The Effect of Virtual Reality on Prosthetic Outcomes in Lower Limb Amputees: A Systematic Review

Abstract

Introduction Lower limb amputation is associated with substantial physical, functional, and psychological impairments that adversely affect mobility, prosthetic use, independence, and quality of life. Conventional physiotherapy plays vital role on rehabilitation; however, maintaining patient engagement and achieving optimal functional recovery can be challenging. Virtual Reality (VR) has emerged as an innovative rehabilitation tool that provides interactive, task-oriented training and real-time feedback, potentially enhancing prosthetic outcomes in individuals with lower limb amputation. Methods  A systematic search of PubMed, PEDro, Cochrane Library, MEDLINE, and Google Scholar were conducted from database inception to February 2026. The search strategy was developed using the PICO framework and included keywords related to lower limb amputation, prosthesis, virtual reality, rehabilitation, balance, gait, pain, and psychological outcomes. Only randomized controlled trials (RCTs) investigating the effectiveness of VR-based rehabilitation in adult lower limb amputees were included. Methodological quality was assessed using the PEDro scale, Cochrane Risk of Bias tool, and GRADE approach. Results: Five RCTs met the inclusion criteria. The findings demonstrated that VR-based rehabilitation improved balance, gait performance, mobility, prosthetic adaptation, and psycho-emotional well-being. Significant reductions in phantom limb pain were also reported. PEDro scores ranged from 5 to 9, indicating fair-to-high methodological quality, while risk of bias was generally low to moderate across studies. Conclusions: Current evidence suggests that VR is an effective adjunct to conventional rehabilitation for improving prosthetic outcomes in lower limb amputees. However, further high-quality studies with larger sample sizes and longer follow-up periods are needed to strengthen the evidence base.