title: Virtual reality for treatment compliance for people with serious mental illness.
abstract: BACKGROUND
  Virtual reality (VR) is computerised real-time technology, which can be used an alternative assessment and treatment tool in the mental health field. Virtual reality may take different forms to simulate real-life activities and support treatment.
  
  
  OBJECTIVE
  To investigate the effects of virtual reality to support treatment compliance in people with serious mental illness.
  
  
  METHODS
  We searched the Cochrane Schizophrenia Group Trials Register (most recent, 17th September 2013) and relevant reference lists.
  
  
  METHODS
  All relevant randomised studies comparing virtual reality with standard care for those with serious mental illnesses. We defined virtual reality as a computerised real-time technology using graphics, sound and other sensory input, which creates the interactive computer-mediated world as a therapeutic tool.
  
  
  METHODS
  All review authors independently selected studies and extracted data. For homogeneous dichotomous data the risk difference (RD) and the 95% confidence intervals (CI) were calculated on an intention-to-treat basis. For continuous data, we calculated mean differences (MD). We assessed risk of bias and created a 'Summary of findings' table using the GRADE approach.
  
  
  RESULTS
  We identified three short-term trials (total of 156 participants, duration five to 12 weeks). Outcomes were prone to at least a moderate risk of overestimating positive effects. We found that virtual reality had little effects regarding compliance (3 RCTs, n = 156, RD loss to follow-up 0.02 CI -0.08 to 0.12, low quality evidence), cognitive functioning (1 RCT, n = 27, MD average score on Cognistat 4.67 CI -1.76 to 11.10, low quality evidence), social skills (1 RCT, n = 64, MD average score on social problem solving SPSI-R (Social Problem Solving Inventory - Revised) -2.30 CI -8.13 to 3.53, low quality evidence), or acceptability of intervention (2 RCTs, n = 92, RD 0.05 CI -0.09 to 0.19, low quality evidence). There were no data reported on mental state, insight, behaviour, quality of life, costs, service utilisation, or adverse effects. Satisfaction with treatment - measured using an un-referenced scale - and reported as "interest in training" was better for the virtual reality group (1 RCT, n = 64, MD 6.00 CI 1.39 to 10.61,low quality evidence).
  
  
  CONCLUSIONS
  There is no clear good quality evidence for or against using virtual reality for treatment compliance among people with serious mental illness. If virtual reality is used, the experimental nature of the intervention should be clearly explained. High-quality studies should be undertaken in this area to explore any effects of this novel intervention and variations of approach.
authors.affiliation: Department of Nursing Science, University of Turku, Turku, Finland.
authors.forename: Maritta
authors.initials: M
authors.lastname: Välimäki
authors.forename: Heli M
authors.initials: HM
authors.lastname: Hätönen
authors.forename: Mari E
authors.initials: ME
authors.lastname: Lahti
authors.forename: Marjo
authors.initials: M
authors.lastname: Kurki
authors.forename: Anja
authors.initials: A
authors.lastname: Hottinen
authors.forename: Kiki
authors.initials: K
authors.lastname: Metsäranta
authors.forename: Tanja
authors.initials: T
authors.lastname: Riihimäki
authors.forename: Clive E
authors.initials: CE
authors.lastname: Adams
mesh_terms: D000328:Adult; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D014584:User-Computer Interface