Table 2 The characteristics of the reviewed articles
# | Author / Year | Research objective | Result | Type disorder /Sample size | Rehabilitation exercises | VR/AR tools and sensors | Tools develop | Movement Recognition and Assessment | Save data | Feedback | Evaluation methods |
|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Guggenberger et al. [31]/2021 | The development was a game for mobility and lower limb strength through bodyweight training in an AR environment | The results show that the game under review has the potential of a low-cost, affordable approach to supporting patients in their home exercise program after THR and completing inpatient rehabilitation | THR People:30 | Squats Step-ups Side-steps | HMD Samsung Galaxy S9/ Huawei P20 smartphone Implements the smartphone’s built-in IMU 3DMAS | Google ARCore API | By calibrating the system, using camera images of the room, ARCore detects feature points, which are used as references for positioning virtual objects and in combination with the IMU data for motion tracking | NM |  +  | NM |
2 | Zhao et al. [32]/ 2021 | Design and implement a system for rehabilitating people who have undergone total knee replacement surgeries | This avatar-based interactive system facilitates rehabilitation exercises at home. They showed that an integrated system could track movements and instantly assess the quality and quantity of movements using XML-defined rules for TKR rehabilitation | TKR | -Namely -Quad set -Side-lying hip abduction -Straight raise leg -Ankle pump | IMU/Kinect | -Unity 3D -SDK -C# program-ming language -XML | -Rule-based framework and the mechanism used to track the movements dynamically | NM |  +  | NM |
3 | Prvu Bettger et al. [33]/ 2019 | They evaluated the clinical outcomes and cost of the virtual PT program compared to traditional care after TKR | Virtual PT with remote rehabilitation reduces the cost of 3 months of health care after TKR while having similar effectiveness compared to the traditional rehabilitation method | TKR People: 287 Mean age: 65 years | -Knee extension -Knee flexion -Gait speed -Safety measures | Kinect | -SDK -Microsoft visual studio 2010 in the Windows 7 operating system -C# programming language | NM |  +  |  +  | -KOOS -PROMIS -Satisfaction with physical function -Physical activity |
4 | Günaydin and Arslan [12]/ 2019 | This paper presents a low-cost rehabilitation support system for lower limb muscle strengthening exercises | This study has successfully developed a system to increase patient participation in treatment and provide physiotherapist tools for remote follow-up | Rehabilitation for the lower limbs People:16 | -Active knee extension exercises to strengthen the quadriceps muscle -Active knee flexion for hamstring muscle strengthening -Terminal extension exercise for vastus medialis obliquus muscle | sEMG (BITalino) | -Unity 3D -APIs provided on the BITalino website | Feature extraction methods are used for electromyography signal analysis |  +  |  +  | -Perceived Usefulness (PU) -Perceived Ease of use (PE) -Attitude (AT) -Intention of use (IU) |
5 | Perez Medina et al. [34]/ 2019 | This paper presents a flexible, scalar, and modular software architecture for the ePHoRt platform | The main role of this work is to act as a conceptual guide for developing remote rehabilitation operating systems | THR | -Hip abduction -Slow flexion of hip and knee -Hip extension -Frontward, sideway, backward | Kinect | -Django 2.0.5 -Model-view-controller (MVC) -CSS -Boostrap 4.1.13 -JQuery 3.1.14 -RESTful API -Kinectron 1.4.2 -Processing 1.4.8 -JavaScript Library/ Three.jsr97 | -The evaluation of the movement quality is carried out by an AI algorithm based on the DTW algorithm -A SVM algorithm was trained to detect the face and process it based on the following criteria |  +  |  +  | The patients must answer a preliminary questionna-ire regarding their health status. The preliminary questionnaire allows the physiotherapist to get relevant patient information, like recent surgeries, levels of pain, and other health problems |
6 | This paper presents the design and implementation of a custom rehabilitation program for patients undergoing TKR and encourages the patient to exercise | Initial testing of the application indicates that patient engagement is enhanced in most cases | TKR 1-People: 6 Age: 30–50, 64–80 2-People: 10 Age: 64–80 | The selected exercise for testing was knee extension | IMU | -Python programming language -The Java native interface -C# programming language -Unity 3D | This study proposes a new classification algorithm that automatically classifies an exercise in real-time as true or false |  +  |  +  | ROM | |
