Search methods for identification of studies

Searches for eligible studies were conducted through online databases, including Medline, the Cochrane Library and Embase.

Search terms included virtual reality, VR, computer simulation, orthop*, arthrop* and surgery, and were appropriately altered and expanded upon for each database (Table (Table1).1). Additionally, the reference lists of identified studies were screened, as well as previous relevant systematic reviews [9, 10]. Titles, abstracts and subsequently full papers were screened for relevancy and data extraction.

Databases and according search strategy

1. ((((virtual reality[MeSH Terms]) OR virtual realt*[Title/Abstract]) OR computer simulation[MeSH Terms]) OR virtual simulat*[Title/Abstract]) OR vr[Title/Abstract]

2. (((((orthopedic[MeSH Terms]) OR arthroplasty[MeSH Terms]) OR arthroplasty, replacement, hip[MeSH Terms]) OR arthroplasty, replacement, knee[MeSH Terms]) OR shoulder[MeSH Terms]) OR spine[MeSH Terms]

3. Surgery

4. (((((((activities, training[MeSH Terms]) OR academic training[MeSH Terms]) OR training) OR activities, educational[MeSH Terms]) OR education) OR trainees) OR task performances, analysis[MeSH Terms]) OR clinical competence[MeSH Terms]

5. #1 AND #2 AND #3 AND #4

1. MeSH [Virtual Reality] explode all trees

2. MeSH [Computer Simulation] this term only

3. MeSH [Orthopedics] explode all trees

4. MeSH [Arthropathy, Neurogenic] in all MeSH products

5. VR OR Computer Instruction

6. Shoulder OR knee OR hip OR spine OR elbow

7. Surgery

8. #1 OR #2 OR #5

9. #3 OR #4 OR #6

10. #8 AND #9 AND #7

1. Virtual reality

2. Virtual reality simulator

3. Computer simulation

4. VR

5. Ortho*

6. Arthro*

7. Knee

8. Shoulder

9. Elbow

10. Spine

11. Ankle

12. Training or Surgical training or Simulation training

13. Trainees or student or resident

14. Task performance

15. Virtual reality OR virtual reality simulator OR computer simulation OR VR

16. Orthop* OR arthro* OR knee OR shoulder OR elbow OR spine OR ankle

17. Training or surgical training or simulation training OR trainees or student OR task performance

18. #15 AND #16 AND #17