VR-Based Physical Therapy Shows Promising Results for Elderly Hip Fracture Patients

A recent case study published in "Cureus", part of "Springer Nature", highlights the potential benefits of virtual reality (VR)-based physical therapy in improving the mobility and independence of elderly patients recovering from hip fractures. This innovative approach, which supplements traditional physical therapy, could play a crucial role in enhancing the quality of life and reducing the risk of secondary fractures among the elderly.

Case Report Highlights

The case study focuses on a woman in her 90s who underwent bipolar hip hemiarthroplasty for a femoral neck fracture sustained from a fall. Post-surgery, she experienced significant difficulties in independent walking due to trunk dysfunction. Despite standard physical therapy, her gait did not improve significantly until VR-based exercises were introduced. Using mediVR KAGURA®, a VR device designed to aid in trunk muscle training, the patient showed notable improvements in posture, balance, and gait within weeks.

Importance of Measuring Mobility and Intervention Impact

Measuring the effectiveness of mobility interventions is vital for several reasons:

1. Quality of Life: Improved mobility directly enhances the quality of life for elderly patients, enabling them to perform daily activities with greater ease. Research by Ganczak et al. (2018) showed that elderly hip fracture patients who regained mobility within six months had significantly higher quality of life scores.

2. Reduced Mortality Rates: Immobility is a significant risk factor for early death among the elderly. Studies have shown that immobilization can lead to complications such as pressure sores, pneumonia, and cardiovascular issues, which contribute to higher mortality rates. According to a study by Friedman and Mendelson (2014), mortality rates one year after a hip fracture can range from 14% to 36%.

3. Prevention of Secondary Fractures: Effective mobility interventions can help prevent secondary fractures, which are common in elderly patients who have already experienced a hip fracture. Vochteloo et al. (2012) reported that 28.6% of hip fracture patients suffer from secondary fractures, highlighting the need for robust rehabilitation protocols.

Global Perspective on Hip Fractures

Globally, hip fractures are a major health concern for the elderly. The World Health Organization (WHO) has documented that hip fractures result in significant morbidity and mortality worldwide. An estimated 1.6 million hip fractures occur globally each year, and this number is expected to increase to 6.3 million by 2050 due to the aging population. In many cases, prolonged immobilization following a fracture exacerbates these rates, underscoring the critical need for effective rehabilitation strategies.

Role of Physiotherapists

Physiotherapists play a crucial role in the recovery process of hip fracture patients. Their expertise in designing and implementing individualized rehabilitation programs is essential for:

1. Restoring Mobility: Through targeted exercises, physiotherapists help improve muscle strength and balance, crucial for preventing falls and subsequent injuries. Ramadi et al. (2022) highlighted that progressive resistance training in rehabilitation programs significantly improves muscle strength and mobility in hip fracture patients.

2. Enhancing Functional Independence: By focusing on both lower extremity and trunk muscle training, physiotherapists aim to restore patients' ability to perform daily activities independently. Wu et al. (2019) found that balance training interventions are effective in improving gait and reducing fall risk among hip fracture patients.

3. Implementing Innovative Therapies: Incorporating new technologies like VR can provide additional benefits, offering a more engaging and effective rehabilitation experience. Bevilacqua et al. (2019) demonstrated that non-immersive VR-based rehabilitation can significantly enhance balance and mobility in older adults.

R-Based Interventions: A New Frontier in Rehabilitation

The effectiveness of VR-based exercise therapy has been demonstrated in recent studies. mediVR KAGURA®, a VR device used for trunk muscle training, has shown promising results in improving gait function in various patient populations. Omon et al. (2019) reported that VR-guided dual-task training improved walking ability in patients with disuse syndrome without increasing leg strength, suggesting that VR can enhance neuromuscular coordination and cognitive function.

In the case study reported by *Cureus*, the patient underwent VR-guided trunk training in a seated position, which led to significant improvements in her gait, posture, and balance. The intervention focused on reaching exercises targeting the trunk muscles, which are crucial for maintaining stability and balance. This approach is particularly beneficial for elderly patients who may find it challenging to perform traditional trunk exercises in supine or side-lying positions.

Neurological Rehabilitation with VR

Over the past 15 years, VR technology has gained traction as a valuable tool in neurorehabilitation. In patients with multiple sclerosis (MS), several studies published in 2023 demonstrated improvements in manual dexterity and upper limb motor function, as well as measures of daily functioning, quality of life, mood, and treatment satisfaction, following VR training . Additionally, a 2022 meta-analysis in *Neurological Sciences* found that home-based VR training improved postural balance in patients with MS, Parkinson's disease, and stroke.

