Virtual Reality Training in Unicompartmental Knee Arthroplasty: A Randomized, Blinded Trial

McKinney, Brandon; Dbeis, Ammer; Lamb, Ashley; Frousiakis, Petros; Sweet, Stephan

doi:10.1016/j.jsurg.2022.06.008

Cited by 18 publications

(28 citation statements)

References 14 publications

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“…In the last 10 years, VRBR has been as a rehabilitative tool in the recovery of TKA with promising results [70], including teaching future orthopedic surgery doctors to perform TKA [71]. The increased scientific production related to the topic has motivated previous reviews to be published [7,[35][36][37].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…After this process, seven studies met the criteria for this study (Figure 1). Six of the included studies were level II, [19][20][21][28][29][30] and one study was level III. 31 improvements in surgical skills after all patients received training with VR and was not randomized.…”

Section: Search Resultsmentioning

confidence: 99%

“…31 improvements in surgical skills after all patients received training with VR and was not randomized. All seven of the included studies achieved a MERSQI score of at least 11.5 [19][20][21][28][29][30][31] of 18, where a mean score of 10.7 is generally considered an acceptable cutoff value for methodological quality in medical education research. 32 One of the included studies raised some concerns in the overall Cochrane risk of bias assessment Figure 2.…”

Section: Search Resultsmentioning

confidence: 99%

“…Within knee arthroplasty, increased procedure durations have been linked to increased infection rates and increased duration of hospital stays as well as costs. 20,35 A recent systematic review of im-mersive VR across several different surgical subspecialties similarly demonstrated consistently shorter time to completion in VR-trained groups. 9 There was no notable difference in the OSATS score between VR-trained group and control group performance in the three included studies that used this tool.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the population in this study examines a wide range of medical trainees, from fourth-year medical students to orthopaedic surgery residents and fellows. All seven of the included studies achieved a MERSQI score of at least 11.5 of 18, 19-21,28-31 where a mean score of 10.7 is generally considered to be an acceptable cutoff value for methodological quality in medical education research. 32 This is consistent with a systematic review by Mao et al 9 on VR for surgical training as a whole, which showed similar findings, with a mean MERSQI score of 11.7 of 18 (1.9).…”

Section: Discussionmentioning

confidence: 99%

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Virtual Reality Is an Effective Tool for Learning Techniques in Arthroplasty: A Systematic Review and Meta-Analysis

Pettinelli

Lee

et al. 2023

JAAOS Glob Res Rev

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Background: There is a scarcity of aggregate literature reporting on the efficacy of virtual reality (VR) concerning surgical skill development within the realm of arthroplasty. The purpose of this study was to evaluate the effect of VR on the training of orthopaedic surgery residents and medical students learning surgical techniques in arthroplasty. Methods: A systematic review was conducted querying PubMed, Cochrane Trials, and Embase in September 2022. Studies were included if they involved education or training of orthopaedic surgery residents/students, used VR, and reported on outcomes measuring surgical skills related to arthroplasty. Outcomes present in a minimum of three studies underwent additional statistical analysis with forest plots. Results: Seven studies met inclusion criteria and included a total sample size of 148 residents/students between MS4-PGY6. Five of the seven included studies showed VR to be an effective training modality, with two studies demonstrating that VR reduced the error rate ( P < 0.05). The two most reported outcomes were procedure duration and objective structured assessment of technical skills. Orthopaedic trainees using VR conducted procedures in markedly less time than control groups (SMD, −0.81 minute; 95% confidence interval, [−1.45 to −0.17 minutes]; P = 0.01). No significant difference was found comparing objective structured assessment of technical skills between VR and control groups (SMD, 0.44; 95% confidence interval, [−1.05 to 1.93]; P = 0.56). Conclusion: Although the extent to which VR can outright replace standard learning modalities is unclear at this time, its usefulness as a supplemental learning modality in arthroplasty, especially in the absence of available on-demand resources, may be of value. A paucity of literature exists to evaluate the effect of a longitudinal VR curriculum on direct patient care performance by orthopaedic surgery residents learning techniques in arthroplasty, necessitating additional study.

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Virtual reality‐based therapy after anterior cruciate ligament injury effectively reduces pain and improves knee function, movement patterns, and dynamic balance: A systematic review and meta‐analysis

Cortés‐Pérez,

Desdentado‐Guillem,

Camacho‐Delgado

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeVirtual reality‐based therapy (VRBT) may be an effective physical therapy complement employed in the rehabilitation of patients with anterior cruciate ligament (ACL) injury. This study aims to assess the effectiveness of VRBT in improving pain, knee function, strength, proprioception, flexion range of motion (ROM), and dynamic balance after ACL injury.MethodsWe conducted this systematic review with meta‐analysis following PRISMA criteria. Since inception to June 2024, we searched in PubMed Medline, WOS, SCOPUS, CINAHL and PEDro without publication date and language restrictions. Randomised controlled trials (RCTs), comprising only patients with ACL injury, that assess the effectiveness of VRBT compared to classical interventions on the outcomes of interest were included. PEDro scale was employed to analyze the methodological quality of the RCTs included. Cohen's standardised mean difference (SMD) and its 95% confidence interval (95% CI) was used to calculate the pooled effect in meta‐analyses.ResultsNine RCTs, providing data from 330 participants (26.96 ± 3.11 years, 85% males) were included. The RCTs included showed good methodological quality (PEDro scale = 6.88 points), being, performance and detection biases, the most common biases reported. Meta‐analyses showed that VRBT was more effective than classical interventions in reducing pain (SMD = −1.15; 95% CI −1.85 to −0.45; p = 0.001; I2 = 0%), and increasing knee function (SMD = 1.71; 95% CI 0.93 to 2.5; p < 0.001; I2 = 0%), strength (SMD = 0.82; 95% CI 0.4–1.23; p < 0.001; I2 = 0%) and flexion ROM (SMD = 0.7; 95% CI 0.37–1.01; p < 0.001; I2 = 0%). Additionally, VRBT improved postero‐medial (SMD = 0.46; 95% CI 0.01–0.9; p = 0.045; I2 = 15.1%) and postero‐lateral CoP excursion (SMD = 0.75; 95% CI 0.3–1.21; p = 0.001; I2 = 0%), being effective in improving dynamic balance.ConclusionVRBT is an effective physical therapy complement to be included in the ACL's rehabilitation programmes due to reduces pain and increases knee function, strength, ROM and dynamic balance after ACL injury.Level of evidenceLevel II evidence.

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Virtual Reality Training in Unicompartmental Knee Arthroplasty: A Randomized, Blinded Trial

Cited by 18 publications

References 14 publications

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

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

Virtual Reality Is an Effective Tool for Learning Techniques in Arthroplasty: A Systematic Review and Meta-Analysis

Virtual reality‐based therapy after anterior cruciate ligament injury effectively reduces pain and improves knee function, movement patterns, and dynamic balance: A systematic review and meta‐analysis

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