7 | Karayigit and Celikcan [37]/ 2018 | This paper presents the design and implementation of knee up, a game to increase knee health | Study results demonstrate that knee-up is generally well-received in terms of usability, engagement, ease of learning-to-play, and exercise sustainability; and validate that the rule-based recognition algorithm works satisfactorily well | Rehabilitation for the lower limbs People: 20 Mean age: 37.6 | Standing Knee Raises Movement (SKRM) | Kinect | - Unity 3D -XML | Implementation of rule-based SSP and SKRM recognition algorithm |  +  | NM | -SSP takes the static skeletal measurements required for the recognition algorithm -Questionn-aire 11 questions on a Likert scale of 1 to 5 -ROM |
8 | Rybarczyk et al. [38]/ 2018 | This paper presents the creation of a remote platform for self-motor rehabilitation and remote monitoring by health professionals to improve patients after hip replacement | The results show high accuracy in evaluating the movements (92% of correct classification). The overall SUS score is 81 out of 100, which suggests a good usability | THR People: 22 Age: 20–50 | NM | Kinect | -Django technology -Python -Node.js | Hidden Markov models approach |  +  |  +  | -SUS -Before the rehabilitation begins, patients must answer a questionnaire, which evaluates their ability to complete the exercises |
9 | Feng et al. [39]/ 2018 | In this paper, a VR-based training system for ankle joint rehabilitation is designed | The experimental results verify the feasibility of the system. The system designed in this paper offers significant potential benefits in rehabilitation but remains to be properly explored | Ankle injury People: 5 | Six types of ankle joint movements | EMG MPU6050 HMC5883 | -C +  + language | This paper proposes a rehabilitation assessment method based on the multi-index fusion of kinematics and EMG signals. The method includes three indexes: root means square of EMG, joint activity, and joint smoothness |  +  |  +  | -RMS -Joint activity -Joint smoothness |
10 | Pruna et al. [40]/ 2017 | The 3D virtual system is presented for the rehabilitation of lower limbs also, and two games are designed to allow flexion, extension, and strengthening movements | They show that the systems have a good acceptance for rehabilitation | Knee osteoarthritis People: 4 Age: 61–78 | Allow the execution of flexion and extension movements as well as knee strengthening | -3 Space Mocap Sensors -YEI 3-Space Mocap movement capture devices - 6 sensors (3 for the left leg and 3 for the right leg) | -Unity 3D -Scripts were developed for the system design | NM | NM |  +  | SEQ usability test |
11 | This paper presents the feasibility of using a serious new game system to improve lower limb musculoskeletal rehabilitation | According to the results, the squat was the most difficult challenge. In addition, any functional rehabilitation exercise’s performance depends on each participant’s physiological characteristics The game showed useful functions for various programs (home rehabilitation and exercise) | Rehabilitation for the lower limbs People: 10 Mean age:24.2 ± 3.79 years | -Easy category: hip adduction/abduction and straight jump exercises -Medium category: hamstring curls, the high knees and one-leg stance exercises, standing exercises -Hard category: Squat exercises | Kinect | -Microsoft XNA Game Studio (Washington, USA) -Visual Studio.Net with C# | Based on the position and direction of a particular joint, an angle can be calculated to stimulate the 3D avatar model. Two types of motion can be considered: single degree of freedom (DOF) motion and multiple DOF motion |  +  |  +  | -They designed a special questionnaire to get participants’ opinions on the developed system’s various aspects (games, exercises, and users) | |
12 | Su and Cheng [43]/ 2016 | This paper investigates the effect of achievement factors on patient rehabilitation after complete knee replacement (TKR) exercises using a game rehabilitation system based on the PCA-ANFIS model | The SUS shows that the PRS is acceptable The developed system allows patients to strengthen their self-efficacy through a game-based rehabilitation environment and allows them a faster and more complete recovery | TKR People: 34 | kicking | Kinect | -Unity 3D | -A combination of PCA and ANFIS has been used to provide a predictive emotion model | NM | NM | - SUS - AKSS -SER scale -Demographic scale |
