The effect of adding virtual reality-based rehabilitation to conventional physiotherapy on pain, function and static balance control in patients with total knee arthroplasty during the acute rehabilitation phase: a randomized controlled trial

Physiotherapy following total knee arthroplasty (TKA) is essential for reducing pain and restoring function and balance. This study evaluated the effects of adding virtual reality (VR)-based therapy to conventional physiotherapy on pain, function, and static balance during early rehabilitation after TKA. Fifty-two patients following TKA (11 males, 41 females; mean age 61.92 ± 6.91 years) were allocated to a control group ( n = 24) receiving conventional physiotherapy or an intervention group ( n = 28) receiving VR-based therapy in addition to conventional physiotherapy. The primary outcome was function, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were pain, assessed using the Visual Analogue Scale (VAS), and static balance, assessed using the Wii Balance Board. Pain and function were assessed at baseline, post-treatment, and one-month follow-up, while static balance was assessed at baseline and post-treatment. Compared with the control group, the intervention group showed significantly greater improvements in WOMAC scores and pain at post-treatment and follow-up ( p < 0.001, η² = 0.36). Static balance improved in both groups, with significantly greater reductions in COP ellipse area and mediolateral mean velocity in the intervention group ( p < 0.001; η² = 0.23 for mediolateral mean velocity). Anteroposterior mean velocity with eyes open decreased significantly only in the intervention group ( p < 0.001), while no significant changes were observed in static balance parameters with eyes closed ( p > 0.05). Adding VR-based therapy to conventional physiotherapy may provide additional short-term benefits for pain, function, and static balance during early rehabilitation after TKA. Further multicenter trials with larger samples and longer follow-up are warranted. The study was registered in the Iranian Clinical Trials Registry with the number IRCT20230524058283N1 on date 10/08/2023.