Effect of Virtual-Reality-Based Rehabilitation on Balance and Functional Mobility Following Lower-Limb Orthopaedic Injury

Abstract

Balance deficits and reduced functional mobility are common and clinically important consequences of lower-limb orthopaedic injury and surgery. Virtual reality (VR) and exergaming platforms are increasingly used to deliver engaging, feedback-rich exercise, yet their effect on balance and mobility outcomes remains debated. This structured narrative review synthesises evidence from systematic reviews, meta-analyses and key randomised controlled trials (RCTs) of VR-based rehabilitation after ankle injury, anterior cruciate ligament reconstruction (ACLR), total knee arthroplasty (TKA) and mixed lower-limb conditions. The more recent source reviews included 6 to 15 RCTs each. In ankle injury, a pooled analysis of four trials reported a small-to-moderate benefit for overall balance (standardised mean difference [SMD] 0.36, 95% CI 0.01–0.71), driven by static rather than dynamic balance. After TKA, reviews agree that VR improves pain and function, but findings for postural control and Timed Up and Go performance are inconsistent. Evidence after ACLR is promising but of low certainty. Across conditions VR was usually superior to or at least comparable with conventional rehabilitation, with no adverse events reported in ankle trials. Methodological quality was frequently poor to fair, samples were small, and follow-up was short. VR is best viewed as an engaging adjunct to, rather than a replacement for, conventional rehabilitation. Larger, adequately powered and standardised trials are needed.