Introduction: This review and meta-analysis aimed to examine the effects of virtual reality (VR) therapy on lymphedema and disability management in post-mastectomy breast cancer patients, following PRISMA protocol. Methods: Databases were extensively searched, including Wiley Online Library, ProQuest, MEDLINE, CINAHL, Google Scholar, Science Direct, and SAGE Journals, covering studies from January 2016 to August 2024. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Nine studies met the inclusion criteria. The findings indicate VR therapy effectively reduces post-mastectomy lymphedema and aids upper limb disability rehabilitation, with sessions lasting 10–50 min. The meta-analysis statistics showed a significant decrease in disability, measured by the disability of the arm, shoulder, and hand (DASH) scale, with an effect size of −0.931 (Z score = −2.713, p = 0.007) and a 95% confidence interval of −1.604 to −0.259. Conclusions: These results strongly support VR’s efficacy in managing lymphedema and disability, recommending its integration into routine care at oncology centers and hospitals. This article explains compelling evidence that VR is effective in helping patients with lymphedema manage their disabilities. Rehabilitation programs using VR after mastectomy should be incorporated into the daily care in oncology centers and hospitals. Further interventional studies are needed to strengthen evidence and refine VRs clinical application.

Journal Section:
Systematic Review
Keywords:
Lymphedema, Virtual reality, Breast cancer, Disability, Mastectomy, Meta-analysis
1.
Fu
MR
,
Aouizerat
BE
,
Yu
G
,
Conley
Y
,
Axelrod
D
,
Guth
AA
, et al.
Model-based patterns of lymphedema symptomatology: phenotypic and biomarker characterization
.
Curr Breast Cancer Rep
.
2021
;
13
:
1
–
18
.
Google Scholar
 
2.
Greene
AK
,
Goss
JA
, editors.
Diagnosis and staging of lymphedema. Seminars in plastic surgery
.
Thieme Medical Publishers
;
2018
.
Google Scholar
 
3.
Allam
O
,
Park
KE
,
Chandler
L
,
Mozaffari
MA
,
Ahmad
M
,
Lu
X
, et al.
The impact of radiation on lymphedema: a review of the literature
.
Gland Surg
.
2020
;
9
(
2
):
596
–
602
.
Google Scholar
 
4.
Jo
Y-J
,
Lee
S-Y
.
The effects of Proprioceptive Neuromuscular Facilitation (PNF) using elastic bands on edema, range of motion, and pain in post-mastectomy patients with upper limb lymphedema: differences between open-hand and closed-hand grips
.
2020
;
18
(
1
):
1
–
10
.
Google Scholar
 
5.
Arnold
M
,
Morgan
E
,
Rumgay
H
,
Mafra
A
,
Singh
D
,
Laversanne
M
, et al.
Current and future burden of breast cancer: global statistics for 2020 and 2040
.
Breast
.
2022
;
66
:
15
–
23
.
Google Scholar
 
6.
Bray
F
,
Laversanne
M
,
Sung
H
,
Ferlay
J
,
Siegel
RL
,
Soerjomataram
I
, et al.
Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries
.
CA Cancer J Clin
.
2024
;
74
(
3
):
229
–
63
.
Google Scholar
 
7.
Fu
MR
,
McTernan
ML
,
Qiu
JM
,
Miaskowski
C
,
Conley
YP
,
Ko
E
, et al.
Co-Occurring fatigue and lymphatic pain incrementally aggravate their negative effects on activities of daily living, emotional distress, and overall health of breast cancer patients
.
Integr Cancer Ther
.
2022
;
21
:
15347354221089605
.
Google Scholar
 
8.
Shamoun
S
,
Ahmad
M
.
Complete decongestive therapy effect on breast cancer related to lymphedema: a systemic review and meta-analysis of randomized controlled trials
.
Asian Pac J Cancer Prev
.
2023
;
24
(
7
):
2225
–
38
.
Google Scholar
 
9.
Simran
C
,
Kajal
S
,
Karishama
C
.
Recent trends and growing knowledge about physiotherapy mangement in breast cancer-related lymphedema
.
Int J convergence Healthc
.
2023
;
3
(
1
):
15
.
Google Scholar
 
10.
Ahmad
M
,
Bani Mohammad
E
,
Anshasi
HA
.
Virtual reality technology for pain and anxiety management among patients with cancer: a systematic review
.
Pain Manag Nurs
.
2020
;
21
(
6
):
601
–
7
.
Google Scholar
 
11.
Atef
D
,
Elkeblawy
MM
,
El-Sebaie
A
,
Abouelnaga
WAI
.
A quasi-randomized clinical trial: virtual reality versus proprioceptive neuromuscular facilitation for postmastectomy lymphedema
.
J Egypt Natl Canc Inst
.
2020
;
32
(
1
):
29
–
9
.
Google Scholar
 