A 2020 multicenter, single-blind randomized controlled trial published in "Developmental Medicine & Child Neurology" compared the effects of a VR rehabilitation intervention combined with conventional occupational therapy to conventional therapy alone in children with cerebral palsy. The VR group showed greater improvements in upper-limb dexterity functions, activities of daily living, and forearm supination. Furthermore, a 2020 study in the "Journal of Aging and Physical Activity" reported that older adults with mild cognitive impairment experienced physical and cognitive benefits following a 6-week home-based VR exercise program, demonstrating the intervention's safety and feasibilit.

Experts such as Dr. Hillel M. Finestone from the University of Ottawa and Dr. Sean Dukelow from the University of Calgary highlight VR's role in enhancing patient engagement and commitment to treatment. Dr. Finestone notes that patients enjoy the 'exer-gaming' activities provided by VR technology, which can make therapy less monotonous and more enjoyable. Dr. Dukelow adds that VR can gamify the rehabilitation experience, making it more engaging and motivating for patients.

The promising results from the case study reported in "Cureus" and the broader findings from "Healthcare (Basel)" and "Neurological Sciences" suggest that VR-based trunk training can significantly enhance the recovery of elderly hip fracture patients and those with neurological conditions. These findings highlight the importance of incorporating innovative therapies in physiotherapy practices to improve patient outcomes. As the global elderly population continues to grow, advancements in rehabilitation strategies like VR-guided exercises will be crucial in reducing mortality rates and enhancing the quality of life for older adults.

References

1. Friedman SM, Mendelson DA: Epidemiology of fragility fractures. Clin Geriatr Med. 2014; 30:175-81. [DOI: 10.1016/j.cger.2014.01.001](https://doi.org/10.1016/j.cger.2014.01.001)

2. Ganczak M, Chrobrowski K, Korzeń M: Predictors of a change and correlation in activities of daily living after hip fracture in elderly patients in a community hospital in Poland: a six‐month prospective cohort study. Int J Environ Res Public Health. 2018; 15:24-6. [DOI: 10.3390/ijerph15010095](https://doi.org/10.3390/ijerph15010095)

3. Vochteloo AJ, Borger van der Burg BL, Röling MA, et al.: Contralateral hip fractures and other osteoporosis-related fractures in hip fracture patients: incidence and risk factors. An observational cohort study of 1,229 patients. Arch Orthop Trauma Surg. 2012; 132:1191-7. [DOI: 10.1007/s00402-012-1520-9](https://doi.org/10.1007/s00402-012-1520-9)

4. Ramadi A, Ezeugwu VE, Weber S, Funabashi M, Lima CA, Perracini MR, Beaupre LA: Progressive resistance training program characteristics in rehabilitation programs following hip fracture: a meta-analysis and meta-regression. Geriatr Orthop Surg Rehabil, 2022; 13:21514593221090799. [DOI: 10.1177/21514593221090799](https://doi.org/10.1177/21514593221090799)

5. Wu JQ, Mao LB, Wu J: Efficacy of balance training for hip fracture patients: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2019; 14:83. [DOI: 10.1186/s13018-019-1125-x](https://doi.org/10.1186/s13018-019-1125-x)

6. Bevilacqua R, Maranesi E, Riccardi GR, et al.: Non-immersive virtual reality for rehabilitation of the older people: a systematic review into efficacy and effectiveness. J Clin Med. 2019; 8:42-4. [DOI: 10.3390/jcm8111882](https://doi.org/10.3390/jcm8111882)

7. Omon K, Hara M, Ishikawa H: Virtual reality-guided, dual-task, body trunk balance training in the sitting position improved walking ability without improving leg strength. Prog Rehabil Med. 2019; 4:20190011. [DOI: 10.2490/prm.20190011](https://doi.org/10.2490/prm.20190011)

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9. Pau M, Porta M, Bertoni R, Mattos FGM, Cocco E, Cattaneo D: Effect of immersive virtual reality training on hand-to-mouth task performance in people with multiple sclerosis: a quantitative kinematic study. Mult Scler Relat Disord Published online December 5, 2022. [DOI: 10.1016/j.msard.2022.104455](https://doi.org/10.1016/j.msard.2022.104455)

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