Non-immersive VR-supplemented rehabilitation improves cognition in older orthopedic inpatients versus standard therapy

OBJECTIVE: This study evaluated the effects of exercise-based rehabilitation on cognitive functions in orthopedic patients and compared conventional rehabilitation with a protocol supplemented by physical activity (PA) performed in a non-immersive virtual reality (nIVR) environment. MATERIALS AND METHODS: A three-week exercise-based intervention was conducted among 48 orthopedic patients with lower limb joint dysfunctions (mean age 69.9 ± 4.8 years) hospitalized at the AccessMedica Rehabilitation Center. Participants were randomly assigned to two groups: the control group (CG; n = 24), which completed a standard kinesiotherapy and physical therapy program, and the experimental group (EG; n = 24), which, in addition to standard therapy, participated in three 30-minute nIVR-based PA sessions per week using interactive applications. Cognitive functions were assessed using the Addenbrooke's Cognitive Examination III (ACE-III)-version A before and version B after the intervention. The intensity of nIVR-based PA was monitored by heart rate telemetry, and participants' perceived enjoyment was assessed using the Physical Activity Enjoyment Scale (PACES). RESULTS: A significant improvement in overall cognitive performance was observed only in the EG following the intervention (p < 0.004, d = -0.643). Significant enhancements were found in attention (p = 0.004) and verbal fluency (p = 0.039). In contrast, patients undergoing conventional rehabilitation demonstrated no statistically significant pro-cognitive effects. The intensity of nIVR-based PA corresponded to a moderate level or close to its upper limit, and participants reported high enjoyment of this form of exercise. CONCLUSION: Supplementing conventional exercise-based rehabilitation with VR-supported physical activity sessions yields superior outcomes in attention and verbal fluency as well as higher overall cognitive results compared to standard rehabilitation programs. Moreover, VR-assisted exercise therapy is perceived by orthopedic patients as highly engaging, while its exercise intensity remains within the range recommended for health benefits in both physical and psychological domains.