{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:53:38Z","timestamp":1790999618983,"version":"4.1.0"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2019,7,25]],"date-time":"2019-07-25T00:00:00Z","timestamp":1564012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Virtual reality (VR) is an interactive technology that allows customized treatment and may help in delivering effective person-centered rehabilitation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>The purpose of this review was to systematically review and critically appraise the controlled clinical trials that investigated VR effectiveness in orthopedic rehabilitation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Data Sources<\/jats:title>\n                  <jats:p>Pubmed, CINAHL, Embase, PEDro, REHABDATA, and Sage publications were searched up to September 2018. In addition, manual searching and snowballing using Scopus and Web of Science were done.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Study Selection<\/jats:title>\n                  <jats:p>Two reviewers screened studies for eligibility first by title and abstract and then full text.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Data Extraction<\/jats:title>\n                  <jats:p>Articles were categorized into general or region-specific (upper limbs, lower limbs, and spine) orthopedic disorders. Study quality was assessed using the Evaluation Guidelines for Rating the Quality of an Intervention Study scoring. Meta-analysis quantified VR effectiveness, compared with no treatment, in back pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Data Synthesis<\/jats:title>\n                  <jats:p>Nineteen studies were included in the quality assessment. The majority of the studies were of moderate quality. Fourteen studies showed that VR did not differ compared with exercises. Compared with the no-treatment control, 5 studies favored VR and 3 other studies showed no differences. For low back pain, the meta-analysis revealed no significant difference between VR and no-treatment control (n\u00a0=\u00a0116; standardized mean difference\u00a0=\u00a0\u22120.21; 95% confidence interval\u00a0=\u00a0\u22120.58 to 0.15).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Limitations<\/jats:title>\n                  <jats:p>Limitations included heterogeneity in interventions and the outcome measures of reviewed studies. Only articles in English were included.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The evidence of VR effectiveness is promising in chronic neck pain and shoulder impingement syndrome. VR and exercises have similar effects in rheumatoid arthritis, knee arthritis, ankle instability, and post-anterior cruciate reconstruction. For fibromyalgia and back pain, as well as after knee arthroplasty, the evidence of VR effectiveness compared with exercise is absent or inconclusive.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzz093","type":"journal-article","created":{"date-parts":[[2019,7,6]],"date-time":"2019-07-06T19:07:44Z","timestamp":1562440064000},"page":"1304-1325","source":"Crossref","is-referenced-by-count":153,"title":["Is Virtual Reality Effective in Orthopedic Rehabilitation? A Systematic Review and Meta-Analysis"],"prefix":"10.1093","volume":"99","author":[{"given":"Mohammed","family":"Gumaa","sequence":"first","affiliation":[{"name":"Department of Physical Therapy for Musculoskeletal Disorders and Its Surgery, Cairo University , Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliaa","family":"Rehan Youssef","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy for Musculoskeletal Disorders and Its Surgery, Cairo University , 24 Mohammed Korium St, 6th District, Nasr City, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,25]]},"reference":[{"key":"2023011903532030700_ref1","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.physio.2016.08.004","article-title":"Effectiveness of virtual reality rehabilitation for children and adolescents with cerebral palsy: an updated evidence-based systematic review","volume":"103","author":"Ravi","year":"2017","journal-title":"Physiotherapy."},{"key":"2023011903532030700_ref2","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1177\/0883073814533007","article-title":"Role of virtual reality for cerebral palsy management","volume":"29","author":"Weiss","year":"2014","journal-title":"J Child Neurol."},{"key":"2023011903532030700_ref3","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.aott.2017.03.008","article-title":"Comparison of virtual reality exergaming and home exercise programs in patients with subacromial impingement syndrome and scapular dyskinesis: short term effect","volume":"51","author":"Pekyavas","year":"2017","journal-title":"Acta Orthop Traumatol Turc."},{"key":"2023011903532030700_ref4","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.ptsp.2013.08.004","article-title":"The effect of Xbox Kinect intervention on balance ability for previously injured young competitive male athletes: a preliminary study","volume":"15","author":"Vernadakis","year":"2014","journal-title":"Phys Ther Sport."