Effectiveness of Virtual Reality-Based Early Postoperative Rehabilitation after Total Knee Arthroplasty: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Abstract

Virtual reality-based rehabilitation (VRBR) is being used in rehabilitation after total knee arthroplasty (TKA). This meta-analysis assesses the effect of immediate and/or maintained effect of VRBR (alone or in combination with conventional therapy (CT) in TKA recovery. To perform this meta-analysis, we searched in PubMed, SCOPUS, WOS, CINAHL, and PEDro until 5 February 2023. We included randomized controlled trials that assessed the effect of VRBR in improving knee pain and function, dynamic balance, range of motion (ROM), and strength, among others, after TKA. The pooled effect was calculated with Cohen’s standardized mean difference (SMD) with a 95% confidence interval (95% CI). Twelve studies, providing data from 997 participants (69.9 ± 8.1 years old), were included. At post-immediate assessment, VRBR is effective in improving knee pain (SMD = −0.36; 95% CI −0.56 to −0.17), knee function (SMD = −0.51; 95% CI −0.75 to −0.27), dynamic balance (SMD = −0.59; 95% CI −1.02 to −0.15), knee flexion ROM (SMD = 0.4; 95% CI 0.17 to 0.62), and extension strength (SMD = 0.43; 95% CI 0.19 to 0.68). Our findings showed that immersive and non-immersive VRBR is effective to be used after TKA, and the effect on knee pain and function may be maintained over 3 or 6 months. A high level of satisfaction and adherence to VRBR was reported.

Effectiveness of Virtual Reality on Postoperative Pain, Disability and Range of Movement after Knee Replacement: A Systematic Review and Meta-Analysis

“…However, no differences were found between the experimental group and the control group for the range of motion measured by short-term ROM. Our results contrast those of other authors, who reported a significant improvement in the experimental groups compared to the control between 2 weeks and 3 months after surgery [ 38 , 39 ].…”

Postoperative Cognitive Impairment and Pain Perception after Abdominal Surgery—Could Immersive Virtual Reality Bring More? A Clinical Approach

“…The same results were found by Olbrecht et al, reinforcing to the fact that pain is mostly diminished by distraction and redirection [22]. Many studies support the theory that distraction leads to most of the analgesia provided by VR [23]. Whether it works directly or indirectly on signaling pathways of pain, attention, or emotion, it is clear that the affective component of pain is influenced by distraction via VR use [23,24].…”

“…Many studies support the theory that distraction leads to most of the analgesia provided by VR [23]. Whether it works directly or indirectly on signaling pathways of pain, attention, or emotion, it is clear that the affective component of pain is influenced by distraction via VR use [23,24]. Another way of influencing painful sensations with VR is pain control, wherein the subject is invited to control the pain while immersed in the virtual reality.…”

“…The results related to this show that through guided-relaxation VR, levels of pain can be significantly lowered, as can be achieved through using distraction VR. Anxiety levels can also be decreased though VR use [23]. In terms of incorporating VR more into the treatment of pain outside the acute setting, Gupta et al proposed that VR technology could also induce neurophysiologic changes in order to diminish the perception of pain [14].…”

Immersive Virtual Reality Therapy Is Supportive for Orthopedic Rehabilitation among the Elderly: A Randomized Controlled Trial

“…The application of VR-based rehabilitation in Orthopedic surgery, especially in THR/TKR, has noticeably and significantly risen [18,19]. Several VRbased protocols have been proposed for rehabilitation following TKR and THR [16,[18][19][20]. However, none of the articles examined the effectiveness of VR-based interventions for symptoms of stress, anxiety, and depression in patients with OA after THR or after TKR.…”