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

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.

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].

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.