Effects of Immersive Virtual Reality-Based Rehabilitation on Quality of Life, Sleep Quality, and Cognitive Function in Women With Fibromyalgia: A Randomized Controlled Trial
Effects of Immersive Virtual Reality-Based Rehabilitation on Quality of Life, Sleep Quality, and Cognitive Function in Women With Fibromyalgia: A Randomized Controlled Trial
Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, cognitive complaints, and psychoemotional symptoms, leading to functional impairment and reduced quality of life. Although exercise is recommended as a first-line non-pharmacological treatment, maintaining long-term adherence remains a major challenge.
Immersive virtual reality (IVR) has emerged as a promising approach to increase motivation and engagement during rehabilitation by integrating therapeutic exercise with interactive virtual environments. This randomized controlled trial evaluated the effects of a six-week exercise program delivered through immersive virtual reality compared with conventional exercise in women with fibromyalgia.
Participants were randomly assigned to either an IVR exercise group or a conventional exercise group. Clinical outcomes were assessed at baseline and after the intervention, including fibromyalgia-related impact, global cognitive screening performance, sleep quality, and psychoemotional symptoms. Treatment adherence and user experience were also evaluated to explore their association with clinical outcomes.
Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, cognitive dysfunction, and psychoemotional symptoms, resulting in substantial reductions in physical function and health-related quality of life. Although therapeutic exercise is considered a core component of fibromyalgia management, maintaining long-term adherence to exercise programs remains challenging due to pain exacerbation, fatigue, and reduced motivation.
Immersive virtual reality (IVR) has emerged as an innovative rehabilitation strategy that integrates therapeutic exercise with interactive virtual environments. By providing real-time visual feedback, immersive environments, and gamified exercise tasks, IVR may improve motivation, enjoyment, and engagement during rehabilitation while promoting adherence to structured exercise programs.
The present study was designed as a two-arm parallel-group randomized controlled trial comparing an immersive virtual reality exercise program with a conventional exercise program in women diagnosed with fibromyalgia according to the 2016 American College of Rheumatology diagnostic criteria. Participants were randomly allocated in a 1:1 ratio to either intervention and completed a supervised six-week rehabilitation program consisting of two sessions per week.
Participants allocated to the IVR group performed a combined intervention consisting of aerobic exercise followed by immersive virtual reality exercise using Meta Quest 2 head-mounted displays (Meta Platforms, Menlo Park, CA, USA) and the FitXR® platform (AeroBox modality). Participants allocated to the control group performed a conventional exercise program matched for treatment frequency and session duration. All intervention sessions were supervised by a physiotherapist trained in the study protocol.
Clinical assessments were performed at baseline and immediately after completion of the intervention. The predefined primary outcomes included fibromyalgia-related impact (FIQR), global cognitive screening performance (MoCA), psychoemotional symptoms (DASS-21), and sleep quality (Jenkins Sleep Questionnaire). Secondary outcomes included treatment adherence and user experience, assessed using the Player Experience of Need Satisfaction (PENS) questionnaire in participants allocated to the IVR group.
The primary objective of the randomized controlled trial was to compare the effects of immersive virtual reality exercise and conventional exercise on clinical outcomes in women with fibromyalgia. In addition, the study was designed to explore whether user experience during immersive virtual reality was associated with treatment adherence and changes in clinical outcomes.
Inclusion Criteria
Exclusion Criteria