Orthopedics · Medical Literature
The effectiveness of virtual reality-based exercises in patients with symptomatic knee osteoarthritis: randomized controlled study.
Abstract
The aim of this study was to investigate the effectiveness of adding non-immersive virtual reality-based exercise to a conventional rehabilitation program for pain, functionality, balance, and quality of life in patients with knee osteoarthritis. This randomized controlled clinical trial involved 60 patients. Measurements were taken before and after treatment (at week 3). Visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, and the Short Form-36 were measured. Postural Stability- Dynamic Overall Stability Index, Functional Reach Composite Score, and Clinical Test of Sensory Interaction on Balance-Composite Score were recorded using the Biodex Balance System. In both groups, statistically significant improvements were observed in visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, the Short Form-36 Physical Functioning, Postural Stability-Dynamic Overall Stability Index, Functional Reach Composite Score, and Clinical Test of Sensory Interaction on Balance-Composite Score scores in the post-intervention period (p<0.001). In both groups, statistically significant improvements were observed in all Short Form-36 subscales [Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health were observed during the post-intervention period (p<0.001)]. In the two-way mixed-methods repeated-measures analysis of variance analysis, the time effect was found to be significant in all Short Form-36 subdimensions (p<0.001). The group-time interaction was not significant in the "Role Physical" and "Mental Health" subdimensions (p=0.151 and p=0.604, respectively). The addition of virtual reality-based exercise to results in greater reductions in pain levels and improvements in disease-specific functional status and overall physical function, postural stability, dynamic balance, and sensory integration. Further improvements in quality of life across all subscales except for physical role limitations and mental health.
Clinical relevance
Knee osteoarthritis is among the most prevalent musculoskeletal conditions globally, causing chronic pain, functional decline, and reduced quality of life, yet optimal adjunctive rehabilitation strategies remain debated. This RCT addresses the gap regarding whether non-immersive virtual reality (VR)-based exercise adds meaningful clinical benefit over conventional rehabilitation alone in symptomatic knee OA patients. Given the growing accessibility of VR platforms in outpatient and physiotherapy settings, these findings are timely for orthopedic and rehabilitation specialists seeking evidence-based technology integration.
Key findings
1. In a 3-week RCT of 60 patients with symptomatic knee OA, both the VR-augmented and conventional rehabilitation groups demonstrated statistically significant improvements in pain (VAS), disease-specific function (WOMAC), and physical quality of life (SF-36 Physical Functioning) post-intervention (p<0.001 for all). 2. Postural stability (Biodex Postural Stability–Dynamic Overall Stability Index), dynamic balance (Functional Reach Composite Score), and sensory integration (Clinical Test of Sensory Interaction on Balance–Composite Score) showed statistically significant improvements in both groups after 3 weeks of intervention (p<0.001). 3. All eight SF-36 subscales (Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health) demonstrated statistically significant within-group improvements in both arms during the post-intervention period (p<0.001). 4. Two-way mixed-methods repeated-measures ANOVA revealed a significant time effect across all SF-36 subdimensions (p<0.001); however, the group-by-time interaction was not statistically significant for the 'Role Physical' (p=0.151) and 'Mental Health' (p=0.604) subscales, indicating comparable gains between groups in these domains. 5. The addition of non-immersive VR-based exercise to conventional rehabilitation produced superior outcomes in pain reduction, disease-specific functional status, overall physical function, postural stability, dynamic balance, and sensory integration compared to conventional rehabilitation alone, with significant group-time interactions observed across these domains. 6. No quantitative between-group effect sizes, confidence intervals, NNT, or NNH values were reported in the abstract, limiting precise magnitude-of-benefit estimation for these superior VR-associated outcomes.
Practice implications
Orthopedic and rehabilitation clinicians should consider incorporating non-immersive VR-based exercise as an adjunct to conventional rehabilitation programs for patients with symptomatic knee OA, particularly to target pain, functional status, postural stability, and dynamic balance, where augmented benefit over standard care was demonstrated within as little as 3 weeks. Patient selection should prioritize those with deficits in sensory integration and balance, as the Biodex-measured outcomes suggest mechanistic benefit in proprioceptive and neuromuscular domains; however, clinicians should not expect VR augmentation to confer additional benefit over conventional therapy for physical role limitations or mental health components of quality of life. Pending future trials with longer follow-up, larger samples, and reported effect sizes and confidence intervals, VR-based exercise should be regarded as a promising but not yet fully quantified adjunct, and treatment decisions should continue to incorporate individualized patient goals, technology availability, and cost-effectiveness considerations.