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Nonimmersive Virtual Reality-Based Exercises Improve Muscle Excitability and Balance in Patients with Knee
Mehmet Sönmez1, Şebnem Avcı2, Fatma Şimşek3
1Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Erzurum Technical University, Yakutiye, Erzurum, Turkey.
Games for Health Journal
|July 25, 2025
Summary
Nonimmersive virtual reality (NIVR) effectively improves knee osteoarthritis (KOA) by enhancing muscle function, balance, and daily living activities. This study shows NIVR significantly reduces pain and boosts patient satisfaction in KOA management.
Area of Science:
- Rehabilitation Medicine
- Biomedical Engineering
- Orthopedics
Background:
- Knee osteoarthritis (KOA) commonly causes pain, reduced strength, impaired daily activities, and balance deficits.
- Traditional physiotherapy may not fully address the multifaceted challenges faced by KOA patients.
- Exploring novel therapeutic modalities like nonimmersive virtual reality (NIVR) is crucial for improving KOA management.
Purpose of the Study:
- To investigate the efficacy of nonimmersive virtual reality (NIVR) in improving muscle excitability and motor neuron activation in KOA patients.
- To assess the impact of NIVR on balance, proprioception, physical function, activities of daily living (ADL), muscle endurance, and patient satisfaction.
- To compare the outcomes of NIVR-augmented physiotherapy with traditional physiotherapy and sham VR in KOA.
Main Methods:
- Forty KOA patients were randomized into an experimental group (EG) receiving traditional physiotherapy plus NIVR exercises and a sham-controlled group (SG) receiving traditional physiotherapy plus sham VR.
- Interventions were administered for 3 weeks, 5 days a week.
- Primary outcomes included muscle excitability (maximal voluntary contraction [MVC]), motor neuron pool activation, and balance. Secondary outcomes included proprioception, endurance, ADL independence, pain, physical function (WOMAC), and satisfaction.
Main Results:
- The experimental group showed significant improvements in muscle endurance, pain levels, and independence in activities of daily living (ADL) compared to the sham group (P < 0.05).
- Significant differences favoring the NIVR group were observed in Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, static and dynamic balance (Timed Up and Go [TUG] test), maximal voluntary contraction (MVC), and proprioception (P < 0.001).
- The NIVR group demonstrated superior outcomes across most measured parameters, indicating a strong positive effect of the intervention.
Conclusions:
- Nonimmersive virtual reality (NIVR) is a feasible and effective therapeutic approach for managing knee osteoarthritis (KOA).
- NIVR significantly enhances muscle excitability, static and dynamic balance, muscle endurance, and proprioception in KOA patients.
- The application of NIVR leads to improved independence in ADL, increased treatment satisfaction, and reduced pain intensity, offering a promising addition to KOA rehabilitation.
