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中华关节外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (01) : 50 -59. doi: 10.3877/cma.j.issn.1674-134X.2026.01.007

荟萃分析

虚拟现实运动在膝骨关节炎患者中应用效果的Meta分析
刘肖雅1,2, 郭珈宜2, 成彦2, 李峰2, 杨艳霞1, 高起1, 杨玉霞2,†(), 岳辰2   
  1. 1350122　福州，福建中医药大学护理学院
    2471002　洛阳，河南省洛阳正骨医院（河南省骨科医院）
  • 收稿日期:2025-05-20 出版日期:2026-02-01
  • 通信作者: 杨玉霞
  • 基金资助:
    国家中医药管理局中医药科学研究专项课题(GZY-KJS-2023-012); 郑州市医疗卫生领域科技创新指导计划项目(2025YLZDJH445); 河南省中医药文化与管理研究项目(TCM2025039)

Meta-analysis on effects of virtual reality exercise in patients with knee osteoarthritis

Xiaoya Liu1,2, Jiayi Guo2, Yan Cheng2, Feng Li2, Yanxia Yang1, Qi Gao1, Yuxia Yang2,†(), Chen Yue2   

  1. 1Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
    2Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang 471000, China
  • Received:2025-05-20 Published:2026-02-01
  • Corresponding author: Yuxia Yang
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引用本文：

刘肖雅, 郭珈宜, 成彦, 李峰, 杨艳霞, 高起, 杨玉霞, 岳辰. 虚拟现实运动在膝骨关节炎患者中应用效果的Meta分析[J/OL]. 中华关节外科杂志(电子版), 2026, 20(01): 50-59.

Xiaoya Liu, Jiayi Guo, Yan Cheng, Feng Li, Yanxia Yang, Qi Gao, Yuxia Yang, Chen Yue. Meta-analysis on effects of virtual reality exercise in patients with knee osteoarthritis[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(01): 50-59.

目的

系统评价虚拟现实运动在膝骨关节炎患者中的应用效果，为临床实践提供依据。

方法

计算机检索PubMed、Web of Science、Cochrane图书馆、荷兰医学文摘数据库（Embase）、中国知网、维普、万方数据库和中国生物医学文献数据库，检索时限从建库至2025年4月30日。纳入研究为比较基于虚拟现实的运动干预与常规干预对膝骨关节炎患者疗效的随机对照试验（RCT），主要结局指标包括疼痛、功能评分或步行测试等相关指标。排除非原始研究、重复发表、非中英文文献以及无法获取全文的文献。文献筛选、数据提取与质量评价均由两名研究者独立完成。采用RevMan 5.4软件进行Meta分析，并使用Stata 18.0进行敏感性分析及发表偏倚检验。

结果

共纳入11篇文献，涉及613例患者。Meta分析显示，与对照组相比，虚拟现实运动干预组在疼痛评分[标准化均差（SMD）=-1.30，95%置信区间（CI）（2.10，-0.51），P=0.001]、WOMAC总分[SMD=-1.51，95% CI（-2.46，-0.55），P=0.002]及特种外科医院（HSS）膝关节评分[均数差（MD）=5.80，95% CI（4.60，7.00），P<0.001]方面均有显著改善，但在10 m步行测试[MD=2.24，95% CI（-2.26，6.75），P>0.05]方面差异无统计学意义。

结论

虚拟现实运动可减轻膝骨关节炎患者疼痛并改善功能结局。未来需开展更多高质量、大样本的RCT研究，以进一步验证其效果并优化干预方案。

关键词: 骨关节炎，膝, 虚拟现实, 运动, 随机对照试验, Meta分析
Objective

To systematically evaluate the effect of virtual reality exercise in patients with knee osteoarthritis and provide evidence for clinical practice.

Methods

Computerized searches of PubMed, Web of Science, the Cochrane Library, Excerpta Medica Database (Embase), China National Knowledge Infrastructure(CNKI), China Science and Technology Journal Database (VIP), Wanfang Data Knowledge Service Platform, and the Chinese Biomedical Literature Database were conducted from inception to 30 April 2025. Randomized controlled trials (RCTs) comparing the efficacy of virtual-reality-based exercise interventions with usual care in individuals with knee osteoarthritis were eligible for inclusion. Primary outcomes included pain intensity, functional scores, or walking-related tests. Non-primary publications, duplicate reports, non-English or non-Chinese articles, and studies for which full texts were unobtainable were excluded. Study selection, data extraction, and quality assessment were performed independently by two reviewers. Meta-analysis was conducted using RevMan software 5.4. Sensitivity analysis and publication bias assessment were performed using Stata 18.0.

