal of Medical Extended Reality, 1(1), jmxr.2023.0013. https://doi.org/10.1089/jmxr.2023.0013
Martínez, F. M. L., Chuqui, D. P. B., Astudillo, E. G. R., & Astudillo, M. S. T. (2024). Aplicación de la realidad virtual y realidad aumentada en la rehabilitación. ATENEO, 26(2), 110–126.
Matamala-Gomez, M., Donegan, T., Bottiroli, S., Sandrini, G., Sanchez-Vives, M. V., & Tassorelli, C. (2019). Immersive Virtual Reality and Virtual Embodiment for Pain Relief. Frontiers in Human Neuroscience, Volume 13-2019. https://doi.org/10.3389/fnhum.2019.00279
Mazzolenis, M. V., Mourra, G. N., Moreau, S., Mazzolenis, M. E., Cerda, I. H., Vega, J., Khan, J. S., & Thérond, A. (2024). The Role of Virtual Reality and Artificial Intelligence in Cognitive Pain Therapy: A Narrative Review. Current Pain and Headache Reports, 28(9), 881–892. https://doi.org/10.1007/s11916-024-01270-2
McConnell, R., Lane, E., Webb, G., LaPeze, D., Grillo, H., & Fritz, J. (2024). A multicenter feasibility randomized controlled trial using a virtual reality application of pain neuroscience education for adults with chronic low back pain. Annals of Medicine, 56(1), 2311846.
McGuinness, L. A., & Higgins, J. P. (2021). Risk‐of‐bias VISualization (robvis): An R package and Shiny web app for visualizing risk‐of‐bias assessments. Research Synthesis Methods, 12(1), 55–61.
Methley, A. M., Campbell, S., Chew-Graham, C., McNally, R., & Cheraghi-Sohi, S. (2014). PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Services Research, 14, 579. https://doi.org/10.1186/s12913-014-0579-0
Miguel-Alonso, I., Checa, D., Guillen-Sanz, H., & Bustillo, A. (2024). Evaluation of the novelty effect in immersive virtual reality learning experiences. Virtual Reality, 28(1), 27.
Miguel-Alonso, I., Rodriguez-Garcia, B., Checa, D., & Bustillo, A. (2023). Countering the novelty effect: A tutorial for immersive virtual reality learning environments. Applied Sciences, 13(1), 593.
Mira, J., Rios, J., Gil-Hernández, E., Abed, N., Ribeiro-Neves, V., Pérez-Esteve, C., Guilabert-Mora, M., Arroyo, A., & Ballester, M. P. (2025). Performance and Perceptions of Health Care Professionals Using an Immersive Virtual Reality Tool for Home Care Training: Observational Feasibility and Acceptability Study. JMIR Serious Games, 13(1), e75104.
MPT, V. K., Amarnath, R., Nusarath jaha, G., Katiyar, P., Rangaswamy, R., & Sinha, A. (2025). Evaluación de la eficacia de los programas de rehabilitación basados en realidad virtual para la recuperación de deportistas adolescentes tras lesiones: Un estudio de métodos mixtos. Retos, 65, 1184–1192. https://doi.org/10.47197/retos.v65.111674
Nguyen, A.-V., Ong, Y.-L. A., Luo, C. X., Thuraisingam, T., Rubino, M., Levin, M. F., Kaizer, F., & Archambault, P. S. (2019). Virtual reality exergaming as adjunctive therapy in a sub-acute stroke rehabilitation setting: Facilitators and barriers. Disability and Rehabilitation: Assistive Technology.
Ogourtsova, T., Archambault, P. S., & Lamontagne, A. (2019). Exploring barriers and facilitators to the clinical use of virtual reality for post-stroke unilateral spatial neglect assessment. Disability and Rehabilitation, 41(3), 284–292.
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan-a web and mobile app for systematic reviews. Systematic Reviews, 5(1), 210. https://doi.org/10.1186/s13643-016-0384-4
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Proffitt, R., Glegg, S., Levac, D., & Lange, B. (2019). End-user involvement in rehabilitation virtual reality implementation research. Journal of Enabling Technologies, 13(2), 92–100.
Ross, E. L., Jamison, R. N., Nicholls, L., Perry, B. M., & Nolen, K. D. (2020). Clinical Integration of a Smartphone App for Patients With Chronic Pain: Retrospective Analysis of Predictors of Benefits and Patient Engagement Between Clinic Visits. J Med Internet Res, 22(4), e16939. https://doi.org/10.2196/16939
Ruiz Muñoz, G. F., & Paz Zamora, Y. E. (2025). Realidad Virtual e Inteligencia Artificial como mediadores en el desarrollo cognitivo a través de la práctica deportiva. Retos, 72, 1133–1140. https://doi.org/10.47197/retos.v72.117520
Ryan, R. M., & Deci, E. L. (2020). Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemporary Educational Psychology, 61, 101860.