12.
Zhou
Z
,
Li
J
,
Wang
H
,
Luan
Z
,
Li
Y
,
Peng
X
.
Upper limb rehabilitation system based on virtual reality for breast cancer patients: development and usability study
.
PLoS One
.
2021
;
16
(
12
):
e0261220
.
Google Scholar
 
13.
Klein
I
,
Kalichman
L
,
Chen
N
,
Susmallian
S
.
Effect of physical activity levels on oncological breast surgery recovery: a prospective cohort study
.
Sci Rep
.
2021
;
11
(
1
):
10432
.
Google Scholar
 
14.
Ryans
K
,
Perdomo
M
,
Davies
CC
,
Levenhagen
K
,
Gilchrist
L
.
Rehabilitation interventions for the management of breast cancer: related lymphedema: developing a patient-centered, evidence-based plan of care throughout survivorship
.
J Cancer Surviv
.
2021
;
17
:
237
–
45
.
Google Scholar
 
15.
Human Rights Code. RSOc H.19 1990 [cited 2023 16 July 2023.]. Available from: http://canlii.ca/t/532d6
16.
Moher
D
,
Liberati
A
,
Tetzlaff
J
,
Altman
D
;
PRISMA Group
.
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
.
Int J Surg
.
2010
;
8
(
5
):
336
–
41
.
Google Scholar
 
17.
Aromataris
E
,
Munn
Z
.
JBI manual for evidence synthesis
.
Joanna Briggs Institute
;
2020
.
Google Scholar
 
18.
Aguirre-Carvajal
M
.
Psychological and functional effects in mastectomized patients treated with virtual reality
.
Cancer Ther Oncol Int J
.
2018
;
9
(
3
):
84
–
8
.
Google Scholar
 
19.
Basha
MA
,
Aboelnour
NH
,
Alsharidah
AS
,
Kamel
FH
.
Effect of exercise mode on physical function and quality of life in breast cancer–related lymphedema: a randomized trial
.
Support Care Cancer
.
2022
;
30
(
3
):
2101
–
10
.
Google Scholar
 
20.
Feyzioğlu
Ö
,
Dinçer
S
,
Akan
A
,
Algun
ZC
.
Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery
.
Support Care Cancer
.
2020
;
28
(
9
):
4295
–
303
.
Google Scholar
 
21.
Harfoush
MS
,
Mohamed Abdelrasol
ZF
,
Anan
ERM
,
Rashad Elsakka
EA
.
Effect of virtual reality-based rehabilitation program versus booklet-based education on self-care practices and prevention of complications among women after mastectomy
.
Tanta Scientific Nurs J
.
2023
;
30
(
3
):
168
–
84
.
Google Scholar
 
22.
House
G
,
Burdea
G
,
Grampurohit
N
,
Polistico
K
,
Roll
D
,
Damiani
F
, et al.
A feasibility study to determine the benefits of upper extremity virtual rehabilitation therapy for coping with chronic pain post-cancer surgery
.
Br J Pain
.
2016
;
10
(
4
):
186
–
97
.
Google Scholar
 
23.
Piejko
L
,
Niewolak
K
,
Fielek
D
,
Pecyna
P
,
Chełminiak
D
,
Zieliński
P
, et al.
Medical resort treatment extended with modern feedback exercises using virtual reality improve postural control in breast cancer survivors. Preliminary study
.
Acta Balneologica
.
2020
;
160
(
2
).
Google Scholar
 
24.
Yassa
ARS
,
NadyAshem
H
,
Abd El Ghani
SE
,
Mogahed
HGH
.
Pilates exercise versus virtual reality on upper limb dysfunction post mastectomy
.
Afr J Biol Sci
.
2024
.
Google Scholar
 
25.
Elkins
MR
,
Moseley
AM
,
Sherrington
C
,
Herbert
RD
,
Maher
CG
.
Growth in the Physiotherapy Evidence Database (PEDro) and use of the PEDro scale
.
Br J Sports Med
.
2013
;
47
(
4
):
188
–
9
.
Google Scholar
 
26.
Cashin
AG
,
McAuley
JH
.
Clinimetrics: physiotherapy evidence database (PEDro) scale
.
J Physiother
.
2020
;
66
(
1
):
59
.
Google Scholar
 
27.
IBM
.
IBM SPSS statistics for windows, version 29.1
.
Armonk (NY)
:
IBM Corp
;
2023
.
28.
Bernas
M
,
Thiadens
SR
,
Stewart
P
,
Granzow
J
.
Secondary lymphedema from cancer therapy
.
Clin Exp Metastasis
.
2022
;
39
(
1
):
239
–
47
.
Google Scholar
 
29.
Byun
HK
,
Chang
JS
,
Im
SH
,
Kirova
YM
,
Arsene-Henry
A
,
Choi
SH
, et al.
Risk of lymphedema following contemporary treatment for breast cancer: an analysis of 7617 consecutive patients from a multidisciplinary perspective
.
Ann Surg
.
2021
;
274
(
1
):
170
–
8
.
Google Scholar
 