Results

Eleven studies involving 613 patients were included. The meta-analysis showed that compared to the control group, the virtual reality exercise intervention group demonstrated significant improvements in pain score [standardized mean difference (SMD)= -1.30, 95% confidence interval (CI) (-2.10, -0.51), P=0.001], total WOMAC score [SMD= -1.51, 95% CI (-2.46, -0.55), P=0.002], and Hospital for Special Surgery (HSS) knee score [mean difference (MD)= 5.80, 95% CI (4.60, 7.00), P<0.001]. However, no statistically significant difference was found in the 10-meter walk test [MD= 2.24, 95% CI (-2.26, 6.75), P>0.05].

Conclusions

Virtual reality exercise can alleviate pain and improve functional outcomes in patients with knee osteoarthritis. Future high-quality, large-sample RCTs are required to further validate these effects and optimize intervention protocols.

Key words: Osteoarthritis, knee, Virtual reality, Exercise, Randomized controlled trial, Meta-analysis
图1 PubMed检索策略
Figure 1 PubMed search strategy
图2 文献筛选流程图
Figure 2 Flowchart of the study selection process
图3 文献偏移风险
Figure 3 Risk of bias summary for each included study
图4 文献偏移风险汇总
Figure 4 Overall risk of bias across all included studies
表1 纳入文献的基本特征（n=11）
Table 1 Baseline characteristics of the included studies
纳入文献（年份）Studies (year) 国家Country 样本量Sample size (E/C) 年龄[岁，（±s）]Age（year） 干预措施Intervention 虚拟现实设备Virtual reality device 干预时间Intervention duration 结局指标Outcome measures
E C
Guede-Rojas等[8]（2025） 智利 30/30 E：68.7±5.4
C：69.0±5.5		 C+游戏化VR运动（任天堂Ring Fit Adventure游戏） 常规治疗 Nintendo Switch 持续10周，3次/周 WOMAC
李明玉等[9]（2024） 中国 35/35 E：69.4±2.1
C：69.5±2.2		 VR康复训练配合抗阻训练 常规运动 Pico Neo 3 持续4周，7次/周，30 min/次 VAS、WOMAC、HSS
Lo等[10]（2024） 中国香港 15/15 E：63.0±5.2
C：64.0±2.2		 沉浸式游戏化VR运动（Captured outdoor garden scenes） 常规运动 VR Shinecon 5.0 持续12周，5次/周，30 min/次 NRS、WOMAC
Oliveira等[11]（2024） 巴西 20/20 E：62.3±7.4
C：62.6±8.6		 游戏化VR运动（Kinect Adventures） 常规运动 Xbox 360视频游戏机配合Microsoft Kinect 360传感器 持续8周，2次/周，50 min/次 VAS、WOMAC
杨曼等[12]（2023） 中国 46/46 E：66.5±7.6
C：67.6±6.4		 C+VR康复训练 常规治疗 - 持续30 d，1次/ d VAS、HSS
Özlü等[13]（2023) 土耳其 35/38 E：53.3±10.4
C：53.7±9.7		 C+沉浸式游戏化VR运动（Fish Game and Monkey Game） 常规治疗 Oculus品牌Quest 128 GB型号VR眼镜 持续3周，5次/周 VAS、WOMAC
Lin等[15]（2022） 中国台湾 20/18 E：75.6±4.4
C：76.0±5.6		 游戏化VR运动（划船运动） 常规运动 CRE系统和LabVIEW软件 持续12周，2次/周，30 min/次 WOMAC、10-MWT
Mete等[14]（2022） 土耳其 30/30 E：59.5±6.7
C：57.0±10.4		 C+游戏化VR运动（Crazy Wings and Blasting Ball） 常规治疗 MarVAJED® 持续6周，5次/周 VAS、WOMAC
Lin等[16](2020) 中国台湾 40/40 E：55.9±15.8
C：58.1±16.9		 游戏化VR运动（Whack-a-mole and Archery） 常规运动 Hot Plus系统(Supreme Investment Co) 持续4周，3次/周，40 min/次 CPGQ、WOMAC、10-MWT
