Evaluation of an early-stage prototype of a virtual reality-based physiotherapy toolkit for individuals with chronic knee pain

Almutairi, Alhanouf 2025. Evaluation of an early-stage prototype of a virtual reality-based physiotherapy toolkit for individuals with chronic knee pain. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Background: Chronic knee pain (CKP) affects quality of life and poses significant challenges for healthcare delivery, with low treatment adherence outside clinical settings. Therapeutic exercise remains a cornerstone intervention for managing CKP, with evidence supporting its effectiveness in improving function and reducing pain. Virtual reality (VR) has emerged as a promising tool for delivering therapeutic exercises in a more engaging and motivating format. However, there remains a paucity of evidence regarding the biomechanical challenges and usability of VR applications for home-based knee rehabilitation. This thesis aimed to evaluate an early-stage prototype of a VR-based physiotherapy toolkit designed for people with CKP with the aim of facilitating therapeutic exercises within a home setting. Method and findings: A total of 40 participants with CKP (52.5% male, 47.5% female, age range 18–56+ years) underwent a single laboratory session during which both kinematic performance and system usability were assessed. The study design was informed by the Medical Research Council (MRC) framework for developing complex interventions and was structured across three parts: part 1 comprised an umbrella review of eight systematic reviews examining the applications of VR-based physiotherapy. This part aimed to identify, synthesise and critically evaluate existing evidence on the application of VR in therapeutic interventions. The findings suggested that while VR demonstrates potential to improve physical function, significant gaps persist in understanding its biomechanics and its usability for home-based physiotherapy settings. The methodological quality of the reviewed research was low, highlighting the need for rigorous and high-quality research in this area. Part 2 evaluated whether an in-house VR-based physiotherapy toolkit can accurately replicate therapeutic movements and provide appropriate challenges across different difficulty levels. Participants performed five VR-based physiotherapy exercise scenarios, during which joint range of motion (ROM) and key muscles’ activity were recorded concurrently. The results demonstrated that progressive increases in exercise difficulty led to enhanced movement demands while preserving symmetrical lower-limb muscle activation. These findings indicate that the system can deliver individualised exercise interventions that adapt to personal movement characteristics following physiotherapy best practices. Part 3 focused on evaluating the usability and acceptability of the VR-based physiotherapy prototype among participants with CKP. Usability was quantitatively established using the System Usability Scale (SUS), yielding a mean score of 76, which is indicative of good overall usability. Qualitative feedback was also collected and exposed to content analysis, which revealed a positive user experience: 389 positive codes were recorded, compared to 62 negative codes. However, specific areas for improvement were identified, including frequent technical challenges (307 codes) and the need for clearer instructional guidance (84 codes). Conclusion: This research demonstrates that VR can offer a promising, engaging, and biomechanically relevant system to deliver therapeutic exercises. However, challenges related to technical reliability and clarity of instructional content require further development to ensure successful long-term implementation. This research contributes to a growing body of evidence supporting the integration of VR into musculoskeletal physiotherapy and provides valuable insights to inform future development and successful implementation in both home and clinical settings.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Healthcare Sciences
Date of First Compliant Deposit:	22 October 2025
Last Modified:	29 Oct 2025 16:29
URI:	https://orca.cardiff.ac.uk/id/eprint/181824

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