INTRODUCTION:

Cognitive and physical impairments are pervasive and have significant implications for the individuals, healthcare systems, and society as a whole. Mild cognitive impairment (MCI), cerebral palsy (CP), and low back pain (LBP) are among the most prevalent health issues that pose substantial challenges to effective management.

MCI, often considered as a transitional stage between normal aging and more serious conditions such as Alzheimer’s disease, affects millions worldwide – leading to memory loss and diminished executive functions^1,2. CP, a lifelong physical disability that mainly affects the movement and posture, impacts 2 to 3 per 1000 live births globally, necessitating ongoing medical and therapeutic intervention^3,4. LBP is one of the leading causes of disability and affecting nearly 540 million people at any given time and imposing a tremendous economic burden due to lost productivity and healthcare costs^5-7.

Current therapeutic interventions for conditions (i.e., pharmacological approach, physical treatment, and cognitive rehabilitation) often have limited efficacy and are fraught with the challenges. Traditional therapies may not fully address the multifaceted needs of patients with these conditions. For instance, medical treatments for the cognitive impairment or chronic pain may offer symptomatic relief but can be associated with adverse side effects and long-term health risks^8-10. Physical therapies highly require consistent, which can be difficult to maintain due to lack of motivation or logistical barriers. Additionally, the high costs of treatments and need for specialized equipment or facilities can limit access to care, notably for individuals in low-resource settings. All these challenges highlight the need for innovative therapeutic approaches that are more effective, engaging, and accessible.

Emergence of metaverse technologies in healthcare:

Metaverse technologies have emerged as a promising digital device in the healthcare sectors. These technologies create immersive and interactive environments that simulate real-world experiences or provide entirely new virtual contexts for therapy and rehabilitation^11-13. The implementation of technologies in the healthcare settings are expanding rapidly, driven by advancements in technology and growing interest from both the clinicians and researchers. In medical training, metaverse technologies are utilized to simulate surgeries and clinical procedures, thus providing trainees with a risk-free environment to practice and refine their skills^14,15. Patient education contexts also benefit from these technologies, with interactive visualizations enhancing understanding of health conditions and treatments, thus improving patient engagement and adherence to the treatment plans. Therapeutic interventions leverage the immersive nature of digital metaverse environments to engage patients in activities that promote physical and cognitive rehabilitation. For instance, metaverse cognitive therapy had shown promise in treating conditions such as post-traumatic stress disorders (PTSD) and anxiety disorders, offering controlled environments where patients can confront and manage their symptoms^16,17.

Potential benefits of metaverse-assisted interventions:

Metaverse-assisted interventions offer potential benefits that significantly enhance therapeutic outcomes. One of main advantages is the enhanced engagement and motivation provided by immersive environments. Conventional or traditional therapeutic methods often struggle to maintain patient engagement, leading to poor adherence and suboptimal outcomes. In contrast, metaverse environments can captivate patient’s attention and make therapy sessions more enjoyable, therefore improving adherence to the treatment protocols¹⁸. Additionally, gamification and interactive features embedded in the digital environments further motivate patients to participate actively in their rehabilitation, potentially leading to better outcomes¹⁹.

Personalization and adaptability are also critical benefits of metaverse technologies. These digital interventions can be tailored to meet the particular needs and preferences of patients, thus providing customized therapy sessions that address their challenges and goals. The adaptability of metaverse environments allows for modifications based on the patient progress, ensuring that all therapies remain relevant and effective over time²⁰. This level of personalization is relatively difficult to achieve with traditional therapeutic approaches and represents a significant advancement in patient-centered care. For instance, metaverse environments can be adjusted in real-time to match the cognitive or physical abilities of the patient, providing a scalable and flexible treatment option²¹. Furthermore, metaverse interventions have potential to be more accessible and cost-effective when compared to traditional therapies. Remote therapy sessions enabled by metaverse technologies can help reduce the need for travel and in-person visits, making it easier for the patients and their caregivers to access care regardless of their geographic location²². This accessibility is especially important for individuals with mobility issues or those living in remote areas. Scalability of digital interventions can lower costs related to therapy delivery, making them a viable option for a broader range of patients. Additionally, the ability to conduct therapy sessions at home, guided by digital environments, can reduce the strain on healthcare facilities and improve patient compliance and outcomes²³.

