Immersive virtual reality–based manual therapy training: a mixed-methods trial

Abstract Manual therapy mobilizations are common therapeutic practices for musculoskeletal conditions, but their acquisition presents significant challenges as it requires the precise, coordinated, and safe execution of specific movements. Traditional teaching approaches often rely on subjective feedback and offer limited real-time guidance, which may hinder skill acquisition. In recent years, immersive Virtual Reality (iVR) has emerged as a promising educational tool, showing potential to enhance learning experiences and increase student motivation. This study aimed to develop and validate a novel teaching approach for manual therapy mobilizations by integrating iVR as a complementary tool in undergraduate education, allowing students to practice techniques with greater precision and efficiency. A mixed-methods cluster randomized controlled trial was conducted with undergraduate students who had no prior experience with the technique. An iVR application for head-mounted displays was developed to teach a knee mobilization technique. Students in the experimental group used the iVR application alongside a traditional instructional session, while the control group received traditional teaching only. Quantitative and qualitative data related to usability, iVR experience, and learning experience were collected after the session. Results showed that students in the experimental group reported higher engagement and motivation when learning manual therapy techniques, although some perceived the traditional method as simpler. Learning experience outcomes indicated improved coordination of translational and rotational movements among iVR users, which is essential for effective manual therapy mobilization. Overall, these findings suggest that iVR can serve as an effective supplementary tool to conventional teaching methods, contributing to enhanced learning and performance outcomes.