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Virtual reality augments movement during physical therapy: a pragmatic randomized trial
Hemphill S, Rodriguez S, Wang E, Koeppen K, Aitken-Young B, Jackson C, Simons L, Caruso TJ
American Journal of Physical Medicine & Rehabilitation 2022 Mar;101(3):229-236
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: Virtual reality (VR) facilitates physical therapy (PT) via improved engagement. While shown to benefit specific patient populations, such as stroke patients, it is less established in otherwise healthy adults and children receiving outpatient PT. The primary objective was to compare total PT-guided movement supplemented with VR (PTMVR) to PT guided movement alone, without VR (PTM). DESIGN: This pragmatic, randomized, crossover study compared PTMVR to PTM in outpatients (ages 6 to 80). This community sample had variable PT indications (injury, postoperative, chronic pain) and in preexisting conditions, therefore participants served as their own controls. Participants received 10 minutes of both PTMVR and PTM, separated by five minutes. The primary outcome was differences in aggregate movement of PT guided exercises. Secondary outcomes explored OMNI rating of perceived exertion (RPE) and participant and physical therapist satisfaction. Paired t-tests, chi-squared tests, and regression models were used to analyze differences. RESULTS: The 41 participants (17 pediatric and 24 adult) moved significantly more during PTMVR compared to PTM (1,120.88 meters versus 672.65 meters p < 0.001), regardless of which intervention was completed first. PTMVR treatment was associated with more movement of the target limbs, lower-body (p < 0.001), upper-body (p < 0.05). OMNI RPE scores did not differ between those who started with PTMVR or PTM, and physical therapist and patient surveys endorsed PTMVR. CONCLUSIONS: Patients completed more PT guided movement during PTMVR than PTM and therapists and patients supported its use. Future studies will examine finer tracking of movements.

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