Current Notion on Virtual Reality Rehabilitation Approach on Post Operative Lower Extremity Conditions: A Narrative Review
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Abstract
Background: Lower extremity surgeries, such as total knee arthroplasty (TKA), total hip arthroplasty (THA), and anterior cruciate ligament (ACL) reconstruction, require extensive rehabilitation to restore mobility and function. Traditional rehabilitation faces challenges such as patient adherence and access to care. Virtual reality (VR) has emerged as a promising tool to enhance rehabilitation outcomes by offering interactive, engaging environments that improve patient motivation.
Methods: A narrative review was conducted to evaluate the current literature on VR-based rehabilitation for post-operative lower extremity conditions. Relevant studiesfrom 2019 to 2024were selected from databases such as PubMed, Scopus, and Cochrane, focusing on VR's application in patients recovering from TKA, THA, ACL reconstruction, and traumatic lower limb amputations.
Results: The review found that VR interventions significantly improved proprioception, balance, and patient engagement compared to traditional rehabilitation methods. VR's interactive nature provided real-time feedback and enhanced patient motivation. However, mixed results were reported regarding VR's superiority in pain management and overall functional outcomes. VR was shown to complement traditional therapy rather than replace it.
Conclusion: VR-based rehabilitation offers a promising adjunct to traditional methods, improving patient engagement and specific functional outcomes. While VR enhances recovery, further research is needed to establish standardized protocols and determine its long-term efficacy in post-operative rehabilitation.
1. Gianola S, Stucovitz E, Castellini G, Mascali M, Vanni F, Tramacere I, et al. Effects of early virtual reality-based rehabilitation in patients with total knee arthroplasty: A randomized controlled trial. Medicine (Baltimore). 2020 Feb;99(7):e19136.
2. Gsangaya MR, Htwe O, Selvi Naicker A, Md Yusoff BAH, Mohammad N, Soh EZF, et al. Comparison between the effect of immersive virtual reality training versus conventional rehabilitation on limb loading and functional outcomes in patients after anterior cruciate ligament reconstruction: A prospective randomized controlled trial. Asia-Pac J Sports Med Arthrosc Rehabil Technol. 2023 Oct;34:28–37.
3. Fascio E, Vitale JA, Sirtori P, Peretti G, Banfi G, Mangiavini L. Early Virtual-Reality-Based Home Rehabilitation after Total Hip Arthroplasty: A Randomized Controlled Trial. J Clin Med. 2022 Mar 22;11(7):1766.
4. Elgendy MH, Helal MM, Habib AA. The influence of virtual reality approach on phantom pain in trans-tibial amputation: A randomized control trail.
5. Pournajaf S, Goffredo M, Pellicciari L, Piscitelli D, Criscuolo S, Le Pera D, et al. Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: A randomized controlled trial. Ann Phys Rehabil Med. 2022 Nov;65(6):101609.
6. Papalia R, Campi S, Vorini F, Zampogna B, Vasta S, Papalia G, et al. The Role of Physical Activity and Rehabilitation Following Hip and Knee Arthroplasty in the Elderly. J Clin Med. 2020 May 9;9(5):1401.
7. Byra J, Czernicki K. The Effectiveness of Virtual Reality Rehabilitation in Patients with Knee and Hip Osteoarthritis. J Clin Med. 2020 Aug 14;9(8):2639.
8. Abbas RL, Cooreman D, Al Sultan H, El Nayal M, Saab IM, El Khatib A. The Effect of Adding Virtual Reality Training on Traditional Exercise Program on Balance and Gait in Unilateral, Traumatic Lower Limb Amputee. Games Health J. 2021 Feb 1;10(1):50–6.
9. Mazurek J, Cieślik B, Wrzeciono A, Gajda R, Szczepańska-Gieracha J. Immersive Virtual Reality Therapy Is Supportive for Orthopedic Rehabilitation among the Elderly: A Randomized Controlled Trial. J Clin Med. 2023 Dec 14;12(24):7681.
