BACKGROUND: Chronic spinal pain (CSP) is a major global health challenge. Virtual reality-based training (VRBT) shows promise as a complementary intervention for exercise therapy (ET). OBJECTIVE: This review aimed to provide conclusive evidence on the effectiveness of ET with and without the incorporation of VRBT for CSP. METHODS: We systematically searched six electronic databases for relevant randomized controlled trials (RCTs) available to July 1, 2024. Two independent reviewers conducted the literature screening, quality assessment, and data extraction processes. Quantitative syntheses used Review Manager 5.4 and Stata 15.1. RESULTS: This analysis included 14 RCTs encompassing 554 participants. Incorporating VRBT into ET significantly enhanced the efficacy of ET for pain intensity and kinesiophobia both immediately after the intervention phase (MD -1.29, 95% CI -1.83 to -0.75, p < 0.001; SMD -1.04, 95% CI -1.95 to -0.13, p < 0.001) and at follow-up (MD -1.44, 95% CI -2.60 to -0.29, p = 0.01; SMD -1.85, 95% CI -3.54 to -0.15, p = 0.03). For disability, ET with VRBT showed significantly greater efficacy only immediately after the intervention phase (SMD -1.02, 95% CI -1.92 to -0.13, p = 0.02). Descriptive analyses showed that VRBT can further enhance the effectiveness of ET in reducing depression and anxiety, key components of negative emotions. However, this study faced limitations such as high heterogeneity (I2 > 90%) and relatively short follow-up durations (up to six months), which may impact the generalizability of these findings. CONCLUSIONS: Current evidence suggests that VRBT can serve as a valuable complement to ET, providing additional benefits for CSP patients, particularly in pain management, functional rehabilitation, and psychological intervention targeting kinesiophobia and negative emotions.

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