Nambi等[17]（2020） 沙特阿拉伯 20/20 E：22.8±1.3
C：21.9±1.3		 游戏化VR运动（Shooting the balls） 常规运动 Pro-Kin system PK 252 N Techno body 持续4周，5次/周，20 min/次 VAS、WOMAC
Kim等[18](2017) 韩国 15/15 E：76.5±8.8
C：77.7±7.9		 普通VR运动（马术模拟器） 常规运动 SlimRider (Shinhwa,MX-0004SE) 持续8周，3次/周，30 min/次 10-MWT
图5 VR（虚拟现实）运动干预对KOA（膝骨关节炎）患者疼痛影响的森林图
Figure 5 Forest plot of the effect of VR (virtual reality) -based exercise intervention on pain in KOA (knee osteoarthritis) patients
表2 VR运动干预对KOA患者疼痛和WOMAC总分影响的亚组分析
Table 2 Subgroup analysis of the effect of VR exercise intervention on pain and total WOMAC score in patients with KOA
结局指标Outcome Measures 亚组Subgroups 纳入文献（篇）Number of included studies 异质性检验结果Heterogeneity 分析模型Analysis model Meta分析结果Meta-analysis results
I2值（%） P值 SMD（95% CI） P值
疼痛Pain              
干预周期Intervention duration ≤4周 3 96 <0.001 随机 -2.37（-4.33，-0.41） 0.02
>4周 4 85 <0.001 随机 -0.80（-1.56，-0.03） 0.04
干预频次Intervention frequency ≤3次/周 2 0 >0.05 固定 -0.28（-0.65，0.10） >0.05
>3次/周 5 92 <0.001 随机 -1.86（-2.85，-0.87） <0.001
WOMAC总分Total WOMAC score              
干预周期Intervention duration ≤4周 2 98 <0.001 随机 -4.25（-10.98，2.47） >0.05
>4周 4 76 0.006 随机 -0.71（-1.33，-0.09） 0.02
干预频次Intervention frequency ≤3次/周 2 46 >0.05 固定 -0.37（-0.77，0.03） >0.05
>3次/周 4 94 <0.001 随机 -2.33（-3.82，-0.83） 0.002
图6 VR（虚拟现实）运动干预对KOA（膝骨关节炎）患者WOMAC（西安大略与麦克马斯特大学骨关节炎指数）总分影响的森林图
Figure 6 Forest plot of the effect of VR(virtual reality)-based exercise intervention on the total WOMAC(Western Ontario and McMaster Universities osteoarthritis index) score in KOA(knee osteoarthritis) patients
图7 VR（虚拟现实）运动干预对KOA（膝骨关节炎）患者HSS（美国特种外科医院）膝关节评分影响的森林图
Figure 7 Forest plot of the effect of VR (virtual reality) -based exercise intervention on the HSS (Hospital for Special Surgery) knee score in KOA (knee osteoarthritis) patients
图8 VR（虚拟现实）运动干预对KOA（膝骨关节炎）患者10-MWT（10m步行计时测试）影响的森林图
Figure 8 Forest plot of the effect of VR (virtual reality) -based exercise intervention on the 10-MWT (10 m-walk test) in KOA(knee osteoarthritis) patients
图9 疼痛评分及WOMAC（西安大略与麦克马斯特大学骨关节炎指数）总分的敏感性分析结果。图A为疼痛评分指标；图B为WOMAC总分指标注：lower CI limit-置信区间下限；upper CI limit-置信区间上限
Figure 9 Sensitivity analysis of pain score and total WOMAC (Western Ontario and McMaster Universities osteoarthritis index) score. A is pain score; B is total WOMAC scoreNote: lower CI limit-the lower confidence limit; upper CI limit-the upper confidence limit.
图10 疼痛评分及WOMAC（西安大略与麦克马斯特大学骨关节炎指数）总分漏斗图。图A为疼痛评分指标；图B为WOMAC总分指标
Figure 10 Funnel plots for pain score and total WOMAC (Western Ontario and McMaster Universities osteoarthritis index) score. A is pain score; B is total WOMAC score
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