Background: Augmented reality (AR) is a relatively new technology which blends virtual objects with real scenes in real time and this may be an effective intervention to use in rehabilitation. Objectives: To systematically review the evidence for the effectiveness of AR applications on rehabilitation outcomes within a physical context. Method: A systematic search of the literature using specified search terms that included studies of any quantitative design testing AR applications in rehabilitation within a physical context. Results: The included 13 studies were of varying designs and generally rated poorly on methodological quality assessment. All studies reported varying degrees of improvement in outcomes with the use of AR applications. The technologies used were mostly in the prototype phase of development and were a mixture of simple and complex systems. Conclusion: AR applications for rehabilitation in a physical context are still in the early stages of development and thus evidence for effectiveness in rehabilitation is limited. The technology appears not ready for general practical use but the encouraging results support further research. IntroductionVirtual reality (VR) applications are increasingly used as adjuncts to rehabilitation. Development of VR technology has made it possible to combine reality with virtual objects in real time, creating a mix of the real environment and the virtual environment to form augmented reality (AR). 1 AR is based on the combination of different technologies and is well known in everyday (media) life, for example, the TV weather channel forecaster in front of the weather map or the recognition of QR codes (square marker patterns) with camera-equipped cell phones. VR technologies completely immerse a user inside a synthetic environment; while immersed, the user cannot see the real world around him. 2 In contrast, AR or mixed reality allows the user to see the real world, with virtual objects superimposed upon or composited with the real world. 3 Therefore, AR supplements reality but does not replace it. 3 Azuma defines AR systems as having three characteristics, namely: (1) they combine real and virtual objects, (2) they are interactive in real time, and (3) they are registered in 3D. 2 AR potentially has the advantage over VR in rehabilitation as it provides better sense of presence and reality judgments of the environment as the elements the patient uses to interact with the application are real. 2,4 In AR systems patients can, for instance see their hands and feet and how they are interacting with the application and the environment. As technology involved in AR becomes more accessible and affordable, a greater uptake of AR interventions in clinical rehabilitation settings is likely. Therefore, it is important to evaluate the effectiveness of AR interventions in rehabilitation to guide future use. To our knowledge, no systematic review of AR applications in rehabilitation related to physical outcomes has been undertaken. This paper reports on a systematic review of the...
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