Effectiveness of Virtual Reality-Based Balance Training Following Total Knee Replacement: A Review of Randomized Trials
Keywords:
N\AAbstract
Background: According to recent Indian surveys, the prevalence of primary knee OA is high. A higher incidence of OA is consistently linked to female gender, age, and a higher BMI. Total Knee Replacement (TKR) is a common surgical option when conservative treatment options such as medication, physical therapy, and lifestyle modifications are ineffective. TKR alongwith physiotherapy is required for faster healing in such patients. Here we are comparing the effect of Virtual Reality (VR)- based rehabilitation and high-intensity exercise program for Total Knee Arthroplasty (TKA).
Methods: In this randomised controlled trial, 60 participants matched the inclusion criteria who underwent Total Knee Replacement (TKR). The study was conducted for a period of 12 months from June 2024 to May 2025. The participants were randomly allotted to VR group (n=30) and a conventional group-high-intensity exercises (n=30). Outcome measures used are the Numeric Pain Rating Scale (NPRS) pain scale, knee range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go (TUG) test.
Result: There were significant changes in within-group differences between the experimental group and the conventional group. The range of mobility demonstrated superior results in VR-based rehabilitation compared to indifferently supporting the experimental group's pain outcome (p≥0.0001), however the numerical Pain Rating Scale substantially showed no differences between the groups. The experimental group outperformed the conventional group in terms of balance, gait, and functional activities, and the patient's functional independence was attained in nine weeks with VR-based rehabilitation as opposed to high-intensity (HI) exercises.
Conclusion: The VR-based rehabilitation showed better outcomes in pain, range of motion, balance, gait and functional independence than a high-intensity exercise programme.
Downloads
Metrics
References
Reid CR, Bush PM, Cummings NH, McMullin DL, Durrani SK. A review of occupational knee disorders. J Occup Rehabil. 2010;20(4):489-501.
Wang Y, Chu M, Rong J, Xing B, Zhu L, Zhao Y, et al. No association of the single nucleotide polymorphism rs8044769 in the fat mass and obesity-associated gene with knee osteoarthritis risk and body mass index: A population-based study in China. Bone & Joint Research. 2016;5(5):169-74.
Yadav R, Verma AK, Uppal A, Chahar HS, Patel J, Pal CP. Prevalence of primary knee osteoarthritis in the urban and rural population in India. Indian Journal of Rheumatology. 2022;17(3):239-43.
Thati S. Gender differences in osteoarthritis of knee: An Indian perspective. Journal of Mid-life Health. 2021;12(1):16-20.
Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. E Clinical Medicine. 2020;29-30:100587.
Holden MK, Dyar T. Virtual environment training-a new tool for neurorehabilitation? Neurol Report 2002;26(2):62-71.
Adamovich SV, Fluet GG, Tunik E, Merians AS. Sensorimotor training in virtual reality: a review. Neuro Rehabilitation 2009;25(1):29-44.
Esculier JF, Vaudrin J, Beriault P, Gagnon K, Tremblay LE. Home-based balance training programme using Wii Fit with balance board for Parkinson's disease: a pilot study. Journal of Rehabilitation Medicine. 2012;44(2):144-50.
Bade MJ, Struessel T, Dayton M, Foran J, Kim RH, Miner T, et al. Early highintensity versus low-intensity rehabilitation after total knee arthroplasty: A randomised controlled trial. Arthritis Care & Research. 2017;69(9):1360-68.
Stratford PW, Kennedy DM, Woodhouse LJ, Spadoni GF. Measurement properties of the WOMAC LK 3.1 pain scale. Osteoarthritis and Cartilage. 2007;15(3):266-72.
Yu J-H, Nekar DM, Kang H-Y, Lee J-W, Oh S-Y. Comparison of Physical Activity Training Using Augmented Reality and Conventional Therapy on Physical Performance following a Total Knee Replacement: A Randomized Controlled Trial. Appl Sci. 2023;13:894.
Bini S, Mahajan J. Clinical outcomes of remote asynchronous telerehabilitation are equivalent to traditional therapy following total knee arthroplasty: a randomized control study. J Telemed Telecare. 2017;23:239–47.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of [37] the hip or knee. J Rheumatol. 1988;15:1833-40.
Shahrbanian S, Ma X, Aghaei N, Korner-Bitensky N, Moshiri K, Simmonds MJ. Use of virtual reality (immersive vs. non immersive) for pain management in children and adults: A systematic review of evidence from randomised controlled trials. Eur J Exp Biol. 2012;2(5):1408-22.
Huang Q, Lin J, Han R, Peng C, Huang A. Using virtual reality exposure therapy in pain management: A systematic review and meta-analysis of randomised controlled trials. Value in Health. 2022;25(2):288-301.
Garcia-Sanchez M, Garcia-Robles P, Osuna-Perez MC, Lomas-Vega R, Obrero Gaitan E, Cortes-Perez I. Effectiveness of virtual reality-based early postoperative rehabilitation after total knee arthroplasty: A systematic review with meta-analysis of randomised controlled trials. Applied Sciences. 2023;13(7):4597.
Nishitha K, Anitha A, Thaheera D. Effectiveness of Virtual Reality-based Rehabilitation and High-intensity Exercise Program for Total Knee Arthroplasty Patients: A Randomised Controlled Trial. Journal of Clinical & Diagnostic Research. 2024 Nov 1;18(11).
Shaheen AA, Algabbani MF, Alshahrani MM, Alshahrani FA, Alsobayel HI, Omar MT, et al. Efficacy of virtual reality-based rehabilitation following total knee replacement: a systematic review and meta-analysis of randomized control trials. Bulletin of Faculty of Physical Therapy. 2025 Mar 5;30(1):15.
Pournajaf S, Goffredo M, Pellicciari L, Piscitelli D, Criscuolo S, Le Pera D, Damiani C, Franceschini M. Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: A randomized controlled trial. Annals of physical and rehabilitation medicine. 2022 Nov 1;65(6):101609.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
