The impact of innovative technology strategies on implementing exercise programs using fully immersive virtual reality for postpartum women

Abstract

Introduction Postpartum women frequently experience lumbo-pelvic pain (LPP) and pelvic floor dysfunction (PFD) due to physiological and biomechanical changes associated with pregnancy and childbirth. These conditions significantly impair functional ability and quality of life (QoL). Innovative rehabilitation approaches such as fully immersive virtual reality (FIVR) may enhance engagement and therapeutic outcomes compared to traditional exercise (TE) programs. Objective To compare the effectiveness of FIVR-based rehabilitation with conventional TE in reducing pain, disability, and psychological distress among postpartum women with LPP. Methods In this randomized controlled trial, 60 postpartum women with LPP were allocated equally to both FIVR intervention group and a TE control group. The FIVR group participated in an 8-session program incorporating immersive pelvic floor training and functional movement exercises with progressive difficulty, including reaction-time tasks and customized range of motion activities. The TE group performed structured pelvic floor muscle training (PFMT) combined with resistance-based exercises. Outcomes assessed included pain intensity (VAS, SF-MPQ), disability (ODI, PGQ, and PFDI), psychological measures (TSK, PCS, DASS, and CSQ), fatigue (FSS), sleep quality (MOS Sleep Scale), and urogenital symptoms (UDI). Intention-to-treat analysis was applied. Results Both groups showed significant improvements across multiple outcomes (p < 0.001). However, the FIVR group demonstrated significantly greater reductions in pain intensity (VAS: 3.29 ± 0.18 vs. 4.80 ± 0.16; p < 0.001) and multidimensional pain (SF-MPQ: 14.20 ± 2.89 vs. 19.73 ± 2.49; p < 0.001), exceeding clinically meaningful thresholds. Disability outcomes (ODI, PGQ) improved more substantially in the FIVR group, while pelvic floor distress (PFDI) showed comparable changes. Psychological improvements, including reduced kinesiophobia and pain catastrophizing, were significantly greater in the VR group (p < 0.001), whereas general psychological distress and coping strategies improved similarly in both groups. Fatigue, sleep quality, and exertion improved in both groups, with sleep quantity favoring FIVR. Urogenital distress improved significantly only in the TE group (p < 0.001). FIVR-related simulator sickness decreased over time, indicating good tolerability. Treatment effects were independent of demographic and obstetric variables. Conclusion Fully immersive FIVR-based rehabilitation is a safe, well-tolerated, and more effective intervention than TE in reducing pain, disability, and maladaptive psychological responses in postpartum women with LPP. While both approaches improve functional and health outcomes, FIVR offers superior benefits in pain management and patient engagement, supporting its integration into postpartum rehabilitation programs.