10. Compare the Effect of Traditional and Virtual Reality Training on Subjective-sense of Instability and Balance in Basketball-players with Functional Ankle Instability: Matched Randomized Clinical Trial. J Biomed Phys Eng [Internet]. 2023 Apr 1 [cited 2024 Oct 13];13(3). Available from: https://jbpe.sums.ac.ir/article_48130.html
11. Peng L, Zeng Y, Wu Y, Si H, Shen B. Virtual reality-based rehabilitation in patients following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Chin Med J (Engl). 2022 Jan 20;135(2):153–63.
12. Kim K, Choi B, Lim W. The efficacy of virtual reality assisted versus traditional rehabilitation intervention on individuals with functional ankle instability: a pilot randomized controlled trial. Disabil Rehabil Assist Technol. 2019 Apr;14(3):276–80.
13. Abbas RL, Cooreman D, Sultan HA, Nayal ME, Saab IM, Khatib AE, et al. Effect of Adding Virtual Reality Training to Traditional Exercise Program on Pain, Mental Status and Psychological Status in Unilateral Traumatic Lower Limb Amputees: A Randomized Controlled Trial. Games Health J. 2024 Aug 1;13(4):245–51.
14. Hadamus A, Błażkiewicz M, Wydra KT, Kowalska AJ, Łukowicz M, Białoszewski D, et al. Effectiveness of Early Rehabilitation with Exergaming in Virtual Reality on Gait in Patients after Total Knee Replacement. J Clin Med. 2022 Aug 23;11(17):4950.
15. Prvu Bettger J, Green CL, Holmes DN, Chokshi A, Mather RC, Hoch BT, et al. Effects of Virtual Exercise Rehabilitation In-Home Therapy Compared with Traditional Care After Total Knee Arthroplasty: VERITAS, a Randomized Controlled Trial. J Bone Jt Surg. 2020 Jan 15;102(2):101–9.
16. Kim SH, Cho SH. Benefits of Virtual Reality Program and Motor Imagery Training on Balance and Fall Efficacy in Isolated Older Adults: A Randomized Controlled Trial. Med Kaunas Lith. 2022 Oct 28;58(11):1545.
17. Nambi G, Abdelbasset WK, Elsayed SH, Alrawaili SM, Abodonya AM, Saleh AK, et al. Comparative Effects of Isokinetic Training and Virtual Reality Training on Sports Performances in University Football Players with Chronic Low Back Pain-Randomized Controlled Study. Evid Based Complement Alternat Med. 2020;2020(1):2981273.
18. Elaraby AER, Shahien M, Jahan AM, Etoom M, Bekhet AH. The Efficacy of Virtual Reality Training in the Rehabilitation of Orthopedic Ankle Injuries: A Systematic Review and Meta-analysis. Adv Rehabil Sci Pract. 2023 Jan;12:11795727231151636.
19. Yildirim Şahan T, Erbahçeci F. Effects of Virtual Reality on Transtibial Amputation Rehabilitation Outcomes: A Randomized Study. Games Health J. 2023 Dec;12(6):459–67.
20. Flórez Fonnegra JP, Pino Prestan AC, López LL, Yepes JC, Pérez VZ. Rehabilitation of Patients with Arthrogenic Muscular Inhibition in Pathologies of Knee Using Virtual Reality. Sensors. 2023 Nov 11;23(22):9114.
21. O G, S B. The effect of virtual reality on pain, kinesiophobia and function in total knee arthroplasty patients: A randomized controlled trial. The Knee [Internet]. 2023 Dec [cited 2024 Oct 16];45. Available from: https://pubmed.ncbi.nlm.nih.gov/37931366/
22. Zavala-González J, Martínez D, Gutiérrez-Espinoza H. Effectiveness of adding virtual reality to physiotherapeutic treatment in patients with total hip arthroplasty. A randomized controlled trial. Clin Rehabil. 2022 May;36(5):660–8.
