Screen-guided rehab shows early promise for arthritic knee pain

Knee osteoarthritis is a major source of chronic pain, and non-drug treatment such as structured exercise is central to managing it, both on its own and around total knee replacement surgery. Extended reality technology, spanning app-guided interactive rehabilitation through to immersive virtual reality headsets, promises to make that rehabilitation more engaging and easier to do from home. Whether it actually improves pain and function, and whether it causes any harm, had not been systematically weighed. This review is the first to sort the evidence by depth of immersion, clinical mechanism and follow-up duration, and to systematically evaluate adverse events.

The reviewers searched databases through May 2023, with an update in December 2025, for randomised trials of extended reality interventions treating knee osteoarthritis pain or supporting recovery after total knee arthroplasty. Twelve trials addressed osteoarthritis and 9 addressed post-surgical recovery, with sample sizes from 36 to 306 participants and most follow-up lasting 3 months or less. Interventions were classified by immersion level and mechanism: interactive digital rehabilitation, virtual reality digitally augmented exercise, VR distraction and VR psychoeducation. Evidence certainty was formally graded, and meta-analyses were run wherever at least 3 studies matched on comparison, outcome and time point.

For knee osteoarthritis, interactive digital rehabilitation may improve pain-related functioning and may lower pain intensity at 6-8 weeks, both rated low certainty, with prediction intervals wide enough to include no effect. After knee replacement, interactive digital rehabilitation may improve pain-related functioning but showed little to no difference in pain intensity at 3-4 months. Single trials suggested VR psychoeducation probably lowers pain at 4 weeks and VR distraction may help at 6 months. VR digitally augmented exercise gave inconsistent results in both settings. Interactive digital rehabilitation was not associated with adverse events, though harms were reported in only 5 studies.

This sits within a fast-growing but still immature literature on digital and immersive rehabilitation. The reviewers reach a notably split verdict: interactive digital rehabilitation may be ready for integration into knee osteoarthritis care, while its use after knee replacement needs more evidence first. Wide prediction intervals and short follow-ups mean effects could differ substantially in new settings, and adverse event reporting is too sparse to judge safety after surgery with confidence. The authors call for randomised trials with implementation outcomes in osteoarthritis, and for trials establishing efficacy and harms before adoption in post-surgical care.

If knee arthritis limits your training or daily life, this is a reason to see app-guided, interactive rehabilitation as a plausible complement to conventional exercise therapy rather than a gimmick, while remembering the certainty is low and the benefit may fade in better trials. The immersive headset end of the spectrum currently has the thinnest support, with mixed results. For anyone facing or recovering from knee replacement, the evidence is weaker still, and function looked more responsive than pain itself. None of this replaces individual guidance from whoever manages your knee.