no abstract because it is letter to editor

Lumbar disc herniation is a prevalent condition that leads to pain, disability, and a reduction in quality of life. While conventional treatments are widely utilized, virtual reality-based exercise programs present a promising alternative. However, the effectiveness of these exercises in the rehabilitation of lumbar disc herniation remains unclear. The aim of this study was to evaluate the effects of virtual reality-based exercises on pain, daily activities, quality of life, and fall risk in individuals with lumbar disc herniation. This randomized controlled trial included 68 patients meeting the study criteria. No other physical disabilities, no surgery in the last 6months, no uncontrolled diseases, no vertigo, knee or joint issues, moderate/low balance impairment, and body mass ındex below 40. Uncontrolled diseases, vertigo, knee/joint issues, cognitive impairments, pregnancy, inability to complete fall risk measurement, or attend follow-ups. Participants were divided into a virtual reality group (n = 34, Mean age ± Standard Deviation = 51.05 ± 13.39, 41.2% male, 58.8% female) and a control group (n = 34, Mean age ± Standard Deviation = 53.55 ± 12.25, 29.4% male, 70.6% female). The virtual reality group performed 28 sessions of virtual reality -based exercises, while the control group received routine hospital treatment. The study was conducted in a single hospital due to equipment limitations in the region. Data were collected using the Patient Information Form, Visual Analog Scale, Oswestry Disability Index, Short Form-36 Quality of Life Scale, and Fall Risk Device. Statistical analyses were performed using Statistical Package for the Social Sciences 20, including t-tests, chi-square tests, effect size analysis, and skewness/kurtosis assessments for homogeneity. The virtual reality group showed a significant reduction in pain (Visual Analog Scale: 3.38 ± 1.48, Cl: -2.49, -0.86, p < 0.05) and disability (Oswestry Disability Index: 21.59 ± 6.00, Cl: -19.92, -7.38, p < 0.05), along with significant improvements in all Short Form-36 Quality Of Life sub-dimensions (p < 0.05).Fall risk scores also decreased significantly in the virtual reality group (Cl: -26.57, -7.26, p < 0.05). There were no significant baseline differences between the groups, confirming their comparability before the intervention. Virtual reality -based exercises effectively reduced pain, improved daily activities and quality of life, and decreased fall risk in lumbar disc herniation patients, suggesting their potential as a complementary rehabilitation approach. Blinding was not applied due to the nature of the interventions, which may introduce a potential risk of bias. This study was registered at ClinicalTrials.gov (Clinical trial number: NCT05463588; Registration date: 08/07/2022). The study was retrospectively registered.

This systematic review and meta-analysis aimed to assess virtual reality (VR)-based exercise effects on walking capacity, fall risk, and quality of life in healthy older adults. Five databases were searched up to January 2025. From 56 trials involving 2927 participants, VR improved six-minute walk distance (MD = 24.59, 95% CI: 20.90-28.28, p < 0.00001), gait speed (MD = 0.04, 95% CI: 0.01-0.07, p = 0.02), and Timed Up-and-Go test (MD = -0.67, 95% CI: -1.08 to -0.25, p = 0.001), while reducing fear of falling (SMD = -0.67, 95% CI: -1.01 to -0.33, p = 0.0001). Quality-of-life gains included physical (MD = 0.31, p = 0.009), environmental (MD = 0.42, p = 0.01), psychological (MD = 0.47, p = 0.003), and social health (MD = 0.31, p = 0.004). VR-based exercise is an effective, engaging tool to enhance mobility, lower fall risk, and promote functional independence and psychosocial well-being.

This study aimed to evaluate the impact of an 8-week virtual reality (VR)-based exercise intervention on mood states among college students compared with traditional aerobic exercise and a control group. A randomized controlled trial was conducted with 56 participants assigned to one of three groups: VR-based exercise, aerobic exercise, and control group. Participants in the two exercise groups completed two 40-minute sessions per week. Mood states were assessed using the Profile of Mood States scale at baseline, 4 weeks, and 8 weeks. Repeated measures analysis of variance revealed significant time-group interactions for tension, anger, fatigue, depression, vigor, and self-related mood, indicating differential effects across groups. Post hoc analyses showed that the VR-based exercise group demonstrated the most improvements in mood, with significant reductions in overall mood disturbance (P < 0.001, VR group 109.00 ± 3.03; traditional group 118.58 ± 3.12; control group 131.55 ± 4.68), tension (P = 0.004, VR group 10.60 ± 0.70; traditional group 12.00 ± 0.60; control group 15.23 ± 0.99), anger (P = 0.015, VR group 9.00 ± 0.50; traditional group 9.68 ± 0.46; control group 11.91 ± 0.90), and depression (P = 0.011, VR group 7.93 ± 0.42; traditional group 8.47 ± 0.51; control group 11.45 ± 0.83), and a significant increase in vigor (P < 0.001, VR group 22.93 ± 0.80; traditional group 19.74 ± 0.70; control group 17.86 ± 0.67) and self-related mood (P = 0.025, VR group 15.80 ± 0.65; traditional group 14.37 ± 0.43; control group 13.64 ± 0.62). The findings suggest that VR-based exercise offers an engaging, immersive experience that can significantly enhance mood states, potentially outperforming traditional exercise. This study highlights the potential of VR as an effective tool for promoting mental health among college populations.

