Effects of Full Immersion Virtual Reality Training on Balance and Knee Function in Total Knee Replacement Patients: A Randomized Controlled Study

Abstract

Background: Recently, new methods have emerged that encourage voluntary participation by allowing patients to perform tasks, including exercises or treatments, in a virtual reality (VR) environment. Aim: This study aimed to examine the effects of full immersion virtual reality training on balance and knee function in patients who had undergone total knee replacement. Design: Single blind randomized controlled trial. Setting: Department of Physical Therapy in a rehabilitation center. Population: A total of 30 elderly patients ([Formula: see text]65 years old) who had undergone total knee replacement. Methods: Participants were randomly allocated to an experimental group ([Formula: see text]) and a control group ([Formula: see text]). The experimental group received with a continuous passive motion machine, exercise therapy, and a full immersion VR training program; the control group received only with a continuous passive motion machine and exercise therapy. Biorescue was used to test static and dynamic balance ability, and the Timed Up and Go and Western Ontario and McMaster Universities tests were used to assess knee function. Paired [Formula: see text]-tests were used to examine differences by time in each group, and independent [Formula: see text]-tests were used to examine differences between the groups. Results: In terms of within-group differences by time, both the experimental group and the control group showed significant changes in the anterior, and posterior limits of stability in both sides; static balance; and knee function. In the between-groups comparison, among static balance tests, there was a significant difference in center of mass path length in the standing position with eyes open ([Formula: see text]); among dynamic balance tests, there were significant differences in left, right, anterior, and posterior limits of stability ([Formula: see text]). Conclusions: VR training produced better early balance ability and knee function than what was seen in the control group. We believe that VR training in initial post-operative rehabilitation of total knee replacement patients may increase the rate of recovery. Clinical Rehabilitation Impact: VR exercise programs are effective in early rehabilitation after total knee replacement, and have clinical value as inexpensive methods that can promote active participation.

Virtual reality-based rehabilitation in patients following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

“…Four studies assessed outcomes of the WOMAC. [ 20 , 28 , 30 , 31 ] Jin et al [ 28 ] estimated WOMAC scores at 1 month, 3 months, and 6 months. Eichler et al [ 30 ] evaluated WOMAC scores at 3 months.…”

“…Gianola et al [ 20 ] assessed the effect of early VR-based rehabilitation on WOMAC scores at 10 days. Yoon and Son [ 31 ] utilized full immersion VR-based rehabilitation and measured the WOMAC at 4 weeks. The WOMAC consists of 24 questions that assess areas, such as pain, stiffness, and daily activities.…”

“…There are a few possible score ranges including 0–240 (derived from the VAS 0–10 or NRS scale), 0–2400 (derived from the VAS 0–100), and 0–96 (derived from a 0–4 Likert scale). [ 33 ] Three studies [ 28 , 30 , 31 ] used the 0–96 points scale, whereas another [ 20 ] chose the 0–2400 points scale. Thus, the SMD calculated the total effect.…”

“…Two studies reported changes in TUG scores. [ 31 ] Piqueras et al [ 18 ] assessed differences of TUG scores from baseline to 10 days and 3 months. [ 18 ] Yoon and Son [ 31 ] recorded TUG scores at 4 weeks.…”

“…[ 31 ] Piqueras et al [ 18 ] assessed differences of TUG scores from baseline to 10 days and 3 months. [ 18 ] Yoon and Son [ 31 ] recorded TUG scores at 4 weeks. Since both studies used different methods of recording, we used the SMD to measure the total effect.…”