Effects of Virtual Reality Environments on Walking in Adults With and Without Knee Osteoarthritis

Trial details

Who runs it

University of Primorska

Trial code

NCT07920120

Record updated

5 November 2026

Original description

Knee osteoarthritis (KOA) is a common musculoskeletal condition associated with pain, impaired physical function, and movement-related fear. Psychological factors, particularly fear of movement (kinesiophobia), may influence movement behavior and limit participation in physical activity and exercise therapy. Immersive virtual reality (VR) provides an opportunity to modify the visual environment and potentially influence how individuals perceive safety and threat during movement. However, it remains unclear how VR-induced perceptions of safety and fear affect gait biomechanics, particularly in individuals with KOA.Read full original descriptionShow less

Validation of VR Strategies for Knee Osteoarthritis Rehabilitation

Knee osteoarthritis (KOA) is a common musculoskeletal condition associated with pain, impaired physical function, and movement-related fear. Psychological factors, particularly fear of movement (kinesiophobia), may influence movement behavior and limit participation in physical activity and exercise therapy. Immersive virtual reality (VR) provides an opportunity to modify the visual environment and potentially influence how individuals perceive safety and threat during movement. However, it remains unclear how VR-induced perceptions of safety and fear affect gait biomechanics, particularly in individuals with KOA.

The aim of this study is to investigate the effects of immersive VR environments designed to promote safety or induce fear on gait biomechanics and psychological responses in individuals with KOA and healthy adults aged 50 years and older.

Participants will perform walking tasks under five experimental conditions: walking without VR, walking in a neutral VR environment, walking in a safety-promoting VR environment on low ground, walking in a fear-inducing VR environment, and walking in a safety-promoting VR environment on high ground.

During each condition, participants will walk along a straight 6-meter walkway at their preferred comfortable speed. Gait biomechanics will be assessed using an inertial motion capture system and force platforms. The primary outcome will be gait speed. Additional biomechanical parameters and subjective responses, including perceived fear, safety, and VR-related experiences, will also be assessed.

The study aims to determine whether VR environments that alter perceived safety and fear influence walking patterns and whether these responses differ between individuals with KOA and healthy adults. It is hypothesized that fear-inducing VR environments will alter gait biomechanics, particularly gait speed, compared with neutral and safety-promoting conditions.

Inclusion: Age 50 years or older; Diagnosis of knee osteoarthritis in one or both knees, confirmed according to the clinical and radiographic criteria of the American College of Rheumatology; Knee pain and radiographically confirmed osteophytes, together with at least one of the following: age over 50 years, morning stiffness lasting less than 30 minutes, or crepitus during active knee movement; Age 50 years or older; No significant gait disturbances.

Exclusion: have sustained an acute knee injury within the previous 6 months; have undergone surgery of the back, hip, knee, ankle, or foot within the previous 12 months; have concomitant systemic inflammatory diseases such as rheumatoid arthritis or gout; neurological conditions (Alzheimer's disease, Parkinson's disease, or metabolic diseases affecting the nervous system); muscular or joint diseases/injuries affecting lower-limb function (e.g., osteoarthritis of the hip and/or ankle, sprains, fractures); or internal medical conditions (cardiovascular, pulmonary and/or oncological diseases, or diabetes with late complications such as diabetic foot or neuropathy) that affect physical capacity; have received intra-articular corticosteroid and/or hyaluronic acid injections within the previous 6 months; have previously experienced pronounced adverse effects when using virtual reality (e.g., severe nausea, vomiting, marked dizziness, or severe disorientation); Healthy Control Group:; have health conditions or musculoskeletal limitations that affect strengthening exercise and limit physical function to a greater extent than knee pain (e.g., low back pain or hip pain); have a history of stroke or myocardial infarction resulting in motor and/or cognitive impairments (including inability to provide informed consent); have balance disorders known to be caused by vestibular dysfunction; have diagnosed epilepsy or a history of epileptic seizures, particularly photosensitive epilepsy; are younger than 50 years; Participants will be excluded from the studies if they:; are on a waiting list for knee arthroplasty within the next year; have knee pain unrelated to KOA; have a knee or hip arthroplasty; have a body mass index (BMI) >32 kg/m²; experience frequent or severe migraines triggered by visual stimuli; have severe visual impairments that are not adequately corrected.

Knee Osteoarthritis (KOA) Group:.

ClinicalTrials.gov NCT07920120