},{"key":"2023011903532030700_ref5","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1007\/s10067-006-0324-0","article-title":"Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritis","volume":"26","author":"Lin","year":"2007","journal-title":"Clin Rheumatol."},{"key":"2023011903532030700_ref6","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1007\/s00586-017-5323-0","article-title":"Remote kinematic training for patients with chronic neck pain: a randomised controlled trial","volume":"27","author":"Bahat","year":"2018","journal-title":"Eur Spine J."},{"key":"2023011903532030700_ref7","doi-asserted-by":"crossref","DOI":"10.7717\/peerj.3211","article-title":"Exergames for women with fibromyalgia: a randomised controlled trial to evaluate the effects on mobility skills, balance and fear of falling","volume":"5","author":"Collado-Mateo","year":"2017","journal-title":"PeerJ."},{"key":"2023011903532030700_ref8","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.physio.2012.04.001","article-title":"Use of Nintendo Wii fit\u2122 in the rehabilitation of outpatients following total knee replacement: a preliminary randomised controlled trial","volume":"98","author":"Fung","year":"2012","journal-title":"Physiotherapy."},{"key":"2023011903532030700_ref9","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.1007\/s00586-016-4388-5","article-title":"Neck motion kinematics: an inter-tester reliability study using an interactive neck VR assessment in asymptomatic individuals","volume":"25","author":"Bahat","year":"2016","journal-title":"Eur Spine J."},{"key":"2023011903532030700_ref10","doi-asserted-by":"crossref","first-page":"112","DOI":"10.3389\/fnhum.2014.00112","article-title":"Moving from virtual reality exposure-based therapy to augmented reality exposure-based therapy: a review","volume":"8","author":"Baus","year":"2014","journal-title":"Front Hum Neurosci."},{"key":"2023011903532030700_ref11","first-page":"193","article-title":"S\u00e1nchez-Vives M V. How we experience immersive virtual environments: the concept of presence and its measurement","volume":"40","author":"Slater","year":"2009","journal-title":"Anu Psicol."},{"key":"2023011903532030700_ref12","doi-asserted-by":"crossref","DOI":"10.1155\/2016\/7075464","article-title":"Motor ingredients derived from a wearable sensor-based virtual reality system for frozen shoulder rehabilitation","volume":"2016","author":"Lee","year":"2016","journal-title":"Biomed Res Int."},{"key":"2023011903532030700_ref13","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jht.2016.07.002","article-title":"Camera-tracking gaming control device for evaluation of active wrist flexion and extension","volume":"30","author":"Shefer Eini","year":"2017","journal-title":"J Hand Ther."},{"key":"2023011903532030700_ref14","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.gaitpost.2017.12.022","article-title":"Reliability and validity of the Wii balance board for assessment of standing balance: a systematic review","volume":"61","author":"Clark","year":"2018","journal-title":"Gait Posture."},{"key":"2023011903532030700_ref15","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s00391-010-0124-7","article-title":"Use of virtual reality technique for the training of motor control in the elderly","volume":"43","author":"Bruin","year":"2010","journal-title":"Z Gerontol Geriatr."},{"key":"2023011903532030700_ref16","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1089\/cpb.2005.8.187","article-title":"Virtual environments for motor rehabilitation: review","volume":"8","author":"Holden","year":"2005","journal-title":"CyberPsychol Behav."},{"key":"2023011903532030700_ref17","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1037\/0090-5550.46.3.296","article-title":"The application of virtual reality technology in rehabilitation","volume":"46","author":"Schultheis","year":"2001","journal-title":"Rehabil Psychol."},{"key":"2023011903532030700_ref18","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1097\/00004356-200023040-00009","article-title":"The use of virtual reality to train powered wheelchair users and test new wheelchair systems","volume":"23","author":"Stott","year":"2000","journal-title":"Int J Rehabil Res."},{"key":"2023011903532030700_ref19","doi-asserted-by":"crossref","first-page":"2298","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.06.010","article-title":"The use of Nintendo Wii in the rehabilitation of poststroke patients: a systematic review","volume":"24","author":"Dos Santos","year":"2015","journal-title":"J Stroke Cerebrovasc Dis."},{"key":"2023011903532030700_ref20","doi-asserted-by":"crossref","DOI":"10.1155\/2015\/342529","article-title":"A decade of progress using virtual reality for poststroke lower extremity rehabilitation: systematic review of the intervention methods","volume":"2015","author":"Luque-Moreno","year":"2015","journal-title":"Biomed Res Int."},{"issue":"11","key":"2023011903532030700_ref21","article-title":"Virtual reality for stroke rehabilitation","author":"Laver","year":"2017","journal-title":"Cochrane Database Syst Rev."},{"issue":"12","key":"2023011903532030700_ref22","article-title":"Virtual reality for rehabilitation in Parkinson\u2019s disease","author":"Dockx","year":"2016","journal-title":"Cochrane Database Syst Rev."