Virtual Reality Versus Conventional Therapy for Hand Function in Tethered Spinal Cord Compression: A Randomized Controlled Trial

Abstract

Background: Tethered spinal cord compression frequently impairs hand function, limiting independence and quality of life. While conventional therapy (CT) is widely used, the potential added benefit of virtual reality–enhanced therapy (VR) for this population remains underexplored. Objective: This study aimed to compare the effectiveness of a six-week VR-based intervention versus CT in improving hand function scores among adults with tethered spinal cord compression, hypothesizing that VR would provide superior functional outcomes. Methods: In this single-center, randomized controlled trial conducted at the Neuro-Rehabilitation Unit of Central Spine Institute, Karachi, 60 adults aged 35–55 years with MRI-confirmed tethered spinal cord compression and baseline Hand Function Score (HFS) ≤60 were randomly assigned to VR or CT. Exclusion criteria included other neurological disorders, severe hand contractures, recent limb injury, and VR contraindications. Both groups completed 18 standardized sessions over six weeks. HFS, the primary outcome, was assessed pre- and post-intervention by blinded evaluators. Statistical analysis was performed using SPSS v26, employing paired and independent t-tests with 95% confidence intervals. Ethical approval was obtained in accordance with the Helsinki Declaration. Results: Baseline demographics were comparable. Mean post-intervention HFS was 69.8 ± 8.2 (VR) and 65.1 ± 9.6 (CT), with both groups showing significant within-group improvement (p<0.001). The between-group difference in HFS favored VR by 4.7 points (95% CI: 1.1–8.3; p=0.02), representing a modest but statistically significant effect. Conclusion: Both VR and CT significantly improved hand function in adults with tethered spinal cord compression, with VR offering a modest additional benefit. Integrating VR into rehabilitation protocols may enhance patient engagement and recovery in this population.