Existing evidence, gaps, and significant of the study:

A growing body of literature supports the use of metaverse tech in cognitive and physical therapy. Existing studies demonstrated the effectiveness of the interventions in improving various health outcomes. For example, metaverse cognitive therapies have been shown to enhance memory and executive functions in patients with cognitive impairments, including those with MCI complaints and dementia²⁴. Similarly, metaverse therapy programs have proven effective in improving motor function and reducing pain in those with CP and LBP issues^25,26. The studies highlight the potential of metaverse technologies to offer innovative solutions for complex health conditions.

Despite all these promising findings, several gaps in the current literature need to be addressed. There is variability in the study designs and intervention protocols, making it challenging to highlight definitive conclusions about the efficacy of interventions. Furthermore, while some studies focused on particular outcomes (e.g., pain reduction or cognitive enhancement), comprehensive evaluations that consider a range of outcomes, (e.g., mental health, quality of life, and patient satisfaction), are lacking^27,28. Addressing these gaps requires more robust, high-quality research to establish the efficacy and safety of metaverse-assisted rehabilitation or therapy.

The significance of this research lies in its potential to provide a more holistic understanding of the benefits and limitations of metaverse application in healthcare. By synthesizing existing evidence, this review aims to provide a comprehensive and unbiased analysis of the impact of these innovative digital interventions particularly on patients with MCI, CP, and LBP, in addition to informing clinical practice and guide future research directions, thus finally contributing to the development of more effective and accessible therapeutic interventions for the cognitive and physical health impairments. Therefore, the main objective of this systematic review is to evaluate the effectiveness of metaverse-assisted interventions in improving cognitive and physical health outcomes.

MATERIALS AND METHODS:

This study strictly adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting and reporting the systematic reviews and meta-analyses to ensure a comprehensive and unbiased synthesis of the available evidence.

Data source and search strategy:

A comprehensive literature search was conducted from 1 to 10 June 2024 across a number of databases, including PubMed, IEEE Xplore, ASME Digital Library, Web of Science, Cochrane Library, and Scopus. Detailed search strings using Boolean operators combined keywords related to Metaverse, therapy, rehabilitation, and therapeutic outcomes. The search strings included: (“metaverse”) AND (“therapy” OR “rehabilitation” OR “therapeutic outcomes”). This approach ensured the identification of studies evaluating the efficacy of metaverse-assisted interventions in improving cognitive and physical health outcomes. The searching process was limited to articles published in the last five years to capture the most recent evidence.

Eligible criteria:

The inclusion criteria for this review encompass randomized controlled trials (RCTs) that examine the effects of metaverse-assisted cognitive therapy or rehabilitation. The target population includes individuals diagnosed with cognitive impairment, such as mild cognitive impairment, as well as those with mental health problem. The interventions of interest are the metaverse-based cognitive therapy or rehabilitation, and the comparators primarily include traditional or conventional therapies, other non-pharmacological interventions, or standard cares. The main outcomes of interest are measures of cognitive function, including memory, attention, and executive function, along with mental health outcomes (i.e., anxiety and depression). The secondary outcomes include patient satisfaction, quality of life, and adherence to therapy. Meanwhile, the exclusion criteria were defined to refine the study selection. Studies not involving metaverse tech were excluded, as were non-English studies unless a comprehensive translation was available. Studies with insufficient data or lacking control groups were also excluded to ensure the quality and reliability of the included evidence.

Study selection:

The selection process of this study involved an initial screening of titles and abstracts to exclude irrelevant studies. This was followed by a full-text review of the remaining studies to determine the final inclusion based on the eligibility criteria. Any uncertainties were resolved through re-evaluation and additional searching if necessary. Meanwhile, the data management was facilitated utilizing a Mendeley reference management software to organize and manage citations efficiently.

Data extraction:

Data extraction of the study was performed comprehensively by the author using a standardized data extraction form. The extracted data mainly included general information and characteristics of the selected studies such as the authors, year of publication, originated countries, study design, sample size, age, gender, and diagnosis. Additionally, intervention details specified the type of metaverse interventions, its duration, frequency, primary and secondary outcomes, assessment tools utilized, and main findings. Additionally, results from the risk of bias assessment were recorded.