},{"key":"2023011903532030700_ref23","doi-asserted-by":"crossref","first-page":"3097","DOI":"10.1589\/jpts.27.3097","article-title":"Effects of virtual reality programs on balance in functional ankle instability","volume":"27","author":"Kim","year":"2015","journal-title":"J Phys Ther Sci."},{"key":"2023011903532030700_ref24","doi-asserted-by":"crossref","first-page":"2280","DOI":"10.1007\/s00167-014-3374-x","article-title":"Immersive virtual reality improves movement patterns in patients after ACL reconstruction: implications for enhanced criteria-based return-to-sport rehabilitation","volume":"24","author":"Gokeler","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"2023011903532030700_ref25","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.math.2014.06.008","article-title":"Cervical kinematic training with and without interactive VR training for chronic neck pain: a randomized clinical trial","volume":"20","author":"Bahat","year":"2015","journal-title":"Man Ther."},{"key":"2023011903532030700_ref26","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1016\/j.jpain.2016.08.011","article-title":"Feasibility and safety of a virtual reality dodgeball intervention for chronic low back pain: a randomized clinical trial","volume":"17","author":"Thomas","year":"2016","journal-title":"J Pain."},{"key":"2023011903532030700_ref27","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1197\/j.jht.2004.02.001","article-title":"An introduction to evidence-based practice for hand therapists","volume":"17","author":"MacDermid","year":"2004","journal-title":"J Hand Ther."},{"key":"2023011903532030700_ref28","doi-asserted-by":"crossref","first-page":"734","DOI":"10.2519\/jospt.2011.3440","article-title":"The effect of therapeutic exercise and mobilization on patients with shoulder dysfunction: a systematic review with meta-analysis","volume":"41","author":"Brudvig","year":"2011","journal-title":"J Orthop Sports Phys Ther."},{"key":"2023011903532030700_ref29","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ."},{"key":"2023011903532030700_ref30","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1016\/j.apmr.2017.02.011","article-title":"Effects of exergames on quality of life, pain, and disease effect in women with fibromyalgia: a randomized controlled trial","volume":"98","author":"Collado-Mateo","year":"2017","journal-title":"Arch Phys Med Rehabil."},{"key":"2023011903532030700_ref31","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1186\/s12891-016-1208-3","article-title":"A prospective pilot study to evaluate an animated home-based physical exercise program as a treatment option for patients with rheumatoid arthritis","volume":"17","author":"Zernicke","year":"2016","journal-title":"BMC Musculoskelet Disord."},{"key":"2023011903532030700_ref32","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1589\/jpts.29.693","article-title":"The effect of horse-riding simulator exercise on the gait, muscle strength and muscle activation in elderly people with knee osteoarthritis","volume":"29","author":"Kim","year":"2017","journal-title":"J Phys Ther Sci."},{"key":"2023011903532030700_ref33","first-page":"6119","article-title":"Virtual reality intervention in postoperative rehabilitation after total knee arthroplasty: a prospective and randomized controlled clinical trial","volume":"11","author":"Jin","year":"2018","journal-title":"Int J Clin Exp Med."},{"key":"2023011903532030700_ref34","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1007\/s00167-012-2034-2","article-title":"Comparison between Nintendo Wii fit and conventional rehabilitation on functional performance outcomes after hamstring anterior cruciate ligament reconstruction: prospective, randomized, controlled, double-blind clinical trial","volume":"21","author":"Baltaci","year":"2013","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"2023011903532030700_ref35","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1111\/sms.12509","article-title":"Wii FitTM exercise therapy for the rehabilitation of ankle sprains: its effect compared with physical therapy or no functional exercises at all","volume":"26","author":"Punt","year":"2016","journal-title":"Scand J Med Sci Sports."},{"key":"2023011903532030700_ref36","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.gaitpost.2017.06.284","article-title":"Effect of Wii FitTM exercise therapy on gait parameters in ankle sprain patients: a randomized controlled trial","volume":"58","author":"Punt","year":"2017","journal-title":"Gait Posture."},{"key":"2023011903532030700_ref37","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1589\/jpts.26.549","article-title":"The effects of VR-based Wii fit yoga on physical function in middle-aged female LBP patients","volume":"26","author":"Kim","year":"2014","journal-title":"J Phys Ther Sci."},{"key":"2023011903532030700_ref38","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1111\/ijcp.12414","article-title":"The effect of horse simulator riding on visual analogue scale, body composition and trunk strength in the patients with chronic low back pain","volume":"68","author":"Yoo","year":"2014","journal-title":"Int J Clin Pract."