Abstract:Exercises in virtual reality (VR) have recently become a popular form of rehabilitation and are reported to be more effective than a standard rehabilitation protocol alone. The aim of this study was to assess the efficacy of adjunct VR training in improving postural control in patients after total knee replacement surgery (TKR). Forty-two patients within 7–14 days of TKR were enrolled and divided into a VR group and a control group (C). The C group underwent standard postoperative rehabilitation. The VR group … Show more
“…The results of this study are consistent with our previously published results that showed no significant advantage of rehabilitation with additional VR training over standard rehabilitation in terms of balance and postural control in the same group of patients [ 11 ]. Gianola et al [ 5 ] also reported no superiority of rehabilitation with VR in terms of pain relief, drug assumptions, and other functional outcomes.…”
Section: Discussionsupporting
confidence: 93%
“…In the recent years, exergaming in immersive, semi-immersive, or nonimmersive virtual reality (VR) increased in popularity. Its advantages include, among others, greater patient motivation, improved (faster) effects of training, and the possibility of correcting movement strategies using feedback features of games [ 10 , 11 , 12 ]. A growing number of studies have shown the utility of training with virtual reality in restoring gait and balance in older people, especially in the backwards stepping test, crossover stepping test [ 13 ], 6-min walking test [ 14 ], and timed up-and-go test [ 15 ].…”
Total knee replacement (TKR) is the treatment of choice for advanced stages of osteoarthritis but it requires good postoperative rehabilitation. This study aimed to assess the effectiveness of exercises using virtual reality to improve gait parameters in patients after TKR. Fifty-nine patients 7–14 days after TKR surgery were divided into a study group (VRG, n = 38) and a control group (CG, n = 21). Both groups underwent the same 4-week rehabilitation protocol. The VRG group had 12 additional nonimmersive virtual reality game sessions on the Virtual Balance Clinic prototype system at 30 min each, focusing on gait and balance improvement. Spatiotemporal, force and foot plantar pressure parameters were collected on an instrumented treadmill during a 30 s walk. The most significant improvement was in the symmetry indices of forefoot force, maximum forefoot force, loading response time, and preswing time (p < 0.05) in both groups. Gait speed increased by 31.25% and 44% in the VRG and CG groups, respectively (p < 0.005). However, the extra exergaming sessions did not significantly improve rehabilitation outcomes. Therefore, additional VR training does not improve gait better than standard rehabilitation alone, but the improvement of gait, especially its symmetry, is significant within the first six weeks after surgery.
“…The results of this study are consistent with our previously published results that showed no significant advantage of rehabilitation with additional VR training over standard rehabilitation in terms of balance and postural control in the same group of patients [ 11 ]. Gianola et al [ 5 ] also reported no superiority of rehabilitation with VR in terms of pain relief, drug assumptions, and other functional outcomes.…”
Section: Discussionsupporting
confidence: 93%
“…In the recent years, exergaming in immersive, semi-immersive, or nonimmersive virtual reality (VR) increased in popularity. Its advantages include, among others, greater patient motivation, improved (faster) effects of training, and the possibility of correcting movement strategies using feedback features of games [ 10 , 11 , 12 ]. A growing number of studies have shown the utility of training with virtual reality in restoring gait and balance in older people, especially in the backwards stepping test, crossover stepping test [ 13 ], 6-min walking test [ 14 ], and timed up-and-go test [ 15 ].…”
Total knee replacement (TKR) is the treatment of choice for advanced stages of osteoarthritis but it requires good postoperative rehabilitation. This study aimed to assess the effectiveness of exercises using virtual reality to improve gait parameters in patients after TKR. Fifty-nine patients 7–14 days after TKR surgery were divided into a study group (VRG, n = 38) and a control group (CG, n = 21). Both groups underwent the same 4-week rehabilitation protocol. The VRG group had 12 additional nonimmersive virtual reality game sessions on the Virtual Balance Clinic prototype system at 30 min each, focusing on gait and balance improvement. Spatiotemporal, force and foot plantar pressure parameters were collected on an instrumented treadmill during a 30 s walk. The most significant improvement was in the symmetry indices of forefoot force, maximum forefoot force, loading response time, and preswing time (p < 0.05) in both groups. Gait speed increased by 31.25% and 44% in the VRG and CG groups, respectively (p < 0.005). However, the extra exergaming sessions did not significantly improve rehabilitation outcomes. Therefore, additional VR training does not improve gait better than standard rehabilitation alone, but the improvement of gait, especially its symmetry, is significant within the first six weeks after surgery.
“…1 . After title, abstract and full text review, 9 RCTs with 835 patients randomized to VR-based telerehabilitation vs. traditional rehabilitation following TKA were identified and included in the final review [ 1 , 4 , 5 , 8 , 10 , 13 , 24 , 26 , 35 ]. Fig.…”
Purpose
The use of virtual reality (VR) based rehabilitation has increased substantially within orthopedic surgery, particularly in the field of total knee arthroplasty (TKA). The objective of this systematic review and meta-analysis was to compare patient-reported outcomes and cost analyses from randomized controlled trials (RCT) utilizing VR-based rehabilitation in patients following TKA.
Methods
MEDLINE, EMBASE, and Cochrane databases were searched for RCTs involving VR-based rehabilitation following TKA. Quantitative synthesis was conducted for pain scores and functional outcomes. Narrative outcomes were reported for results not amenable to quantitative synthesis.
Results
A total of 9 RCTs with 835 patients were included with follow-up ranging from 10 days to 6 months postoperatively. No differences in pain scores were demonstrated between VR-based and traditional rehabilitation at 2 weeks and 3 months postoperatively. VR-based rehabilitation demonstrated improved functional outcomes at 12 weeks (
n
= 353) postoperatively [mean difference (MD) − 3.32, 95% confidence interval (CI) − 5.20 to − 1.45, moderate certainty evidence] and 6 months (
n
= 66) postoperatively [MD − 4.75, 95% CI − 6.69 to − 2.81, low certainty evidence], compared to traditional rehabilitation. One trial demonstrated significant cost savings with the use of VR-based rehabilitation.
Conclusions
VR-based rehabilitation for patients undergoing TKA represents an evolving field that may have advantages over traditional therapy for some patients. The current review is limited by the low quality of evidence in the literature. This is a rapidly evolving field with more trials needed to determine the impact of VR-based rehabilitation on patients undergoing TKA.
Level of evidence
Level I; meta-analysis of randomized controlled trials.
Supplementary Information
The online version contains supplementary material available at 10.1007/s00167-022-06910-x.
“…Virtual models lay the groundwork for comprehensive analyses of therapeutic effectiveness, offering the potential to pinpoint the most advantageous solutions for patients. Notably, these models can appraise the effect of skeletal implant geometry [ 12 ], delineate the course of patient rehabilitation, such as maneuvering with crutches [ 13 ], and assess post-surgical recuperation processes such as knee replacement [ 14 ], ligament reconstruction [ 15 , 16 ], or spinal fixation system influences [ 17 ].…”
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