Virtual reality for rehabilitation and engagement in pediatric intensive care: a systematic review of feasibility, safety and outcomes

Vollständiger Abstract

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Children admitted to pediatric intensive care units (PICUs) are at risk of acquired weakness, delirium, and long-term functional and neurocognitive morbidity. Although early rehabilitation is recommended to mitigate these adverse outcomes, its delivery remains challenging. Virtual reality (VR) has been proposed as a means of enhancing engagement in rehabilitation in this setting. This systematic review evaluated the feasibility, safety, and outcomes of VR delivered to children during routine pediatric intensive care to support rehabilitation, participation in rehabilitation, or emotional regulation. Three databases were searched through 8 August 2026, and the reference list of one relevant scoping review was screened; two reviewers independently screened all records (Cohen's κ = 0.85). Six studies involving 188 children were included: one randomized pilot trial, one prospective single-arm trial, two cross-sectional single-arm studies, and two case reports. Risk of bias was high, serious, or critical in every appraised study, and the certainty of evidence was very low across all outcome domains. The randomized trial found higher consciousness scores at 2 weeks in the VR group but no difference in social and personal functional ability at 3 months. In uncontrolled studies, most children were rated as highly engaged and reported enjoying VR, while parents reported a calming effect more frequently than the children themselves; a transient increase in one heart rate variability parameter occurred during VR but was not sustained afterward. Adverse events were reported in four of the six studies at rates of 3.1% to 20%, comprising dizziness, nausea, visual discomfort, and mild irritability, with one serious event adjudicated as unrelated to VR; the two studies that applied pre-specified criteria recorded no events and one unrelated event, respectively. VR appears feasible and safe for hemodynamically stable, alert children in the PICU and is consistently associated with high engagement. However, whether VR improves functional outcomes remains uncertain. Eligibility, rather than tolerability, may be the principal barrier to implementation, and the available evidence applies to only a minority of the PICU population. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024607286 , PROSPERO, CRD42024607286