Virtual Reality and Digital Interventions for Whiplash-Associated Disorders: A Systematic Review of Pain, Disability, Sensorimotor Function and Psychological Outcomes

Abstract

Background: Whiplash-associated disorders (WAD) are associated with persistent pain, disability, sensorimotor dysfunction, and psychological distress. Digital rehabilitation and virtual reality (VR) interventions have emerged as potential approaches to enhance rehabilitation delivery, accessibility, self-management, and patient engagement. However, evidence relating specifically to individuals with WAD has not previously been synthesised. Objective: To evaluate the effectiveness and feasibility of VR and digital rehabilitation interventions for adults with WAD. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Electronic databases were searched from inception to September 2026. Eligible studies included adults with WAD receiving VR or digital rehabilitation interventions. Outcomes included pain, disability, movement-related and sensorimotor outcomes, psychological outcomes, work outcomes, service utilisation, and implementation outcomes. Findings were synthesised using a Synthesis Without Meta-analysis (SWiM) approach, with exploratory meta-analysis undertaken where appropriate. Certainty of evidence was evaluated using GRADE. Results: Fourteen studies met the inclusion criteria, comprising three VR studies and eleven digital intervention studies. Digital interventions consistently improved pain, disability, cervical function, psychological outcomes, adherence, and service utilisation. Moderate-certainty evidence supported improvements in disability, movement-related outcomes, psychological outcomes, and service utilisation. Internet-supported neck-specific exercise achieved outcomes comparable to physiotherapist-led rehabilitation while substantially reducing therapist contact. VR interventions demonstrated particular promise for influencing movement behaviour, movement confidence, psychological adaptation, and rehabilitation engagement. However, evidence for improvements in pain and disability was inconsistent and generally derived from small feasibility or experimental studies, resulting in low or very low certainty evidence. Conclusions: Digital rehabilitation interventions appear capable of delivering clinical outcomes comparable to conventional rehabilitation while improving accessibility and reducing healthcare utilisation. VR interventions may provide additional value for addressing movement-related fear, sensorimotor dysfunction, and rehabilitation engagement. Nevertheless, evidence remains limited, and future research should prioritise understanding mechanisms of action, implementation processes, and patient characteristics associated with treatment response.

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