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Although multimodal therapy, including physiotherapy, behavioural therapy\/psychotherapy and education is recommended, implementation is limited due to shortcomings in healthcare delivery. Digital solutions such as virtual reality (VR) could offer possibilities to address these shortcomings and become increasingly common. However, the evidence base for VR in chronic LBP is conflicting. Nine existing meta-analyses show substantial variance in effect sizes, ranging from SMD 0.07 to 8.15, due to heterogeneity in population, interventions and outcome measurements, with most often limited quality of evidence. Therefore, a high-quality systematic review focussing on chronic primary LBP, incorporating mechanisms of action and state-of-the-art meta-analysis is warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We will conduct a systematic review, employing a comprehensive and sensitive search strategy in all relevant databases. We will include randomised controlled studies that investigate the effects of virtual reality versus other interventions (active and non-active) or no intervention on physical functioning, pain intensity and health related quality of life in patients with chronic primary low back pain. We will assess risk of bias with the Cochrane risk of bias tool 2 (RoB2) and certainty of the evidence with GRADE criteria. We will use a random-effects model for all statistical analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This systematic review will provide trustworthy evidence about the effects of VR in chronic primary low back pain by employing rigorous methods of search string development, comprehensive database search, quality evaluation and control, data extraction, documentation and analysis incorporating theory of change. Anticipated intervention heterogeneity will be addressed by pre-specified subgroup analyses and appropriate methods of meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>PROSPERO 2025 CRD420251250648<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13643-026-03307-6","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T10:42:49Z","timestamp":1787913769000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Virtual reality for chronic primary low back pain in adults: systematic review protocol"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4222-1605","authenticated-orcid":false,"given":"Axel","family":"Sch\u00e4fer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Kaiser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Elser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kopkow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Elsner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"3307_CR1","unstructured":"WHO. 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