Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: A randomized controlled trial

Background: Virtual reality (VR) and serious games (SGs) are widespread in rehabilitation for many orthope-dic and neurological diseases. However, few studies have addressed the effects of rehabilitation with VR-based SGs on clinical, gait, and postural outcomes in individuals with total knee replacement (TKR). Objective: The primary objective was the efficacy of balance training using non-immersive VR-based SGs compared to conventional therapy in TKR patients on the Time Up and Go test. Secondary objectives included the efficacy on clinical, gait, and postural outcomes.Methods: We randomly allocated 56 individuals with unilateral TKR to the experimental group (EG) or con-trol group (CG) for 15 sessions (45 min; 5 times per week) of non-immersive VR-based SGs or conventional balance training, respectively. The primary outcome was functional mobility measured by the Timed Up and Go test; secondary outcomes were walking speed, pain intensity, lower-limb muscular strength, indepen-dence in activities of daily living as well as gait and postural parameters.Results: We found significant within-group differences in all clinical outcomes and in a subset of gait (p<0.0001) and postural (p <= 0.05) parameters. Analysis of the stance time of the affected limb revealed sig-nificant between-group differences (p = 0.022): post-hoc analysis revealed within-group differences in the EG (p = 0.002) but not CG (p = 0.834). We found no significant between-group differences in other outcomes.Conclusions: Balance training with non-immersive VR-based SGs can improve clinical, gait, and postural out-comes in TKR patients. It was not superior to the CG findings but could be considered an alternative to the conventional approach and can be added to a regular rehabilitation program in TKR patients. The EG had a more physiological duration of the gait stance phase at the end of the treatment than the CG. ClinicalTrials.gov: NCT03454256 (c) 2021 Elsevier Masson SAS. All rights reserved.