13 | Zhiyu et al. [44] /2015 | This paper was to determine the feasibility of the Kinect in assisting subjects in performing a single posterior chain strengthening exercise | Game testing showed that our system is fast, accurate, robust, and works well for game control | ACL People: 6 | -Jumping action by the side-lying hip abduction exercise | -Kinect -Marker-based vicon system | Unity3D | -Hough leg angle estimator (HE) | NM | NM | NM |
14 | Antón et al. [45]/ 2015 | This paper presents the development of the Kinect rehabilitation system (KiReS) | Participants also found the interaction with Kinect easy and enjoyable, showing a predisposition to using the system again | THR People: 7 Mean age:56 | Ten exercises for both the left and the right hip | Kinect | NM | They used an algorithm to detect movements, the two main elements of which are the position classification and the exercise recognition methods They use a variant of the DTW algorithm |  +  |  +  | Patients’ subjective perceptions: Likert scale questionnaire In three categories: the system, the user’s experience, and the interface |
15 | Choi et al. [46]/ 2015 | A program was developed for leg-strengtheni-ng exercises and balance assessment using Microsoft Kinect | The developed program can enable users to conduct leg-strengtheni-ng exercises and balance assessments at home | Rehabilitation for the lower limbs People: 5 Mean age: 24.8 ± 2.9 | -Three leg-strengthening exercises (knee flexion, hip flexion, and hip extension) – OLST | Kinect | -SDK -Microsoft visual studio 2010 in windows 7 -C# | -Calculating the angles at the hip and knee joints using the position data around the joints | NM |  +  | - OLST |
16 | Gonzalez-Franco et al. [47]/ 2014 | This paper addressed the problem of patients’ adherence to physiotherapy and motivation using a VR game interface | Patients would be able to perform the whole therapy on their own at home. We can conclude that the system has been proven usable as all participants could start, follow and finish the treatment independently without external intervention | TKR People: 16 Mean age: 26.18 | -The potentially familiar exercises included:(semi-recumbent heel slides, sitting knee extension-flexion, and a straight leg raise extracted from the rehabilitation protocols for Knee Arthroscopy Rehabilitation) -The unfamiliar exercises involved: (3 combinations of hip flexion and knee extension exercises) | -Wocket: three-axis positioning miniature wireless accelerometer | - Unity3D | NM |  +  |  +  | Ten points Likert -scale questionnaire to report: ( Interactions- Attention demanding- Learning- Control- Usability- Time perception) |
17 | Garcia and Felix Navarro [48]/ 2014 | This paper focuses on developing the Mobile RehApp, an augmented reality-based mobile device application designed for therapeutic support that aims to assist physiotherapists and patients on ankle sprain rehabilitation | This implementation enhances user interaction as no game controllers or sensors are required to make the game intuitive and easy to use. More importantly, this implementation has the potential to be used as a means to provide home-based therapy, increasing levels of motivation and adherence to rehabilitation | Ankle sprain | ROM exercises | Custom-made AR marker | -Unity 3D -SDK | NM |  +  |  +  | NM |
18 | Patanapanich et al. [49] | This paper presents a physical rehabilitation system | The results show SPRS allows patients to rehab correctly with a slight error which is better than exercise without assistance from the software | Rehabilitation for the lower limbs | -Hip extension -Side leg raise -knee flexion -Hip flexion Plantar flexion -Tandem walk -Sidewalk Chair Stands -Timed Up&Go | Kinect | -OpenNI2 -NITE2 API - Visual C +  +  | Variables that used to detect movement |  +  |  +  | NM |
19 | This paper is intended to develop a lower limb fracture post-operative guided interactive rehabilitation training system for the hip, knee, and ankle joints and establish a method of motion analysis and a method of motion performance assessment in conjunction with wireless sensor technology and animation techniques | The medical evidence shows that a guided rehabilitation system can enhance the patient’s motivation and willingness to be committed to rehabilitation training and increase the quality and amount of exercise activity during the training process | After a fracture surgery | -Bending knee -Raise thigh | IMU(Gyro) | Unity 3D | The state values ​​of an object with IMU |  +  |  +  | NM | |
20 | Maurer et al. [52] | This paper presents a prototype game as a controlled learning environment for home use | The prototype-controlled learning environment can provide more efficient and accurate rehabilitation | TKR | Knee-bend exercises | Kinect | NM | NM |  +  |  +  | NM |