Dear Readers, With great gratitude, we present the first edition of the Indonesian Journal of Physical and Medical Rehabilitation Volume 14. This edition marks an important initial step in this academic year, while also being a manifestation of our consistency in presenting the latest research and thoughts in the field of physical and medical rehabilitation. In this edition we proud to present fourteen articles that are well worth reading. Readers will find a variety of articles that reflect advances in science, clinical practice, and innovations in rehabilitation services. Among them is an interesting article examining the effectiveness of virtual reality-based exercise therapy for cerebral palsy patients, as well as research about effectiveness of dry needling on reducing pain, increasing range of motion of the neck in myofascial pain syndrome. We also highlight a case report about abdominal wall pain after varicocele surgery. The patient has received various types of treatment for five months, including prolotherapy and radiofrequency ablation on the ilioinguinal nerve, but has not recovered. Re-evaluation has been conducted and it was found that the cause of abdominal wall pain is the entrapment of the anterior cutaneous nerve. Diagnosing based on patient complaints and directed anamnesis accompanied by accurate physical examination is key in laying the foundation for the treatment plan. Accurate therapy outcomes are preceded by a correct diagnosis. A proper treatment plan targets the correct cause of pain and the pathophysiology behind it. We believe that the articles in this edition not only enrich the scientific knowledge but also provide practical guidelines for clinicians, researchers, and policymakers in improving the quality of rehabilitation services in Indonesia and the surrounding areas. We extend our gratitude to all the authors, reviewers, and the editorial team who have worked hard to maintain the quality and scientific integrity of this journal. We invite readers to participate in the development of this journal through manuscript contributions, constructive criticism, and academic collaboration. Respectful greetings, Dr. dr. Rita Vivera Pane SpKFR., N.M (K)., FIPM., CIPS., FIPP Editor-in-Chief Indonesian Journal of Physical and Medical Rehabilitation

ObjectiveThe primary aim of this study is to compare the effectiveness of early active limb movement facilitated by virtual reality technologies with conventional exercise therapy in enhancing patient recovery in the Respiratory Intensive Care Unit. The follow-up period covers 1 week.MethodsIn this prospective randomized controlled trial, patients were allocated to either a control group, which received standard exercise therapy, or a virtual reality group, which utilized virtual reality software and equipment for active exercises. Patients were followed for 1 week. The study compared compliance, safety, and rehabilitative outcomes between these groups. Data were analysed using a linear mixed-effects model.ResultsPatients in the virtual reality-based exercise group exhibited significantly higher levels of average daily exercise time, out-of-bed exercise time, and overall exercise compliance compared with the control group (p < 0.05). There were no reports of adverse events related to exercise in either group. Notably, within the first week of intervention, the virtual reality-based exercise group showed significant improvements in various parameters, including muscle strength, grip strength, body mass index, and the Barthel Index, outperforming the control group in these areas (all p < 0.05).ConclusionBased on 1 week of follow-up data, the study confirms that virtual reality-based exercise modalities are more efficacious than traditional exercise approaches in enhancing exercise duration, compliance, and various health outcomes in Respiratory Intensive Care Unit patients. This approach also contributes to reducing Respiratory Intensive Care Unit stay duration. The system’s effectiveness could be further increased by integrating more varied and engaging rehabilitation games and features tailored to the needs of ICU patients.Trial registration: Chictr.org: ChiCTR1900021452LAY ABSTRACTThis study explored whether using virtual reality technology to help patients in the Respiratory Intensive Care Unit perform early limb exercises could improve their recovery compared to traditional exercise methods. Patients were divided into two groups: one used virtual reality to assist with exercises, while the other followed standard exercise routines. Over one week, the virtual reality group showed better results in terms of exercise time, muscle strength, grip strength, and overall recovery. The study found that virtual reality-based exercises were more engaging and effective, leading to higher patient compliance and faster improvements in physical health. This suggests that virtual reality could be a valuable tool in helping Respiratory Intensive Care Unit patients recover more quickly and efficiently.

