Efficacy of virtual reality-based rehabilitation following total knee replacement: a systematic review and meta-analysis of randomized control trials

Abstract Objective To determine whether VR-based rehabilitation (VRBR) reduced pain and improved balance, proprioception, joint function, gait speed, and health-related quality of life (HRQOL) following Total knee replacement (TKR). Methods The Cochrane, MEDLINE/PubMed, Google Scholar, and the Physiotherapy Evidence Database (PEDro) were searched. The randomized controlled trials (RCTs) were included if they were in English, participants aged ≥ 18 years, underwent a unilateral or bilateral TKR and were treated using VRBR. Non-randomized studies, ununified outcomes, and RCTs with incomplete data were excluded. The methodological quality and Risk of Bias were assessed using the PEDro scale and Cochrane Collaboration tool respectively. The overall effect was estimated using Cohen’s standardized mean difference (SMD) with a 95% confidence interval (CI). Results Fifteen RCTs with 1,046 participants were included in the systematic review; 13 RCTs with 11 outcome measures were included in the meta-analysis. VRBR significantly reduced pain (SEM: − 0.36, 95% CI: − 0.73 to 0.00, P = .05), improved dynamic balance (SMD: − 0.75, 95% CI: − 1.32 to − 0.19, P = .009), and knee function (SMD: − 0.75; 95% CI: − 1.05 to 0.13, P < .0001) immediate post-intervention. No significant differences were found in proprioception, gait speed, and HRQOL ( P > .05). Conclusion Immersive and non-immersive VRBR are effective following TKR. The effect on pain and function may be sustained over three or six months. For proprioception, gait speed, and HRQOL, VRBR is not superior to conventional therapy.