Immersive virtual reality for functional hand and finger rehabilitation: results from a randomized controlled trial in 150 patients after traumatic hand injuries

Abstract Traumatic hand injuries frequently result in prolonged functional impairment. Adherence to conventional rehabilitation is frequently limited by pain, fatigue, and low engagement. Virtual reality systems may increase training volume, but many rely on handheld controllers and lack integration. StableHandVR is an immersive, gamified VR application using optical hand tracking for task-oriented functional hand and finger rehabilitation. In a single-center randomized controlled trial, 150 inpatients undergoing rehabilitation after traumatic hand injuries were assigned to either the StableHandVR intervention (n = 75) or an active control (n = 75) performing untargeted hand exercises during passive 360° VR exposure. Both groups completed 12 supervised sessions over three weeks. The primary outcome was active range of hand motion (ROM); secondary outcomes included thumb opposition (Kapandji), grip strength, upper-limb function (DASH), pain (NRS), quality of life (SF-36), usability (SUS), intrinsic motivation (IMI), and training adherence. The intervention group achieved significantly greater gains in wrist ROM (+27.8° vs. +17.3°; p < 0.001), and thumb opposition (p = 0.04). Pain during movement decreased in both groups. Patients using StableHandVR voluntarily exceeded the prescribed training volume by 63%, reporting higher perceived effort (p < 0.001), usefulness (p = 0.018), and excellent usability (SUS = 85.3). StableHandVR was found to enhance motor recovery, engagement, and adherence, supporting its integration into clinical rehabilitation pathways.