Effects of immersive virtual reality-based exercise on quality of life, stress, anxiety, depression, and handgrip strength in fibromyalgia: A pilot study

Fibromyalgia (FM) is characterized by persistent widespread pain that severely impacts quality of life. Immersive virtual reality-based exercise (iVRE) is emerging as a therapeutic modality for chronic pain management. However, research on iVRE in FM patients has primarily focused on perceived pain intensity (PI), with limited exploration of underlying analgesic mechanisms. This study aims to explore the effects of iVRE on PI, considering risk of poor outcomes (RPO) stratification, and on mechanical pain sensitivity (MPS) in FM. A single-arm, uncontrolled, pre-post-test exploratory study was conducted in subjects with FM. The intervention included 2 weekly 15-min iVRE sessions for 6 weeks. PI (numeric rating scale [NRS]) and MPS (pressure pain thresholds [PPTs] at the upper trapezius, lumbar spine, and knee) were assessed at baseline, after the first session (to assess exercise-induced hypoalgesia), and postintervention. RPO was assessed using the Keele STarT MSK Tool. Eleven participants completed the study. No adverse effects were reported. Clinically important reductions were observed in PI (mean difference [MD]: −2.36, 95% CI: [−4.15, −0.58], d = 0.89; p &lt; 0.05) with this effect being associated with baseline RPO. No observable changes were found in PPTs (all 95% CIs included 0, p &gt; 0.05). In this sample, iVRE appears to reduce PI but not PPTs, suggesting the persistence of MPS and limitations in activating endogenous pain inhibitory mechanisms. Further randomized controlled trials with larger samples are needed to corroborate these results.

Physical inactivity is a major public health issue among college students, often exacerbated by academic pressures and lifestyle shifts. Traditional exercise interventions often face challenges with adherence due to low motivation and engagement. Immersive virtual reality (VR)-based exercise interventions may address these barriers by providing interactive and motivating experiences, yet empirical evidence regarding their psychological and physiological benefits remains scarce. This study aimed to evaluate the effects of a 4-week immersive VR-based exercise intervention on psychological and physiological health outcomes in college students. A randomized controlled trial was conducted involving 36 college students randomized into either a VR exercise group (n=17) or a no-intervention control group (n=19). Participants in the VR group engaged in immersive VR cycling sessions (two 60-minute sessions weekly) using the VirZoom VR system, while the control group continued their normal routines. Psychological outcomes assessed pre- and post-intervention included exercise motivation (Behavioral Regulation in Exercise Questionnaire-2), mood states (Brunel Mood Scale), and depressive symptoms (Beck Depression Inventory). Physiological outcomes assessed were cardiovascular fitness (3-Minute Step Test) and body composition (Bioelectrical Impedance Analysis). We used a two-way repeated measures Analysis of Variance (ANOVA) to analyze the effects of the intervention. Significant time×group interactions indicated enhanced intrinsic motivation (P=.02, η²=0.25), improved mood states with increased vigor (P=.01, η² =0.18), and decreased confusion (P=.01, η²=0.17), fatigue (P=.02, η²=0.16), and tension (P=.003, η²=0.24) in the VR group. Depressive symptoms were also significantly reduced (P=.03, η²=0.14). Physiological outcomes showed significant improvements in the VR group, including decreased body fat percentage (p<.001, η²=0.34) and enhanced cardiovascular fitness (P<.001, η²=0.47) compared to control group. The present study indicated that a 4-week immersive VR-based exercise may confer short-term psychological and physiological outcomes among college students compared to the no-intervention control group under the COVID-19 pandemic-related constraints. Future studies should adopt active-control and be conducted in real-world settings, incorporating objectively-determined intensity monitoring and follow-up to further investigate the effectiveness and real-world scalability. ClinicalTrials.gov: NCT06902727.