23. Gumaa M, Rehan Youssef A. Is Virtual Reality Effective in Orthopedic Rehabilitation? A Systematic Review and Meta-Analysis. Phys Ther. 2019 Oct 28;99(10):1304–25.
24. L F, A K, D N, Y K. The influence of early virtual reality intervention on pain, anxiety, and function following primary total knee arthroplasty. Complement Ther Clin Pract [Internet]. 2022 Nov [cited 2024 Oct 16];49. Available from: https://pubmed.ncbi.nlm.nih.gov/36347152/
25. Hussein Jabbar MA, Ashnagar Z, Hadian MR, Jalaie S, Moghadam ST. Investigating the Effects of Exergame Training on Functional Activities Among Newly-Fitted Patients with Unilateral Transtibial Amputation: A Preliminary Study. J Mod Rehabil [Internet]. 2024 Sep 8 [cited 2024 Dec 5]; Available from: https://publish.kne-publishing.com/index.php/JMR/article/view/16424
26. Hong S, Lee G. Effects of an Immersive Virtual Reality Environment on Muscle Strength, Proprioception, Balance, and Gait of a Middle-Aged Woman Who Had Total Knee Replacement: A Case Report. Am J Case Rep. 2019 Nov 7;20:1636–42.
27. Shin D, Hong S. A Study on the Effectiveness of VR Rehabilitation Training Content for Older Individuals with Total Knee Replacement: Pilot Study. Healthc Basel Switz. 2024 Jul 29;12(15):1500.
28. Yoon S, Son H. Effects of full immersion virtual reality training on balance and knee function in total knee replacement patients: a randomized controlled study. J Mech Med Biol. 2020 Nov;20(09):2040007.
29. Gazendam A, Zhu M, Chang Y, Phillips S, Bhandari M. Virtual reality rehabilitation following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2022 Feb 19;30(8):2548.
30. Blasco J, Igual-Camacho C, Blasco M, Antón-Antón V, Ortiz-Llueca L, Roig-Casasús S. The efficacy of virtual reality tools for total knee replacement rehabilitation: A systematic review. Physiother Theory Pract. 2021 Jun 1;37(6):682–92.
31. Ambron E, Buxbaum LJ, Miller A, Stoll H, Kuchenbecker KJ, Coslett HB. Virtual reality treatment displaying the missing leg improves phantom limb pain: A small clinical trial. Neurorehabil Neural Repair. 2021 Oct 27;35(12):1100.
2. Gsangaya MR, Htwe O, Selvi Naicker A, Md Yusoff BAH, Mohammad N, Soh EZF, et al. Comparison between the effect of immersive virtual reality training versus conventional rehabilitation on limb loading and functional outcomes in patients after anterior cruciate ligament reconstruction: A prospective randomized controlled trial. Asia-Pac J Sports Med Arthrosc Rehabil Technol. 2023 Oct;34:28–37.
3. Fascio E, Vitale JA, Sirtori P, Peretti G, Banfi G, Mangiavini L. Early Virtual-Reality-Based Home Rehabilitation after Total Hip Arthroplasty: A Randomized Controlled Trial. J Clin Med. 2022 Mar 22;11(7):1766.
4. Elgendy MH, Helal MM, Habib AA. The influence of virtual reality approach on phantom pain in trans-tibial amputation: A randomized control trail.
5. Pournajaf S, Goffredo M, Pellicciari L, Piscitelli D, Criscuolo S, Le Pera D, et al. Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: A randomized controlled trial. Ann Phys Rehabil Med. 2022 Nov;65(6):101609.
6. Papalia R, Campi S, Vorini F, Zampogna B, Vasta S, Papalia G, et al. The Role of Physical Activity and Rehabilitation Following Hip and Knee Arthroplasty in the Elderly. J Clin Med. 2020 May 9;9(5):1401.