},{"key":"2023011903532030700_ref39","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1589\/jpts.25.985","article-title":"The effects of the Nintendo Wii exercise program on chronic work-related low back pain in industrial workers","volume":"25","author":"Park","year":"2013","journal-title":"J Phys Ther Sci."},{"key":"2023011903532030700_ref40","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.3899\/jrheum.100759","article-title":"Pain mechanisms in osteoarthritis: understanding the role of central pain and current approaches to its treatment","volume":"38","author":"Mease","year":"2011","journal-title":"J Rheumatol."},{"key":"2023011903532030700_ref41","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/j.cell.2014.11.003","article-title":"Identification of spinal circuits transmitting and gating mechanical pain","volume":"159","author":"Duan","year":"2014","journal-title":"Cell."},{"key":"2023011903532030700_ref42","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1007\/s11926-012-0285-z","article-title":"The role of the central nervous system in osteoarthritis pain and implications for rehabilitation","volume":"14","author":"Murphy","year":"2012","journal-title":"Curr Rheumatol Rep."},{"key":"2023011903532030700_ref43","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s11926-002-0038-5","article-title":"Evidence of involvement of central neural mechanisms in generating fibromyalgia pain","volume":"4","author":"Staud","year":"2002","journal-title":"Curr Rheumatol Rep."},{"key":"2023011903532030700_ref44","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1002\/art.20063","article-title":"Evidence of augmented central pain processing in idiopathic chronic low back pain","volume":"50","author":"Giesecke","year":"2004","journal-title":"Arthritis Rheum."},{"key":"2023011903532030700_ref45","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s11926-011-0206-6","article-title":"Evidence for shared pain mechanisms in osteoarthritis, low back pain, and fibromyalgia","volume":"13","author":"Staud","year":"2011","journal-title":"Curr Rheumatol Rep."},{"key":"2023011903532030700_ref46","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/j.ejpain.2010.01.001","article-title":"Driving plasticity in the motor cortex in recurrent low back pain","volume":"14","author":"Tsao","year":"2010","journal-title":"Eur J Pain."},{"key":"2023011903532030700_ref47","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/j.neuron.2015.07.029","article-title":"Dorsal horn circuits for persistent mechanical pain","volume":"87","author":"Peirs","year":"2015","journal-title":"Neuron."},{"key":"2023011903532030700_ref48","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1002\/art.37739","article-title":"Central pain mechanisms in the rheumatic diseases: future directions","volume":"65","author":"Phillips","year":"2013","journal-title":"Arthritis Rheum."},{"key":"2023011903532030700_ref49","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.jmpt.2004.04.005","article-title":"Central neuronal plasticity, low back pain and spinal manipulative therapy","volume":"27","author":"Boal","year":"2004","journal-title":"J Manipulative Physiol Ther."},{"key":"2023011903532030700_ref50","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/S0079-6123(00)29026-2","article-title":"Referred pain as an indicator for neural plasticity","volume":"129","author":"Arendt-Nielsen","year":"2000","journal-title":"Prog Brain Res."},{"key":"2023011903532030700_ref51","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/PSY.0b013e318218e1fb","article-title":"Usual and unusual care: existing practice control groups in randomized controlled trials of behavioral interventions","volume":"73","author":"Freedland","year":"2011","journal-title":"Psychosom Med."},{"key":"2023011903532030700_ref52","doi-asserted-by":"crossref","first-page":"5541","DOI":"10.3390\/ijerph10115541","article-title":"How technology in care at home affects patient self-care and self-management: a scoping review","volume":"10","author":"Peeters","year":"2013","journal-title":"Int J Environ Res Public Health."}],"container-title":["Physical Therapy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ptj\/advance-article-pdf\/doi\/10.1093\/ptj\/pzz093\/28999980\/pzz093.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ptj\/article-pdf\/99\/10\/1304\/48760018\/ptj_99_10_1304.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ptj\/article-pdf\/99\/10\/1304\/48760018\/ptj_99_10_1304.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T03:54:29Z","timestamp":1674100469000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ptj\/article\/99\/10\/1304\/5537309"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,25]]},"references-count":52,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2019,10,28]]}},"URL":"https:\/\/doi.org\/10.1093\/ptj\/pzz093","relation":{},"ISSN":["0031-9023","1538-6724"],"issn-type":[{"value":"0031-9023","type":"print"},{"value":"1538-6724","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,10]]},"published":{"date-parts":[[2019,7,25]]}}}