{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T03:25:15Z","timestamp":1791084315505,"version":"4.1.0"},"reference-count":68,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Extended reality (XR) is increasingly used in rehabilitation, showing potential to enhance clinical outcomes. Recently, integrating digital human modeling (DHM) with XR has gained attention. This systematic review aimed to evaluate the effectiveness of combining 3D and 4D DHM with XR in rehabilitation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic literature search was conducted according to PRISMA 2020 guidelines on the 28<jats:sup>th<\/jats:sup> of May 2024 in five databases (PubMed, IEEE Database, Cochrane Library, Web of Science, and Science Direct). All types of experimental studies investigating the effectiveness of XR using 3D and 4D DHM in rehabilitation were included. Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) and Evidence-Based Guideline Development (EBRO) were used to evaluate the methodological quality of the studies included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 1048 articles found, 16 were included in this review. These studies focused on 3D DHM in XR-based rehabilitation across various conditions and demonstrated superior effectiveness, especially in individuals with neglect, anorexia nervosa, bulimia nervosa, and type 2 diabetes in comparison with conventional therapy. DHM, captured via 3D cameras and combined with motion analysis or Wii remotes, was integrated into XR systems like VR games and avatar therapy. The studies reveal positive impacts on functional (e.g., upper limb function, gait, balance, quality of life), physical (e.g., pain reduction, spasticity, joint range), psychological (e.g., depression, emotional regulation, body image), and general health outcomes (e.g., body composition, metabolic health).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite variability in study parameters, limited evidence suggests that 3D DHM in XR-based rehabilitation may enhance physical and psychological recovery across various pathologies. This review highlights the potential of DHM and XR integration but underscores the need for further research with larger samples, longer follow-ups, and standardized measures to confirm these technologies\u2019 reliability and effectiveness in rehabilitation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p><jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42024553551<\/jats:ext-link>, identifier CRD42024553551.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fbioe.2025.1496168","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T08:05:35Z","timestamp":1741766735000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Using 3D and 4D digital human modeling in extended reality-based rehabilitation: a systematic review"],"prefix":"10.3389","volume":"13","author":[{"given":"Mengdi","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"Saeys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Maryam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inva","family":"Gjeleshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoda","family":"Nazarahari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Truijen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Scataglini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"104012","DOI":"10.1016\/J.COMPBIOMED.2020.104012","article-title":"Computational frame of ligament in situ strain in a full knee model","volume":"126","author":"Adouni","year":"2020","journal-title":"Comput. 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