7. Byra J, Czernicki K. The Effectiveness of Virtual Reality Rehabilitation in Patients with Knee and Hip Osteoarthritis. J Clin Med. 2020 Aug 14;9(8):2639.
8. Abbas RL, Cooreman D, Al Sultan H, El Nayal M, Saab IM, El Khatib A. The Effect of Adding Virtual Reality Training on Traditional Exercise Program on Balance and Gait in Unilateral, Traumatic Lower Limb Amputee. Games Health J. 2021 Feb 1;10(1):50–6.
9. Mazurek J, Cieślik B, Wrzeciono A, Gajda R, Szczepańska-Gieracha J. Immersive Virtual Reality Therapy Is Supportive for Orthopedic Rehabilitation among the Elderly: A Randomized Controlled Trial. J Clin Med. 2023 Dec 14;12(24):7681.
10. Compare the Effect of Traditional and Virtual Reality Training on Subjective-sense of Instability and Balance in Basketball-players with Functional Ankle Instability: Matched Randomized Clinical Trial. J Biomed Phys Eng [Internet]. 2023 Apr 1 [cited 2024 Oct 13];13(3). Available from: https://jbpe.sums.ac.ir/article_48130.html
11. Peng L, Zeng Y, Wu Y, Si H, Shen B. Virtual reality-based rehabilitation in patients following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Chin Med J (Engl). 2022 Jan 20;135(2):153–63.
12. Kim K, Choi B, Lim W. The efficacy of virtual reality assisted versus traditional rehabilitation intervention on individuals with functional ankle instability: a pilot randomized controlled trial. Disabil Rehabil Assist Technol. 2019 Apr;14(3):276–80.
13. Abbas RL, Cooreman D, Sultan HA, Nayal ME, Saab IM, Khatib AE, et al. Effect of Adding Virtual Reality Training to Traditional Exercise Program on Pain, Mental Status and Psychological Status in Unilateral Traumatic Lower Limb Amputees: A Randomized Controlled Trial. Games Health J. 2024 Aug 1;13(4):245–51.
14. Hadamus A, Błażkiewicz M, Wydra KT, Kowalska AJ, Łukowicz M, Białoszewski D, et al. Effectiveness of Early Rehabilitation with Exergaming in Virtual Reality on Gait in Patients after Total Knee Replacement. J Clin Med. 2022 Aug 23;11(17):4950.
15. Prvu Bettger J, Green CL, Holmes DN, Chokshi A, Mather RC, Hoch BT, et al. Effects of Virtual Exercise Rehabilitation In-Home Therapy Compared with Traditional Care After Total Knee Arthroplasty: VERITAS, a Randomized Controlled Trial. J Bone Jt Surg. 2020 Jan 15;102(2):101–9.
16. Kim SH, Cho SH. Benefits of Virtual Reality Program and Motor Imagery Training on Balance and Fall Efficacy in Isolated Older Adults: A Randomized Controlled Trial. Med Kaunas Lith. 2022 Oct 28;58(11):1545.
17. Nambi G, Abdelbasset WK, Elsayed SH, Alrawaili SM, Abodonya AM, Saleh AK, et al. Comparative Effects of Isokinetic Training and Virtual Reality Training on Sports Performances in University Football Players with Chronic Low Back Pain-Randomized Controlled Study. Evid Based Complement Alternat Med. 2020;2020(1):2981273.
18. Elaraby AER, Shahien M, Jahan AM, Etoom M, Bekhet AH. The Efficacy of Virtual Reality Training in the Rehabilitation of Orthopedic Ankle Injuries: A Systematic Review and Meta-analysis. Adv Rehabil Sci Pract. 2023 Jan;12:11795727231151636.
