Evaluating the Efficacy of Virtual Reality Exergaming in Frozen Shoulder Rehabilitation: A Randomized Clinical Trial

Objective: Frozen shoulder is a common condition causing shoulder pain and stiffness, with conventional therapies often hindered by low adherence due to their repetitive and painful nature. This randomized clinical trial aimed to evaluate the clinical effectiveness of immersive virtual reality (VR) exergaming in frozen shoulder rehabilitation.Materials and Methods: Fifty-four patients with primary frozen shoulder were randomly assigned to a VR therapy (VRT) group or a conventional therapy (CT) group. Both groups underwent 18 sessions over 6 weeks, consisting of 20 minutes of continuous passive motion exercises followed by 20 minutes of either VR exergaming or conventional functional exercises. We chose Beat Saber for the VR intervention, a rhythm game in which players slice blocks in sync with music. Its "level editor" allowed us to customize block patterns to simulate therapeutic shoulder movements.Results: Primary outcomes included passive range of motion (PROM) in external rotation, abduction, and flexion. Secondary outcomes assessed shoulder function (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) and resting pain (visual analog scale [VAS]). Assessments were conducted at baseline, postintervention, and 12 weeks after the trial. Both groups showed significant improvements in PROM, DASH, and VAS scores compared with baseline (P < 0.001). Between-group analysis revealed no significant differences in DASH (P = 0.483) or VAS (P = 0.220). However, the VRT group achieved superior abduction (P = 0.015) and flexion (P = 0.031), with no significant difference in external rotation (P = 0.637).Conclusion: These findings suggest VR exergaming is a promising adjunct to CT for frozen shoulder. Further studies are needed to investigate the influence of VR game design on rehabilitation outcomes.