Data synthesis:

For data synthesis, a narrative synthesis was initially performed to describe the characteristics and findings of selected studies. Where applicable, thematic synthesis of the qualitative data was conducted. The quantitative synthesis, or meta-analysis, was performed when there was sufficient homogeneity among the studies in terms of interventions and outcomes. Random-effects or fixed-effects models were implemented depending on the level of heterogeneity. Measures of treatment effect included standardized mean differences (SMD) for the continuous outcomes and risk ratios (RR) or odds ratios (OR) for dichotomous outcomes, with corresponding 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic and Chi-squared test. Sensitivity analyses were conducted to outline the robustness of the findings, and subgroup analyses were performed based on many factors such as type of cognitive impairment, type of intervention, and study quality.

Risk of bias and quality assessment:

The quality assessment was performed using the Cochrane Risk of Bias Tool for RCT studies, which evaluates domains (e.g., selection bias, performance bias, detection bias, attrition bias, and reporting bias). The risk of bias assessment was performed by the author with careful consideration to minimize the subjectivity and ensure a rigorous evaluation of the included studies.

Ethical consideration:

This study is a systematic review and meta-analysis of existing research on metaverse-assisted interventions and does not involve direct interaction with human or animal subjects. As it analyzes data from previously published studies that have already undergone ethical review, no additional ethical approval is required.

RESULT:

The searching results of this study were documented and illustrated in the PRISMA flow diagram (Figure 1). The identification phase of this review involved a comprehensive search across various databases, yielding a total of 47 studies after duplicates were removed. Specifically, the searching strategy identified 2 records from PubMed database, 18 from IEEE Xplore, 2 from ASME digital library, none from Web of Science, 4 from Cochrane Library, and 37 from Scopus.

Moon et al. (2023) focused on the rehabilitation for children with CP using metaverse technology over a similar duration. The main outcome measure was gross motor function, evaluated through the GMFCS and performance logs. This study confirmed significant enhancements in the gross motor function, better engagement, and better task performance, with the mean GMFCS scores improving from 16.15 ± 3.16 to 17.43 ± 2.88. Lastly, Yu (2024) explored the impact of metaverse-assisted virtual yoga on patients with LBP complaints over eight weeks, with sessions held twice a week. The outcomes assessed primarily included levels of pain, anxiety, and depression, using the VAS and self-reported questionnaires. The findings had confirmed a significant reduction in pain, anxiety, and depression with the mean scores decreasing from 4.0 ± 0.75 to 2.5 ± 0.5. Additionally, high participant adherence and positive feedback underscored the intervention’s acceptability and effectiveness.

Meta-analysis of metaverse-assisted interventions:

The selected studies (Figure 3) present data on the post-test outcomes for both intervention and control groups. Moon et al. (2023) evaluated the impact of metaverse rehabilitation on children with CP, reporting mean GMFCS scores of 17.43 (SD = 2.88) for the intervention group and 16.15 (SD = 3.16) for the control group, with a SMD of 0.41 (95% CI: -0.37 to 1.19) and a contribution of 12.8% weight to overall analysis, indicating modest improvements in the intervention group. Meanwhile, Oh et al. (2023) investigated the cognitive therapy for MCI using a metaverse environment – finding mean MMSE-KC scores of 23.73 (SD = 3.72) in the intervention group and 21.68 (SD = 3.62) in the control group, resulting in an SMD of 0.55 (95% CI: 0.02 to 1.09) and a 27.2% weight contribution, suggesting the significant cognitive improvements. Yu (2024) focused on the virtual yoga sessions for LBP with the intervention group showing a mean pain level of 2.5 (SD = 0.5) compared to 4.0 (SD = 0.75) in the control group, yielding an SMD of -2.34 (95% CI: -2.70 to -1.98) and a substantial 60.0% weight contribution, confirming a significant reduction in the pain levels. This analysis included 142 study participants in both experimental and control groups, producing a total SMD of -1.20 (95% CI: -1.48 to -0.93), demonstrating a significant overall effect favoring the intervention groups despite high heterogeneity (I² = 98%, p < 0.00001).

