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. 2024 Jun 19:15:1424815.
doi: 10.3389/fphys.2024.1424815. eCollection 2024.

Efficacy of virtual reality exercise in knee osteoarthritis rehabilitation: a systematic review and meta-analysis

Wei Wei  1 , Haiting Tang  1 , Yu Luo  1 , Shichang Yan  1 , Qipei Ji  1 , Zhixiang Liu  1 , Huaqiang Li  1 , Fei Wu  2 , Shenqiao Yang  1 , Xin Yang  1
Affiliations

Efficacy of virtual reality exercise in knee osteoarthritis rehabilitation: a systematic review and meta-analysis

Wei Wei et al. Front Physiol. .

Abstract

Background: This systematic review and meta-analysis aims to investigate the effects of virtual reality (VR) exercise compared to traditional rehabilitation on pain, function, and muscle strength in patients with knee osteoarthritis (KOA). Additionally, the study explores the mechanisms by which VR exercise contributes to the rehabilitation of KOA patients.

Methods: We systematically searched PubMed, the Cochrane Library, Embase, Web of Science, Scopus, and PEDro according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search spanned from the library construction to 24 May 2024, focusing on randomized controlled trials Primary outcomes included pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and muscle strength. Meta-analysis was conducted using RevMan (version 5.4) and Stata (version 14.0). The bias risk of included studies was assessed using the Cochrane RoB 2.0 tool, while the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Results: This meta-analysis and systematic review included nine studies involving 456 KOA patients. The results indicated that VR exercise significantly improved pain scores (SMD, -1.53; 95% CI: -2.50 to -0.55; p = 0.002), WOMAC total score (MD, -14.79; 95% CI: -28.26 to -1.33; p = 0.03), WOMAC pain score (MD, -0.93; 95% CI: -1.52 to -0.34; p = 0.002), knee extensor strength (SMD, 0.51; 95% CI: 0.14 to 0.87; p = 0.006), and knee flexor strength (SMD, 0.65; 95% CI: 0.28 to 1.01; p = 0.0005), but not significantly for WOMAC stiffness (MD, -0.01; 95% CI: -1.21 to 1.19; p = 0.99) and physical function (MD, -0.35; 95% CI: -0.79 to -0.09; p = 0.12).

Conclusion: VR exercise significantly alleviates pain, enhances muscle strength and WOMAC total score in KOA patients, but improvements in joint stiffness and physical function are not significant. However, the current number of studies is limited, necessitating further research to expand on the present findings.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024540061, identifier CRD42024540061.

Keywords: knee osteoarthritis; meta-analysis; rehabilitation; systematic reviews; virtual reality.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of study selection according to PRISMA guidelines.
FIGURE 2
FIGURE 2
Risk-of-bias graph and summary. (A) Overall risk of bias, with each category presented as percentages. (B) Risk of bias of the studies included in the systematic review.
FIGURE 3
FIGURE 3
Forest plot for VR-based exercise compared with controls in pain.
FIGURE 4
FIGURE 4
Sensitivity analysis of pain.
FIGURE 5
FIGURE 5
Forest plot for VR-based exercise compared with controls in WOMAC.
FIGURE 6
FIGURE 6
Sensitivity analysis of WOMAC.
FIGURE 7
FIGURE 7
Forest plot for VR-based exercise compared with controls in muscle strength.
See this image and copyright information in PMC

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