19. Yildirim Şahan T, Erbahçeci F. Effects of Virtual Reality on Transtibial Amputation Rehabilitation Outcomes: A Randomized Study. Games Health J. 2023 Dec;12(6):459–67.
20. Flórez Fonnegra JP, Pino Prestan AC, López LL, Yepes JC, Pérez VZ. Rehabilitation of Patients with Arthrogenic Muscular Inhibition in Pathologies of Knee Using Virtual Reality. Sensors. 2023 Nov 11;23(22):9114.
21. O G, S B. The effect of virtual reality on pain, kinesiophobia and function in total knee arthroplasty patients: A randomized controlled trial. The Knee [Internet]. 2023 Dec [cited 2024 Oct 16];45. Available from: https://pubmed.ncbi.nlm.nih.gov/37931366/
22. Zavala-González J, Martínez D, Gutiérrez-Espinoza H. Effectiveness of adding virtual reality to physiotherapeutic treatment in patients with total hip arthroplasty. A randomized controlled trial. Clin Rehabil. 2022 May;36(5):660–8.
23. Gumaa M, Rehan Youssef A. Is Virtual Reality Effective in Orthopedic Rehabilitation? A Systematic Review and Meta-Analysis. Phys Ther. 2019 Oct 28;99(10):1304–25.
24. L F, A K, D N, Y K. The influence of early virtual reality intervention on pain, anxiety, and function following primary total knee arthroplasty. Complement Ther Clin Pract [Internet]. 2022 Nov [cited 2024 Oct 16];49. Available from: https://pubmed.ncbi.nlm.nih.gov/36347152/
25. Hussein Jabbar MA, Ashnagar Z, Hadian MR, Jalaie S, Moghadam ST. Investigating the Effects of Exergame Training on Functional Activities Among Newly-Fitted Patients with Unilateral Transtibial Amputation: A Preliminary Study. J Mod Rehabil [Internet]. 2024 Sep 8 [cited 2024 Dec 5]; Available from: https://publish.kne-publishing.com/index.php/JMR/article/view/16424
26. Hong S, Lee G. Effects of an Immersive Virtual Reality Environment on Muscle Strength, Proprioception, Balance, and Gait of a Middle-Aged Woman Who Had Total Knee Replacement: A Case Report. Am J Case Rep. 2019 Nov 7;20:1636–42.
27. Shin D, Hong S. A Study on the Effectiveness of VR Rehabilitation Training Content for Older Individuals with Total Knee Replacement: Pilot Study. Healthc Basel Switz. 2024 Jul 29;12(15):1500.
28. Yoon S, Son H. Effects of full immersion virtual reality training on balance and knee function in total knee replacement patients: a randomized controlled study. J Mech Med Biol. 2020 Nov;20(09):2040007.
29. Gazendam A, Zhu M, Chang Y, Phillips S, Bhandari M. Virtual reality rehabilitation following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2022 Feb 19;30(8):2548.
30. Blasco J, Igual-Camacho C, Blasco M, Antón-Antón V, Ortiz-Llueca L, Roig-Casasús S. The efficacy of virtual reality tools for total knee replacement rehabilitation: A systematic review. Physiother Theory Pract. 2021 Jun 1;37(6):682–92.
31. Ambron E, Buxbaum LJ, Miller A, Stoll H, Kuchenbecker KJ, Coslett HB. Virtual reality treatment displaying the missing leg improves phantom limb pain: A small clinical trial. Neurorehabil Neural Repair. 2021 Oct 27;35(12):1100.
| Issue | Articles in Press | |
| Section | Review Article(s) | |
| Keywords | ||
| Virtual reality, Rehabilitation, Lower Limb arthroplasty, Lower limb soft tissue injuries | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Wadhokar O, Tandon V, Yede S, Bhardwaj J, Saini S, Palekar T. Current Notion on Virtual Reality Rehabilitation Approach on Post Operative Lower Extremity Conditions: A Narrative Review. jmr. 2025;(-).
