{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T14:16:57Z","timestamp":1794665817952,"version":"4.9.1"},"reference-count":41,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Osteoarthritis (OA) is a chronic, degenerative joint disease. The main symptoms include pain that can cause loss of function and stiffness, as well as swelling, reduced range of motion, crepitus, joint deformity, and muscle weakness. It leads to irreversible structural changes, that in advanced stages can require surgical interventions. The aim of this review was to summarize the current literature about the role of virtual reality (VR), exergames and digital technologies in patients with knee osteoarthritis before or after total knee arthroplasty, to understand if it is possible to prevent and reduce the symptoms and if these new technologies are more effective than conventional rehabilitation therapies. Materials and Methods: We conducted a systematic search of PubMed, Cochrane Library, Scopus, and PEDro from inception to November 2024. The review adhered to the PRISMA 2020 guidelines, and the protocol was prospectively registered in PROSPERO (registration number: CRD42024541890). We included randomized controlled trials (RCTs) enrolling participants aged 60 years or older, in which VR or telerehabilitation programs were compared with conventional rehabilitation approaches. Eligible studies had to report at least one of the following outcomes: pain, functionality, stability, or adherence. Two independent reviewers screened titles and abstracts, assessed full-text eligibility, extracted data, and evaluated the risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Fourteen randomized controlled trails (RCTs) (1123 participants; mean age 68.2 years) were included. VR and telerehabilitation generally outperformed conventional rehabilitation for pain (8\/13 studies, \u22120.9 to \u22122.3 VAS points) and functionality (7\/13 studies, WOMAC improvement 8\u201315%, TUG \u22121.2 to \u22122.8 s). Compliance was higher in most technology-assisted programs (6\/7 studies, 70\u2013100% adherence). Stability outcomes were less consistent, with only 1\/4 studies showing clear benefit. One study favored conventional rehabilitation for functionality. Overall risk of bias was low-to-moderate, with heterogeneity mainly driven by intervention duration, platform type, and supervision level. Conclusions: Structured telerehabilitation, non-immersive VR, and interactive online exercise programs, especially those offering real-time feedback, show comparable or superior benefits to conventional rehabilitation in older adults with knee OA or after TKA, particularly for pain reduction, functional gains, and adherence. These approaches enhance accessibility and home-based care, supporting their integration into clinical practice when in-person therapy is limited.<\/jats:p>","DOI":"10.3390\/medicina61091587","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T13:01:13Z","timestamp":1756818073000},"page":"1587","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Role of Virtual Reality, Exergames, and Digital Technologies in Knee Osteoarthritis Rehabilitation Before or After Total Knee Arthroplasty: A Systematic Review of the Interventions in Elderly Patients"],"prefix":"10.3390","volume":"61","author":[{"given":"Ludovica Di","family":"Curzio","sequence":"first","affiliation":[{"name":"Universit\u00e0 Campus Bio-Medico di Roma, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8694-1404","authenticated-orcid":false,"given":"Teresa","family":"Paolucci","sequence":"additional","affiliation":[{"name":"Universit\u00e0 degli Studi di \u201cG. D\u2019Annunzio\u201d, 66100 Chieti-Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Miccinilli","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Campus Bio-Medico di Roma, 00128 Rome, Italy"},{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3396-4100","authenticated-orcid":false,"given":"Marco","family":"Bravi","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Campus Bio-Medico di Roma, 00128 Rome, Italy"},{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6142-3096","authenticated-orcid":false,"given":"Fabio","family":"Santacaterina","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Campus Bio-Medico di Roma, 00128 Rome, Italy"},{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucrezia","family":"Giorgi","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2347-7544","authenticated-orcid":false,"given":"Silvia","family":"Sterzi","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loredana","family":"Zollo","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Campus Bio-Medico di Roma, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0204-9831","authenticated-orcid":false,"given":"Andrea","family":"Bernetti","sequence":"additional","affiliation":[{"name":"Universit\u00e0 del Salento, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Bressi","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Campus Bio-Medico di Roma, 00128 Rome, Italy"},{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Giorgino, R., Albano, D., Fusco, S., Peretti, G.M., Mangiavini, L., and Messina, C. 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