Aging may affect quality of life (QOL). This study aimed to evaluate the impact of semi-immersive VR-based exercise on the QOL of young-old and middle-old adults. This study was a randomized controlled trial involving older adults aged 65–85 years. Methods: Two age groups were each randomly assigned to experimental (EG) and control (CG) groups. The EG underwent a 75–90 min semi-immersive VR-based exercise intervention twice a week for 12 weeks, whereas the CG continued with their usual daily activities. Each participant’s psychological QOL was assessed using the World Health Organization’s QOL Instrument-Older Adults Module (WHOQOL-OLD). Results: Compared with their CG counterparts, the EG older adults exhibited significantly higher QOL scores in four WHOQOL-OLD dimensions (i.e., sensory abilities, autonomy, social participation/isolation, and death and dying) and had a superior overall QOL. Furthermore, we observed significant decreases in the autonomy and overall QOL dimensions in CG older adults. On comparing the young-old and middle-old adults, a significant decrease in the past, present, and future activity QOL dimension was exclusively found in CG young-old adults. Conclusions: Semi-immersive VR-based exercise is a promising digital tool for supporting the psychological QOL of older adults across different age groups. This suggests that older persons, particularly young-old adults, should be encouraged to maintain physical activity habits in their daily lives in order to improve their QOL.

Background: Individuals affected by stroke have reduced functional ability, personal autonomy, and social capacities due to motor and cognitive deficits. Due to the limits of traditional rehabilitation, alternative tactics targeting motor skill development and making use of the factors increasing experience-dependent plasticity have recently evolved, including activities using virtual reality (VR) technology. Purpose: To determine the effect of VR-based Therapy along with Conventional exercises in reducing upper limb motor impairment, Cognition Deficits, Depression, and improving quality of life in Individuals with Stroke. Relevance: This research provides valuable insights into the potential of innovative technologies to enhance patient outcomes. Participants: Individuals within the age group 30-60 years, diagnosed with sub-acute stage of stroke. Design: The study was a randomized controlled trial. Ethical approval had been taken from the institutional Ethical Committee Punjabi University Patiala (No.37/I/IEC/PUP/2023) Methods: The study included 10 Stroke survivors. They were randomly Divided into Two groups Group A (Experimental) and Group B (Control). In Group A received 30 minutes of VR- based therapy along with 30 minutes of Conventional therapy, 5 times per week for 4 weeks. Group B received 30 minutes of Conventional therapy twice a day for 5 times a week for 4 weeks. Participants were evaluated prior to the rehabilitation and at the end of 4 weeks. Fugl Meyer Assessment-UA, Montreal Cognitive Assessment, Stroke impact scale, and Beck Depression Inventory were used as outcome measures. Result: The improvements in MoCA (p=0.007), BDI (p=0.03) and SIS (Mobility (p=0.001), Emotion (p=0.03), Memory, and thinking (p=0.04) scores were significantly greater in the Experimental group than in the Control group. Conclusion: VR-based exercise therapy along with conventional therapy has additional benefit for stroke upper limb rehabilitation.

With substantial resources allocated to develop virtual reality (VR)-based rehabilitation exercise programs for poststroke motor rehabilitation, it is important to understand how patients with stroke perceive these technology-driven approaches, as their perceptions can determine acceptance and adherence. This study aimed to examine the perceptions of patients with stroke regarding an immersive VR-based exercise system developed to deliver shoulder, elbow, forearm, wrist, and reaching exercises. A questionnaire was used to assess the perceptions of 21 inpatients who had experienced stroke (mean time from stroke onset: 37.2, SD 25.9 days; Brunnstrom stage of stroke recovery for the arm: 3-5) regarding the perceived usefulness of, ease of use of, attitude toward, intrinsic motivation for, and intention to use the exercise system. The measurement items were rated on a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree), with higher values indicating more positive perceptions. Descriptive statistics were used to summarize the responses. Moreover, we conducted semistructured interviews that were audio recorded, transcribed, and subjected to content analysis to identify thematic patterns. The questionnaire results revealed that the patients' perceptions of the exercise system were positive (mean ratings >6). The content analysis revealed 6 positive themes from 73 statements about the exercise system: ease of use, usefulness, enjoyment, motivation, accessibility, and game design. Conversely, 15 statements reflected negative perceptions, which were clustered into 3 themes: difficulty in handling VR devices, uncomfortable experiences when using VR devices, and monotony. Integrating VR technology into poststroke functional exercises holds significant promise based on patient interests. However, patient preferences and adaptability must be considered to promote the technology's success. VR-guided exercises should be user-friendly, health-promoting, engaging, and well-designed. Furthermore, addressing challenges, such as bulkiness, motion sickness, discomfort, and exercise monotony, is crucial for the widespread adoption and diffusion of this technology.

