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Virtual and Augmented Reality for Chronic Musculoskeletal Rehabilitation: A Systematic Review and Exploratory

Theodora Plavoukou1, Pantelis Staktopoulos1, Georgios Papagiannis2

  • 1Laboratory of Musculoskeletal Physiotherapy, Department of Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Egaleo Campus, 12243 Athens, Greece.

Bioengineering (Basel, Switzerland)
|July 29, 2025
PubMed
Summary

Virtual reality (VR), augmented reality (AR), and exergaming enhance rehabilitation for chronic musculoskeletal disorders (CMDs), improving pain and function. These technologies show promise as effective adjuncts to traditional physiotherapy.

Keywords:
augmented realitychronic painexergamingmeta-analysismusculoskeletal disordersphysiotherapyrehabilitationvirtual reality

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Area of Science:

  • Rehabilitation Medicine
  • Digital Health
  • Biomedical Engineering

Background:

  • Chronic musculoskeletal disorders (CMDs) are a major cause of disability, often unresponsive to conventional physiotherapy.
  • Emerging technologies like virtual reality (VR), augmented reality (AR), and exergaming offer novel rehabilitation approaches.
  • Comparative effectiveness of these advanced modalities for CMDs requires systematic evaluation.

Purpose of the Study:

  • To systematically review and meta-analyze the effectiveness of VR, AR, and exergaming in improving pain, function, balance, and psychological outcomes in adults with CMDs.
  • To compare the efficacy of different immersive and interactive technologies in rehabilitation.
  • To identify research gaps and guide future studies in technology-enhanced CMD rehabilitation.

Main Methods:

  • Systematic review and exploratory meta-analysis adhering to PRISMA 2020 guidelines.
  • Searched major databases (PubMed, Cochrane CENTRAL, Scopus, PEDro) for randomized controlled trials (RCTs) up to May 2025.
  • Assessed risk of bias using PEDro scale and Downs and Black checklist; pooled pain outcome data using random-effects model where feasible.

Main Results:

  • Thirteen RCTs (n=881) were included, utilizing immersive VR, AR, exergaming, and motion-tracking systems.
  • Significant pooled effect favoring VR/AR for pain reduction (SMD = -1.14) was observed in eight RCTs (n=610).
  • Exergaming improved physical performance; immersive VR enhanced kinesiophobia and psychological outcomes; AR was underrepresented.

Conclusions:

  • VR, AR, and exergaming are effective adjuncts to conventional rehabilitation for CMDs, improving pain and function with high adherence.
  • These technologies demonstrate significant potential for enhancing patient outcomes in musculoskeletal rehabilitation.
  • Further research is needed on long-term effects, economic evaluations, and direct modality comparisons.