Gamification in knee osteoarthritis rehabilitation: A systematic review of clinical evidence

Knee osteoarthritis (KOA) is a prevalent cause of pain and disability, and long-term adherence to exercise-based rehabilitation remains a significant challenge. Gamification, delivered through exergames, virtual reality (VR), and other seriousgame platforms, has been proposed to enhance motivation and optimize clinical outcomes in this population. The present study aimed to systematically synthesize the clinical evidence on gamified rehabilitation using virtual rehabilitation tools, active video games, sensor-enhanced telerehabilitation, or wearable devices with feedback in adults with KOA. Databases including PubMed, PEDro, and Embase (2015–2025) were searched for randomized controlled trials (RCTs) and clinical trials evaluating game-based, VR, or digital-feedback interventions in KOA. Studies comparing interventions to conventional exercise, usual care, or no intervention were included. Outcomes were pain (Visual Analog Scale) and functional disability (Western Ontario and McMaster Universities Osteoarthritis (OA) Index and knee injury and OA outcome score). The PEDro scoring was used to assess the quality of Methods, and the ROB2 tool was used to assess the risk of bias. Across the included trials, gamified rehabilitation was at least as effective as traditional programs and frequently yielded additional short-term improvements in pain and functional disability in individuals with KOA. Interventions were generally feasible, safe, and acceptable to patients with KOA. Gamification represents a promising adjunct to evidence-based KOA exercise therapy, particularly for improving pain and disability, but small sample sizes, weaknesses of the methods, technological heterogeneity, and scarce long-term follow-up limit current evidence. High-quality RCTs with standardized outcome sets, individual follow-up, and economic evaluations are needed to define the optimal role and cost-effectiveness of gamified rehabilitation in routine KOA care.