The use of the virtual world is becoming increasingly widespread due to technological advancements and the current generation's greater interest in technology. Virtual reality, one of the innovative technologies of the 21st century, involves the use of computer technology to create an interactive three-dimensional world that gives the user a sense of spatial presence. In individuals with hemodialysis, spinal cord injuries, early-onset cerebral palsy, and cognitive decline, virtual reality-based exercise has been observed to have the potential to create positive effects on the individual's physiological, psychological, and rehabilitation outcomes when compared to traditional exercise. Although the literature suggests that virtual reality is important in both the educational field and in reducing various symptoms, there is a need for well-designed, blinded, and large-sample randomized controlled trials to demonstrate its effectiveness.

Forward Head Posture (FHP) is one of the most commonly occurring musculoskeletal abnormalities. Despite exercise therapy being an effective approach for FHP treatment, it can be long, monotonous, and tedious. Virtual reality (VR) can be used as an innovative solution to address these challenges. We designed an affordable and immersive VR-based exercise therapy (VRET) system for FHP correction. The VRET contents (i.e., exercises and VR scenarios) were determined by physiotherapists and game designers at the focus group meetings. Hardware requirements include a VR box, smartphone, and sensors (i.e., a smartphone accelerometer and an affordable Inertial Measurement Unit (IMU)) to measure head motions and transfer them via Wi-Fi to the VRET system. The IMU was designed using the MPU6050, Arduino Nano, and ESP8266-01S. Gwet's AC1, Game Experience Questionnaires (GEQ), and System Usability Scale (SUS) were used to measure intra-rater reliability, user experience, and system usability, respectively. The determined exercises, including Capital Flexion-Extension and Chin Tuck, were designed in the form of a shooting game. A physiotherapist and twenty-one FHP individuals took part in evaluating the system. High precision was obtained for the designed IMU (i.e., pitch and roll < 0.1° and yaw < 1.3 °). Gwet's AC1 and SUS results showed very good intra-rater reliability (coefficient = 0.892) and excellent usability (score = 87.14), respectively. According to the mean scores of the GEQ, participants were confident about competence, immersion, flow, and positive affect components. The development of low-cost VRET systems for FHP correction is a step towards facilitating rehabilitation challenges by providing positive experiences for users as well as helping them perform therapeutic exercises correctly.

OBJECTIVES Current regulations for Korean firefighters primarily emphasize exercise during working hours without specifying particular exercise methods. This study aims to evaluate the exercise intensity of the stepwise Korean Firefighter Fitness Program (KFFP) using Kinect-based mixed reality device (Virtual mate, VM), considering the demanding 24-hour shift work and high physical strength requirements. The objective is to assess its potential as one of the exercise methods and provide valuable insights.METHODS CResearchers recruited 30 participants to evaluate the exercise intensity based on the cardiopulmonary responses induced by the Stepwise Korean Firefighter Fitness Program (KFFP) using Virtual Mate (VM). Initially, the participants' resting heart rate, maximum heart rate (HR&lt;sub&gt;max&lt;/sub&gt;), and maximum oxygen consumption (VO&lt;sub&gt;2max&lt;/sub&gt;) were measured. Subsequently, researchers monitored the participants' cardiopulmonary responses by employing portable gas analyzers and wireless heart rate monitors while implementing the Stepwise KFFP with VM. Exercise intensity related to cardiopulmonary responses was recorded using both absolute parameters (VO&lt;sub&gt;2&lt;/sub&gt;, HR) and relative parameters (%VO&lt;sub&gt;2max&lt;/sub&gt;, %HRR, %HR). Researchers utilized repeated measures analysis of variance for statistical analysis.RESULTS The analysis of the stepwise KFFP using VM showed significant increases all parameters as the program advanced(&lt;i&gt;p&lt;/i&gt;&lt;.001). VO&lt;sub&gt;2&lt;/sub&gt; increased from around 19.4 ml/kg/min in Step 1 to approximately 22.8 ml/ kg/min in Step 3. Similarly, %HRR rose from roughly 40.6% in Step 1 to about 53.9% in Step 3.CONCLUSIONS Upon evaluating the stepwise KFFP based on the exercise intensity levels recommended by ACSM, it is confirmed that the stepwise KFFP using VM comprises both moderate-intensity and highintensity exercises. This approach is deemed effective and can serve as a fitness management method for firefighters working in 24-hour shift patterns that demand high fitness levels.