Figure 3. Forest plot of standardized mean differences in metaverse interventions

The primary aim of this review was to evaluate the effectiveness of metaverse-based interventions in enhancing cognitive and physical health outcomes. The study systematically analyzed RCTs to determine the impact of these innovative interventions on patients with MCI, CP, and LBP issues. Metaverse-assisted interventions represent a significant advancement in the modern healthcare, providing immersive, engaging, and personalized therapeutic environments that potentially improve patient outcomes across a variety of medical conditions. The meta-analysis and studies included in this paper provide compelling evidence supporting the effectiveness of metaverse-based interventions. The forest plot summarizing the SMD illustrates significant improvements in the primary outcomes of cognitive function, motor skills, and pain management among the intervention groups compared to control groups.

The cognitive improvements observed in patients with MCI, as exhibited in the Oh et al.’s study, are particularly noteworthy²⁹. The study concluded that the participants in the intervention group showed significant enhancements in MMSE-KC scores, with a mean increase from 21.68 ± 3.62 to 23.73 ± 3.72. These results suggest that metaverse environments effectively stimulate cognitive functions, potentially through mechanisms such as increased engagement, interactive learning, and personalized feedback. In the contexts of motor function, Moon et al. (2023) confirmed substantial improvements in children with CP³⁰. The intervention group exhibited enhanced gross motor function, as measured by GMFCS with mean scores rising from 16.15 ± 3.16 to 17.43 ± 2.88. These findings highlight the benefits of metaverse-assisted therapy, which offers interactive and motivating environments for the physical rehabilitation, thereby increasing patient engagement and adherence to therapeutic regimens. For patients with LBP issues, Yu (2024) found significant reductions in the pain, anxiety, and depression following the virtual yoga sessions³¹. The intervention group reported a decrease in the mean pain levels from 4.0 ± 0.75 to 2.5 ± 0.5 followed by positive feedback and high adherence rates. The outcomes highlight the potential of metaverse tech interventions to provide effective pain management solution and improve mental health problems, possibly due to the immersive and relaxing nature of the virtual yoga sessions.

The findings of this paper align with existing literature on the digital and metaverse interventions in healthcare, confirming and extending previous research. The studies have consistently shown that virtual metaverse helps enhance cognitive and physical therapy outcomes by providing engaging and interactive environments^32,33. This study adds to the growing body of evidence by showing the specific benefits of metaverse-assisted interventions across a range of conditions, highlighting their contributions to the field including the comprehensive analysis of the interventions for diverse health conditions and the detailed examination of their efficacy through rigorous RCT studies. By focusing on cognitive, motor, and pain-related outcomes, this study provides novel insights into the broad applicability and potential mechanisms of these digital interventions, suggesting that the metaverse can serve as a versatile platform for various therapeutic purposes.

The effectiveness of metaverse tech-based interventions can be attributed to several key mechanisms of action. Immersion and engagement play a crucial role, as the nature of virtual environments can captivate patient’s attention and encourage active participation in therapeutic activities^34-36. This engagement can lead to improved levels of adherence to treatment protocols and better therapeutic outcomes. Additionally, personalization and adaptability are other critical factors. Digital metaverse environments can be tailored to meet patient’s needs, providing customized therapy sessions that address specific challenges and preferences. This personalization helps enhance the effectiveness of interventions by ensuring that they are relevant and engaging for each patient, thus leading to more meaningful and sustained improvements in health outcomes^37-39.

Practical implications:

The practical implications of the study findings are substantial. In clinical settings, metaverse-based interventions can be integrated into the standard treatment protocols to provide patients with innovative and effective therapy options. For example, cognitive therapy for MCI, motor therapy for CP, and pain management for LBP can all benefit from the use of metaverse technology, which offer engaging and personalized therapeutic experiences. Additionally, the metaverse environments hold promise for training and education in healthcare settings. These digital approaches can be utilized to train healthcare professionals, providing them with realistic and immersive simulations to enhance their skills and knowledge. As a result, it can lead to improved patient cares and outcomes, as well-trained professionals are better equipped to deliver effective interventions ^40-42.

