PURPOSE: This systematic review examined the effects of exergaming interventions on knee proprioception in patients with knee osteoarthritis and the characteristics of the interventions and proprioception assessment methods.
METHODS: EBSCO, EMBASE, PubMed, and Web of Science were searched from April to May 2026, with the final search completed on May 15, 2026. Studies were eligible if they included adults with clinically diagnosed knee osteoarthritis, applied motion-based interactive games or virtual reality-based exercise, quantitatively assessed knee proprioception, and used a randomized controlled trial design. Of the 1,176 records identified, five studies involving 248 participants met the inclusion criteria. Two reviewers independently performed the study screening, data extraction, and risk-of-bias assessments. The extracted data included the participant characteristics, intervention type, exercise content, dose, comparator, proprioception assessment protocol, and within- and between-group outcomes. The risk of bias was evaluated using the Cochrane RoB 2 tool.
RESULTS: The included studies evaluated Wii-based exergaming, audiovisual exergaming, immersive virtual reality, and non-immersive virtual reality. Knee proprioception was assessed primarily using joint position sense or joint angle reproduction tasks. Four studies reported significant within-group improvements in exergaming-based groups, but the superiority over comparator interventions was inconsistent. Four studies had some concerns regarding the overall risk of bias, and one had a high risk of bias.
CONCLUSION: Exergaming may improve the knee joint position sense, but current evidence does not establish superiority over conventional rehabilitation. Nevertheless, larger, methodologically rigorous trials will be needed before routine clinical recommendation can be made.