The Effects of Immersive Virtual Reality in Patients With Grade 1-2 Adhesive Capsulitis

Our study was designed as a single-center, randomized, controlled, prospective trial aiming to compare the effectiveness of immersive virtual reality-based exercise therapy and conventional therapy in patients diagnosed with Grade 1-2 adhesive capsulitis.Patients who consent to participate will be randomly assigned to two groups:

Intervention Group (n = 15): Patient education + Home exercise program + Immersive virtual reality-based exercise therapy

Control Group (n = 15): Patient education + Home exercise program + Conventional exercise therapy

Intervention Process All participants will receive treatment twice a week for six weeks, with each session lasting 30 minutes. The initial assessment will be conducted before the first session, and the final assessment will take place at the end of the sixth week. Both the immersive virtual reality-based exercise group and the conventional exercise group will receive patient education. The educational content aims to describe the natural course of the disease, promote activity modification to encourage functional and pain-free range of motion, and adjust stretching intensity to suit the patient's current level.

Patient education will be delivered once, face-to-face, for 30 minutes before the interventions begin, and it will cover five main topics:

Introduction to the Disease: General information about adhesive capsulitis. Pain Mechanisms and Perception: Education on pain pathways and interpretation. Encouragement of Activity: Emphasis on safely using the shoulder within pain-free limits during daily life activities.

Preparation for Treatment: Explanation that the virtual reality-based therapy will be conducted in a gamified and motivating environment, while the control group will receive traditional physiotherapy methods.

Exercise Adherence and Follow-up: Emphasis on the importance of active participation for treatment success and the monitoring of progress through pre- and post-assessments.

Hanchard et al. strongly supported the implementation of patient education and home exercise programs in individuals with adhesive capsulitis.

Home Exercise Program In addition to patient education, both groups will perform the same home exercise program. Participants will carry out the exercises at home for 30 minutes a day, five days a week, over a six-week period (on non-intervention days). The home exercise program will be progressive and similar to the conventional therapy applied by the physiotherapist. It will include range of motion (ROM) exercises, stretching exercises, and pendulum exercises.

Immersive Virtual Reality-Based Exercise Group In the immersive virtual reality group, the Oculus Quest 2 headset will be used with the Guided Tai Chi and Reach Shoulder Health applications, both applied progressively. Oculus Quest 2 is a virtual reality headset used for therapeutic purposes in shoulder rehabilitation and has been previously applied in patients with adhesive capsulitis.

The Template for Intervention Description and Replication (TIDieR) checklist and guide were used to describe the intervention protocols in detail, ensuring reproducibility and clinical applicability. Both the immersive virtual reality and conventional exercise intervention programs were developed in accordance with TIDieR recommendations.

The Reach Shoulder Health program is an interactive virtual reality application that gamifies shoulder rehabilitation exercises. It includes a variety of modules designed to enhance upper extremity range of motion, coordination, and muscle activation-particularly beneficial for patients with restricted shoulder mobility such as adhesive capsulitis. The program progressively trains shoulder mobilization, target-reaching, hand-eye coordination, range of motion, and muscle strengthening around the shoulder. Its game modules, including Firefly Assessment, Space Gunner, Bullseye, Tube Trouble, Star Beams, and Power Pop, are structured to be both entertaining and therapeutic, incorporating multiple levels to increase patient motivation and treatment adherence. Participants will progress through five levels each week over the six-week period.

The Guided Tai Chi application is another virtual reality program designed to enhance shoulder mobility and provide pain-free movement experiences while reducing anxiety and improving motivation in patients with adhesive capsulitis. The exercises in this application will also be progressively increased in difficulty across beginner, intermediate, and advanced levels throughout the six-week intervention.

Conventional Exercise Group Participants in the conventional exercise group will receive a 30-minute exercise session twice a week for six weeks. The program will include range of motion exercises, pendulum exercises, finger ladder activities, stretching, and strengthening exercises. All exercises will be applied progressively, increasing in intensity over time.

Evaluation All participants will be assessed for pain levels, shoulder range of motion, ability to perform daily living activities, sleep quality, and cognitive functions using valid and reliable measurement tools before and after the interventions. Assessments will be conducted at the first session and at the end of the sixth week, and pre- and post-intervention results will be compared.

• Shoulder Function (Shoulder Pain and Disability Index - SPADI) [Срок оценки: Baseline and at the end of the 6-week intervention period]
• Shoulder Range of Motion (ROM) [Срок оценки: Baseline and at the end of the 6-week intervention period]
• Pain Catastrophizing (Pain Catastrophizing Scale - PCS) [Срок оценки: Baseline and at the end of the 6-week intervention period]
• Sleep Quality (Pittsburgh Sleep Quality Index - PSQI) [Срок оценки: Baseline and at the end of the 6-week intervention period]
• Digit Span Test [Срок оценки: Baseline and at the end of the 6-week intervention period]
• Wisconsin Card Sorting Test [Срок оценки: Baseline and at the end of the 6-week intervention period]
• Benton Visual Retention Test [Срок оценки: Baseline and at the end of the 6-week intervention period]
• Virtual Reality Discomfort Questionnaire [Срок оценки: At the end of the first Virtual Reality session]
• Virtual Reality Satisfaction Questionnaire [Срок оценки: At the end of the first Virtual Reality session]