Strengths and limitations of the study:

The strengths of this review include its innovative approach, rigorous methodology, and broad applicability. The use of metaverse environments in therapeutic interventions represents a cutting-edge model that offers new avenues for non-pharmacological rehabilitations. All the included RCTs were designed, employing standardized assessment tools and comprehensive outcome measures to ensure the reliability and validity of the study findings. However, a number of limitations should be acknowledged. The study limitations mainly include small sample sizes, short follow-up durations, and potential biases in participant selection, which may affect the generalizability of the study results. Additionally, the meta-analysis study exhibited high heterogeneity (I² = 98%), explaining considerable variability in effect sizes across studies. This heterogeneity may impact the overall interpretation of the results, necessitating cautious consideration of the findings⁴³.

Future research directions:

Future research should aim to address all these limitations by conducting long-term studies with larger sample sizes to validate the findings. Further exploration of the benefits and mechanisms of metaverse interventions is warranted, with a focus on understanding how the technologies can be optimized for different patient populations and conditions. Technological advancements will likely play a significant role in the evolution of metaverse-based interventions. The integration of emerging technologies such as artificial intelligence and machine learning can enhance the adaptability and personalization of the virtual environments, leading to even more effective and engaging therapeutic experiences⁴⁴. Future studies should also explore the potential of these advancements to further improve patient outcomes.

CONCLUSION:

The findings of this study confirm the significant potential of metaverse-assisted interventions to revolutionize healthcare settings by providing the immersive, engaging, and personalized therapeutic environments. The substantial improvements observed in cognitive functions, motor skills, and pain management highlight the efficacy of these digital interventions across a range of health conditions. Continued research and development in this area are essential to fully realize the transformative potential of integrating metaverse tech into the therapeutic practices, enhancing patient care and outcomes.

CONFLICT OF INTEREST:

The author has no conflicts of interest regarding this investigation.

ACKNOWLEDGMENTS:

The author would like to extend his deepest gratitude to the School of Pharmacy, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, for their unwavering support and resources that significantly contributed to the success of this paper. Additionally, the heartfelt appreciation goes to the 1984-EL research team for their contributions, dedication, and collaborative efforts throughout the project.

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Received on 09.07.2024 Revised on 14.12.2024

Accepted on 17.04.2025 Published on 01.12.2025

Available online from December 06, 2025

Research J. Pharmacy and Technology. 2025;18(12):5709-5717.

DOI: 10.52711/0974-360X.2025.00824

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Author(s)	Country	Study Design	Sample	Age	Gender	Diagnosis
Oh et al. (2023)²⁹	South Korea	RCT	56	74.23 ± 7.50 (I); 71.45 ± 3.95 (C)	M: 8 (I), 3 (C); F: 23 (I), 22 (C)	MCI
Moon et al. (2023)³⁰	South Korea	RCT	26	17.43 ± 2.88 (I); 16.15 ± 3.16 (C)	M: 6 (I), 6 (C); F: 7 (I), 7 (C)	CP
Yu (2024)³¹	South Korea	RCT	202	38.71 ± 7.63 (I); 39.00 ± 7.57 (C)	M: 51 (I), 49 (C); F: 48 (I), 51 (C);	LBP

Author(s)	Intervention	1^st Outcomes	2^nd Outcomes	Tools	Main Findings
Oh et al. (2023)²⁹	Cognitive Therapy for MCI; 4 weeks twice a week.	MMSE-KC scores	Performance time, hints used, items picked up, correct/incorrect answers	MMSE-KC, data logs from VR content	Significant improvement in MMSE-KC scores for MCI group (Mean (SD) score before was 21.68 ± (3.62) while after was 23.73 ± (3.72)), reduced performance time, fewer hints used, more correct items picked up.
Moon et al. (2023)³⁰	Rehabilitation for Cerebral Palsy; 4 weeks twice a week.	Gross Motor Function	Time on task, engagement	GMFCS, performance logs	Improved gross motor function in CP patients (Mean (SD) score before was 16.15 ± (3.16) while after was 17.43 ± (2.88)), increased engagement, and better task performance.
Yu (2024)³¹	Yoga for Low Back Pain; 8 weeks Twice a week	Pain, Anxiety, Depression	Participant feedback, adherence	VAS, self-reported questionnaires	Reduction in pain levels, decreased anxiety and depression or VAS (Mean (SD) score before was 4 ± (0.75) while after was 2.5 ± (0.5)), high adherence and positive feedback from participants.