Immersive virtual reality upper-limb exercises in people with Parkinson’s disease: an observer-blinded randomised controlled trial

Sep 30, 2026

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Immersive virtual reality (iVR) is evaluated as an engaging rehabilitation option for people with Parkinson’s disease (PD), with effectiveness versus conventional upper-limb training (CON-ULT) remaining uncertain. This bi-centre observer-blinded randomized controlled trial compares iVR-ULT and CON-ULT on motor and non-motor outcomes. Participants received 30-minute sessions, four times per week, for four weeks in inpatient rehabilitation, with primary endpoints targeting arm and hand function.

LanguageEnglish

CategoryHealthcare

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Pages17

Reading Time43 min

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Abstract

Background

Methods

Results

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Keywords

Background

Heinzle etal. Journal of NeuroEngineering and Rehabilitation (2026) 23:9 [https://doi.org/10.1186/s12984-025-01851-1](https://doi.org/10.1186/s12984-025-01851-1) Journal of NeuroEngineering and Rehabilitation RESEARCH Open Access Immersive virtual reality upper-limb exercises in people with Parkinson’s disease: an observer-blinded randomised controlled trial Klaus Heinzle 1, Janice Habig2, Markus Prögl höf2, Anna Diwald3, Sarah Mildner2, Michaela Haslinger 1, Fabienne Lehner4, Michaela Stampfer-Kountchev4, Robert Hatschenberger5, Christian Brenneis,4,6 and Barbara Seebacher2,6,7* Abstract Background Upper-limb dysfunction is common in Parkinson’s disease (PD) . Immersive virtual reality (iVR) offers an engaging rehabilitation approach, but its effectiveness versus conventional therapy remains unclear. This bi-centre observer-blinded randomised controlled trial compared iVR-and conventional upper-limb training (CON-ULT) on motor and non-motor outcomes in people with PD. Methods Participants were randomised (1:1) to iVR upper-limb training (iVR-ULT) or CON-ULT for 30 min, 4 times/ week, over 4 weeks of inpatient rehabilitation. Primary outcomes were arm function (Action Research Arm Test) and hand function (Jebsen-Taylor Hand Function Test) analysed by intention-to-treat. Secondary outcomes included dexterity, finger coordination, disease severity, motivation, health-related quality of life (HRQoL), adherence, acceptability, and iVR system usability (System Usability Scale, SUS) . Outcomes were assessed pre-and postintervention by blinded therapists. Results Of 97 patients screened, 58 were randomised: 29 to iVR-ULT and 29 to CON-ULT. No group-by-time interaction effects were observed in arm function. Both groups showed improved arm function (iVR-ULT: right, effect size r = 0 .402, p = 0 . 034; left, r = 0 .437, p = 0 . 021; CON-ULT: right, r = 0 . 640, p = 0 . 001; left, r = 0 . 567, p = 0 . 002; mediumto-large effects) . For hand function, significant changes were found only after CON-ULT (right: r = 0 . 656, p = 0 . 0004; left, r = 0 . 628, p = 0 . 0007), reflecting a small between-group effect (r = 0 . 275, p = 0 . 038) . For secondary outcomes, no group-by-time interaction effects were found. Across time, both groups improved in gross and fine dexterity (medium-to-large effects) . Right-hand motor speed and coordination (Finger Tapping Test) improved significantly in only the iVR-ULT group (r = 0 . 516, p = 0 . 0064), while left-hand performance improved in both groups. Disease severity improved modestly in both groups (iVR-ULT: r = 0 .431, p = 0 . 023; CON-ULT: r = 0 . 387, p = 0 . 037; medium effects), while Hoehn & Yahr stage remained stable. HRQoL analyses suggested changes in activities of daily living-related (r = 0 .494, p = 0 . 009) and cognition-related domains (r = 0 . 391, p = 0 . 039) after iVR-ULT, stigma after CON-ULT (r = 0 . 386, p = 0 . 038) and emotional well-being after both interventions (r = 0 .447, p = 0 . 018; r = 0 .406, p = 0 . 029), with low-to-medium effect *Correspondence: Barbara Seebacher [barbara.seebacher@i-med.ac.at](barbara.seebacher@i-med.ac.at) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the arti

FAQs

What rehabilitation approaches were compared in the trial?

The trial compared immersive virtual reality upper-limb training (iVR-ULT) with conventional upper-limb training (CON-ULT). Both were delivered over inpatient rehabilitation.

How long and how often were the training sessions delivered?

Participants received 30-minute upper-limb training sessions four times per week for four weeks.

What were the primary outcome measures?

Primary outcomes were arm function (Action Research Arm Test) and hand function (Jebsen-Taylor Hand Function Test), assessed with intention-to-treat and evaluated by blinded therapists before and after the intervention.

Sep 30, 2026

Uploaded by Ben