Impact of immersive virtual reality combined with lifestyle modification on upper limb function, pain intensity, and range of motion in post-surgical breast cancer survivors: A randomized controlled trial

Abstract

Objective: To compare the effects of immersive virtual reality (VR) and conventional physical therapy (CPT), with or without lifestyle modification (LM), on upper-limb function, pain intensity, and shoulder range of motion (ROM) in post-surgical breast cancer survivors. Methodology: This four-arm randomized controlled trial (May 2025–April 2026) conducted at Holy Family Hospital Rawalpindi, KINIFIT Physiotherapy, Sehat Pain Management and Physiotherapy Clinic, Islamabad. Sixty women aged 30–60 years, two to four months post-mastectomy/lumpectomy (excluding active/bilateral cancer or lymphoedema), randomized into four groups for eight weeks. VR+LM, VR Only, CPT+LM, or CPT Only. Primary outcomes were pain (Numeric Pain Rating Scale, NPRS) and upper limb function (Disabilities of the Arm, Shoulder and Hand, DASH). Secondary was shoulder range of motion ROM and lifestyle adherence. Results: NPRS showed a significant Group ×Time interaction( p < .001, partial η² = .262) and large between-group differences at Week 8 (η² = .634); VR+LM achieved the greatest pain reduction. DASH improved significantly within all groups (p < .001), with the largest reduction in CPT+LM and significant between-group differences by Week 8 (η² = .252), interaction was not significant (p = .182). CPT+LM produced the greatest shoulder ROM gains, notably internal rotation. Lifestyle adherence was high for walking, sleep, and breathing (83–90%), low for diet (75%). Conclusion: Virtual Reality with lifestyle modification provided the greatest analgesic benefit, whereas conventional physical therapy with lifestyle modification achieved superior functional and range-of-motion recovery in post-surgical breast cancer rehabilitation.