IntroductionObesity is a complex and multifactorial disease that has affected many adolescents in recent decades. Clinical practice guidelines recommend exercise as the key treatment option for adolescents with overweight and...

There are many complications after an electrical burn injury, including neuromuscular defects, paresis or paralysis, Gillian barre syndrome, transverse myelitis, or amyotrophic lateral sclerosis. The aim of this study was to investigate the effect of virtual reality-based exercises on balance and hand grip strength in post electrical burn-induced hemiparetic patients. A randomized control trial pre- and post-experimental design with intra-rater reliability and inter-rater agreement was undertaken. Thirty post-electrical burn-induced hemiparetic patients (19 males and 11 females, aged 15 to 25 years) were randomly allocated into two equal groups (group A and B). Group A (n = 15) received virtual reality-based exercise in addition to the conventional physical therapy program. Group B (n = 15) received conventional physical therapy program only. The treatment was applied 3 sessions per week for 12 consecutive weeks. Posture stability and hand grip strength were measured by the Biodex balance system and handheld dynamometer, respectively. Data was collected prior to the first treatment and at the end of the 12-week trial and all statistical calculations were done using the computer program IBM SPSS. A statistically significant increase in the overall stability index and the power of hand grip strength was observed in both groups after treatment (p &lt; 0.05), especially in group A, which received VR - based exercise training. Thus, group A showed a greater improvement in postural stability and hand grip strength than group B (p &lt; 0.05). Virtual reality-based exercises as well as conventional physical therapy program were effective in improving posture stability and hand grip strength in post electrical burn-induced hemiparetic patients.

BPPV (benign paroxysmal positional vertigo) is one of the most prevalent causes of vertigo.The clinical features include nausea, imbalance, nystagmus, light-headedness, dizziness, fear of fall. Various exercises and maneuvers have been proved to be beneficial till date. Many technologies had also contributed in the physical rehabilitation. Virtual rehabilitation using virtual reality (VR) is a novel innovation in therapy. Virtual reality is widely used in treating the patients and adding to get back to their day-to-day life. Occulus quest 2 is a VR device. Depending on the patient's motions, Oculus Quest enables you to interact genuinely while immersing yourself in a virtual reality. BPPV is a very common condition and Posterior canal BPPV (PC-BPPV) is commonest of all. Most of the available literature targets conventional treatment including Exercises for repositioning and adaptation of otoconia. Comparative studies between the conventional rehabilitation protocols have also been done. There is paucity of research on virtual rehabilitation in PC-BPPV. VR utilizing Oculus Quest 2, a device designed to incorporate VR environment can be used to mobilize the patients head position there by repositioning the otoconia. Lack of evidence related to Virtual rehabilitation and specifically Oculus Quest 2 emphasises the need to study its effects on BPPV outcomes like balance, dizziness, quality of life and nystagmus. In this study, an attempt is made to use the oculus quest 2 for BPPV rehabilitation in addition to standard treatment. Patients will be divided into 2 groups control and experimental. Control group will receive Brandt-droff exercise on the other hand experimental will receive occulus quest 2 game “Coaster combat” in adjunct to the conventional. Berg balance scale, nystagmus time quality of life, dizziness handicap index and vertigo symptom scale are the outcomes. Outcomes will be assed at baseline and after 4 weeks.

Virtual reality-based exercise interventions on quality of life, some balance factors and depression in older adults: A systematic review and meta-analysis of randomized controlled trials

The long-term consequences of congenital diaphragmatic hernia (CDH), which include altered lung functions and compromised cardiopulmonary capacity, impact functional performance and quality of life. This study investigates the effects of virtual reality-based exercise programs on pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life in children with repaired CDH. A randomized controlled clinical trial was performed. Fifty-two children with repaired CDH (aged 6-10 years) were enrolled and randomly allocated to virtual reality-based exercises plus traditional physical therapy (VR-EX group, n = 26) or traditional physical therapy alone (control group, n = 26). Interventions were conducted three times a week for 12 weeks. Pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life were assessed before and after the intervention. The VR-EX group demonstrated significantly enhanced post-treatment pulmonary functions and cardiopulmonary capacity compared to the control group after accounting for the pre-treatment values (p < 0.05). In addition, the values in functional performance and quality of life measures showed significantly larger improvements in the VR-EX group (p < 0.05). Children with repaired CDH may benefit more from VR-based exercises when combined with traditional physical therapy than from traditional physical therapy alone regarding their pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life.