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 randomised controlled trial
BMC Musculoskeletal Disorders · 14 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Early rehabilitation after TKA is a high-volume, routine part of care, and low-cost motion-sensing VR is increasingly marketed as an add-on, so knowing whether it adds real benefit beyond extra therapy time is practical for counselling and resource planning.
The evidence
This single-centre Iranian randomised trial tested whether adding about 30 minutes of Kinect-based virtual reality (VR) exercise, in 6 of 10 sessions, to standard physiotherapy in the first weeks after total knee arthroplasty improves function, pain and static balance. Among the 52 patients analysed, the VR group had WOMAC scores about 17 points lower (better) than controls after the two-week programme and about 15 points lower at one-month follow-up. Pain and eyes-open sway measures also favoured VR. Ten randomised patients (7 controls, 3 VR) dropped out before treatment and were excluded, so the analysis was per-protocol and fell short of the planned sample.
knee function: Mean difference 17.29 (95% CI unavailable; WOMAC).
Why this rigour score?
RCTDesign starting point: 59.5
Raised the score
- Concealed allocation+5.1
- Prospectively registered+5.1
Lowered the score
- Only 1 months of follow-up−9.3
- Underpowered−8.5
Methods at a glance
Recorded assessment- Outcome assessors blindedNot reported
- Allocation concealedMet
- Random sequence generatedMet
- Intention-to-treat analysisNot reported
- Adequate statistical powerUnderpowered
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 59.5
- Concealed allocation
- +5.1
- Random sequence generation
- +2.5
- Compared against current standard of care
- +3.4
- Only 1 months of follow-up
- −9.3
- 16% loss to follow-up
- −3
- Underpowered
- −8.5
- Prospectively registered
- +5.1
- A positive result from only 62 patients
- −3.4
- A positive result from a single centre
- −4.3
- Final rigour score rounded
- 47 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.If supervised VR exercise improves short-term WOMAC scores after TKA, which patients (for example, those with poor early balance or low motivation) would you most consider referring for VR-augmented rehabilitation?
2.Given that the VR group also received more supervised exercise time, how would you counsel a patient asking whether paying for VR rehabilitation is worth it versus simply doing more conventional therapy and home exercise?
Original publication title
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