30.
Shamoun
S
,
Ahmad
M
.
Literature review on breast cancer-related lymphedema and related factors
.
Arch Oncol
.
2023
;
29
(
2
):
22
–
7
.
Google Scholar
 
31.
Kuruvilla
AS
,
Krajewski
A
,
Li
X
,
Yang
J
,
Mulay
SR
,
Agha
SM
, et al.
Risk factors associated with postmastectomy breast cancer lymphedema: a multicenter retrospective analysis
.
Ann Plast Surg
.
2022
;
88
(
3 Suppl 3
):
S239
–
45
.
Google Scholar
 
32.
Mohamed
MH
,
Radwan
RE
,
ElMeligie
MM
,
Ahmed
A
,
Sakr
HR
,
ElShazly
M
.
The impact of lymphedema severity on shoulder joint function and muscle activation patterns in breast cancer survivors: a cross-sectional study
.
Support Care Cancer
.
2024
;
33
(
1
):
37
.
Google Scholar
 
33.
Pradhan
P
,
Sharman
AR
,
Palme
CE
,
Elliott
MS
,
Clark
JR
,
Venchiarutti
RL
.
Models of survivorship care in patients with head and neck cancer in regional, rural, and remote areas: a systematic review
.
J Cancer Surviv
.
2024
:
1
–
18
.
Google Scholar
 
34.
Bevilacqua
R
,
Maranesi
E
,
Riccardi
GR
,
Donna
VD
,
Pelliccioni
P
,
Luzi
R
, et al.
Non-immersive virtual reality for rehabilitation of the older people: a systematic review into efficacy and effectiveness
.
J Clin Med
.
2019
;
8
(
11
):
1882
.
Google Scholar
 
35.
Moreira
ARC
.
Dynamic analysis of upper limbs movements after breast cancer surgery
.
2014
.
Google Scholar
 
36.
Nerini
C
,
Burk
S
,
Andretta
E
,
Chirico
A
,
Giordano
A
.
The effects of virtual reality on pain and anxiety in pediatric oncology patients
.
Res
.
2024
;
04
(
01
):
29
.
Google Scholar
 
37.
Lee
K
,
Lee
S
,
Kim
J
.
Wound pain management: the present and the future
.
J Wound Manag Res
.
2024
;
20
(
3
):
199
–
211
.
Google Scholar
 
38.
Melillo
A
,
Chirico
A
,
De Pietro
G
,
Gallo
L
,
Caggianese
G
,
Barone
D
, et al.
Virtual reality rehabilitation systems for cancer survivors: a narrative review of the literature
.
Cancers
.
2022
;
14
(
13
):
3163
.
Google Scholar
 
39.
El-Sayed
D
,
Khalaf
M
,
Hussein
M
.
Psychometric properties of Arabic version of the modified QuickDASH-9 scale to measure the quality of recovery after dorsal hand burn injury
.
Int J Pharmtech Res
.
2016
;
9
(
8
):
09
–
15
.
Google Scholar
 
40.
Zeng
Y
,
Zhang
J-E
,
Cheng
AS
,
Cheng
H
,
Wefel
JS
.
Meta-analysis of the efficacy of virtual reality–based interventions in cancer-related symptom management
.
Integr Cancer Ther
.
2019
;
18
:
1534735419871108
.
Google Scholar
 
41.
Bani Mohammad
E
,
Ahmad
M
.
Virtual reality as a distraction technique for pain and anxiety among patients with breast cancer: a randomized control trial
.
Palliat Support Care
.
2019
;
17
(
1
):
29
–
34
.
Google Scholar
 
42.
Ahmad
M
,
Bani Mohammad
E
,
Tayyem
E
,
Al Gamal
E
,
Atout
M
.
Pain and anxiety in patients with breast cancer treated with morphine versus tramal with virtual reality
.
Health Care Women Int
.
2023
;
45
(
7
):
782
–
95
.
Google Scholar
 
43.
Buche
H
,
Michel
A
,
Piccoli
C
,
Blanc
N
.
Contemplating or acting? Which immersive modes should be favored in virtual reality during physiotherapy for breast cancer rehabilitation
.
Front Psychol
.
2021
;
12
:
631186
.
Google Scholar
 
44.
Yazdipour
AB
,
Saeedi
S
,
Bostan
H
,
Masoorian
H
,
Sajjadi
H
,
Ghazisaeedi
M
.
Opportunities and challenges of virtual reality-based interventions for patients with breast cancer: a systematic review
.
BMC Med Inform Decis Mak
.
2023
;
23
(
1
):
17
–
6
.
Google Scholar
 
© 2025 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2025
You do not currently have access to this content.