Ryan, R. M., & Sapp, A. R. (2007). Basic psychological needs: A self-determination theory perspective on the promotion of wellness across development and cultures. In I. Gough & J. A. McGregor (Eds.), Wellbeing in Developing Countries: From Theory to Research (pp. 71–92). Cambridge University Press. Cambridge Core. https://doi.org/10.1017/CBO9780511488986.004
Scheer, J., Areias, A. C., Molinos, M., Janela, D., Moulder, R., Lains, J., Bento, V., Yanamadala, V., Dias Correia, F., & Costa, F. (2023). Engagement and Utilization of a Complete Remote Digital Care Program for Musculoskeletal Pain Management in Urban and Rural Areas Across the United States: Longitudinal Cohort Study. JMIR Mhealth Uhealth, 11, e44316. https://doi.org/10.2196/44316
Schreiter, M., Hennrich, J., Wolf, A. L., & Eymann, T. (2025). The influence of previous experience on virtual reality adoption in medical rehabilitation and overcoming knowledge gaps among health care professionals: Qualitative interview study. Journal of Medical Internet Research, 27, e62649.
Shi, J. L.-H., & Sit, R. W.-S. (2024). Impact of 25 Years of Mobile Health Tools for Pain Management in Patients With Chronic Musculoskeletal Pain: Systematic Review. Journal of Medical Internet Research, 26. https://doi.org/10.2196/59358
Simón-Vicente, L., Rodríguez-Cano, S., Delgado-Benito, V., Ausín-Villaverde, V., & Delgado, E. C. (2024). Cybersickness. A systematic literature review of adverse effects related to virtual reality. Neurología (English Edition), 39(8), 701–709.
Thomas, J. S., France, C. R., Applegate, M. E., Leitkam, S. T., & Walkowski, S. (2016). Feasibility and safety of a virtual reality dodgeball intervention for chronic low back pain: A randomized clinical trial. The Journal of Pain, 17(12), 1302–1317.
Threapleton, K., Drummond, A., & Standen, P. (2016). Virtual rehabilitation: What are the practical barriers for home-based research? Digital Health, 2, 2055207616641302.
Torous, J., & Roberts, L. W. (2017). Needed Innovation in Digital Health and Smartphone Applications for Mental Health: Transparency and Trust. JAMA Psychiatry, 74(5), 437–438. https://doi.org/10.1001/jamapsychiatry.2017.0262
Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Korwisi, B., Kosek, E., Lavand’homme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., … Wang, S.-J. (2019). Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 160(1), 19–27. https://doi.org/10.1097/j.pain.0000000000001384
Tuck, N., Pollard, C., Good, C., Williams, C., Lewis, G., Hames, M., Aamir, T., & Bean, D. (2022). Active virtual reality for chronic primary pain: Mixed methods randomized pilot study. JMIR Formative Research, 6(7), e38366.
Vrijens, B., De Geest, S., Hughes, D. A., Przemyslaw, K., Demonceau, J., Ruppar, T., Dobbels, F., Fargher, E., Morrison, V., & Lewek, P. (2012). A new taxonomy for describing and defining adherence to medications. British Journal of Clinical Pharmacology, 73(5), 691–705.
Ye, G., Koh, R. G., Jaiswal, K., Soomal, H., & Kumbhare, D. (2023). The use of virtual reality in the rehabilitation of chronic nonspecific neck pain: A systematic review and meta-analysis. The Clinical Journal of Pain, 39(9), 491–500.
Zuki, F. S. M., Sulaiman, S., Merienne, F., Ricca, A., Guillet, C., & Saad, M. N. M. (2024). Assessing the impact of enriched virtual reality on motivation and engagement in stroke rehabilitation. IEEE Access, 12, 143585–143598.
Downloads
Publicado
Edição
Secção
Licença
Direitos de Autor (c) 2026 Gonzalo Arias-Álvarez, José Manuel Gómez-Pulido, Daniel Pecos-Marín, Cyndi Meneses-Castaño
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição-NãoComercial-SemDerivações 4.0.
Autores que publicam nesta revista concordam com os seguintes termos:
- Autores mantém os direitos autorais e assegurar a revista o direito de ser a primeira publicação da obra como licenciado sob a Licença Creative Commons Attribution que permite que outros para compartilhar o trabalho com o crédito de autoria do trabalho e publicação inicial nesta revista.
- Os autores podem estabelecer acordos adicionais separados para a distribuição não-exclusiva da versão do trabalho publicado na revista (por exemplo, a um repositório institucional, ou publicá-lo em um livro), com reconhecimento de autoria e publicação inicial nesta revista.
- É permitido e os autores são incentivados a divulgar o seu trabalho por via electrónica (por exemplo, em repositórios institucionais ou no seu próprio site), antes e durante o processo de envio, pois pode gerar alterações produtivas, bem como a uma intimação mais Cedo e mais do trabalho publicado (Veja O Efeito do Acesso Livre) (em Inglês).
Esta revista é a "política de acesso aberto" de Boai (1), apoiando os direitos dos usuários de "ler, baixar, copiar, distribuir, imprimir, pesquisar, ou link para os textos completos dos artigos". (1) http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess
