Each study eligible for data extraction was tested against CASP criteria [11] for critical appraisal and Robvis [12] for risk of bias before continuing with data synthesis.

Due to the heterogeneous data and methodology in the eligible articles, statistical analysis was not possible, and a narrative analysis was performed. Data extracted included specialty of focus (i.e. knee, hip, shoulder), participant number and level of training, VR simulator model, the simulated task and assessment, outcome measures and main conclusions drawn through study results.