Digital and virtual reality–based rehabilitation versus conventional therapy for rotator cuff tears and post-repair recovery: a systematic review and meta-analysis

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Background: To evaluate the effectiveness of virtual reality-based rehabilitation compared to conventional rehabilitation methods in improving shoulder functions, range of motion (ROM), strength, and pain relief in patients recovering from rotator cuff repair. To assess the impact of virtual reality-based rehabilitation on rehabilitation adherence and patient satisfaction in postoperative rotator cuff repair recovery. Methods: A systematic literature search of PubMed, Cochrane Library, Dimensions AI, and Google Scholar was performed from inception to February 14, 2025. Studies involving patients who underwent rotator cuff repair and comparing virtual reality (VR)-based rehabilitation with standard physical therapy were included. Data were extracted and synthesized. Meta-analysis was conducted for outcomes reported by multiple studies, and risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool. Results: Of 599 screened records, 6 studies (n ≈ 332 patients) met the inclusion criteria. There was no statistically significant difference between VR-based and conventional rehabilitation in reducing perceived pain and improving patient-reported functional outcomes. Importantly, VR-based therapy led to significantly greater improvement in shoulder abduction ROM than conventional rehabilitation. However, gains in shoulder flexion and external rotation were not significantly different between groups. Patient adherence and satisfaction varied with rehabilitation modality: home-based digital programs tended to improve adherence, while satisfaction depended on individual preferences for supervision. Conclusion: VR-based rehabilitation is a feasible alternative or adjunct to traditional physiotherapy after rotator cuff repair. It yields postoperative outcomes (pain relief, functional improvement, and strength recovery) comparable to standard rehabilitation, with a clear advantage in enhancing shoulder abduction ROM. Digital rehabilitation may improve patient compliance through greater engagement and accessibility, although integration of periodic clinician interaction may be necessary to maximize patient satisfaction. These findings support incorporating digital health technology into postoperative shoulder rehab protocols, tailored to individual patient needs.