Limited evidence examining visual feedback in rehabilitation for generalised knee pain: a scoping review and call for further research

Lead author	Intervention	Outcome measure	Baseline	Final	Change	p-value
Kernozek [50]	Squatting with 3D motion capture analysis VF (post-training)	PFJ force (BW)	4.64 ± 1.05	3.97 ± 0.81	−0.67 BW	<0.001^a
		Knee extension moment (Nm/BW)	0.11 ± 0.02	0.10 ± 0.02	−0.01 Nm/BW	0.01^a
		Hip extension moment (Nm/BW)	0.06 ± 0.04	0.04 ± 0.03	−0.02 Nm/BW	0.001^a
		Quadriceps forces (BW)	4.67 ± 0.98	4.06 ± 0.87	−0.61 BW	<0.001

j_advrehab-2026-0003_tab_007

Search term	Alternate terms included	Search details
#1: Knee pain	Knee ache, PFP	(((‘knee’[MeSH Terms] OR ‘knee’[All Fields] OR ‘knee joint’[MeSH Terms] OR (‘knee’[All Fields] AND ‘joint’[All Fields]) OR ‘knee joint’[All Fields]) AND (‘pain’[MeSH Terms] OR ‘pain’[All Fields])) OR ((‘knee’[MeSH Terms] OR ‘knee’[All Fields] OR ‘knee joint’[MeSH Terms] OR (‘knee’[All Fields] AND ‘joint’[All Fields]) OR ‘knee joint’[All Fields]) AND (‘ache protein human’[Supplementary Concept] OR ‘ache protein human’[All Fields] OR ‘ache’[All Fields] OR ‘pain’[MeSH Terms] OR ‘pain’[All Fields])) OR (‘patellofemoral pain syndrome’[MeSH Terms] OR (‘patellofemoral’[All Fields] AND ‘pain’[All Fields] AND ‘syndrome’[All Fields]) OR ‘patellofemoral pain syndrome’[All Fields] OR (‘patellofemoral’[All Fields] AND ‘pain’[All Fields]) OR ‘patellofemoral pain’[All Fields]))
#2: VF	Feedback, biofeedback, mirror therapy, virtual reality, gamification, CAREN, Computer assisted rehabilitation environment, external focus	(‘feedback, sensory’[MeSH Terms] OR (‘feedback’[All Fields] AND ‘sensory’[All Fields]) OR ‘sensory feedback’[All Fields] OR (‘visual’[All Fields] AND ‘feedback’[All Fields]) OR ‘visual feedback’[All Fields] OR (‘feedback’[MeSH Terms] OR ‘feedback’[All Fields] OR ‘feedbacks’[All Fields] OR ‘feedback s’[All Fields]) OR (‘biofeedback, psychology’[MeSH Terms] OR (‘biofeedback’[All Fields] AND ‘psychology’[All Fields]) OR ‘psychology biofeedback’[All Fields] OR ‘biofeedback’[All Fields]) OR (‘mirror movement therapy’[MeSH Terms] OR (‘mirror’[All Fields] AND ‘movement’[All Fields] AND ‘therapy’[All Fields]) OR ‘mirror movement therapy’[All Fields] OR (‘mirror’[All Fields] AND ‘therapy’[All Fields]) OR ‘mirror therapy’[All Fields]) OR (‘virtual reality’[MeSH Terms] OR (‘virtual’[All Fields] AND ‘reality’[All Fields]) OR ‘virtual reality’[All Fields]) OR (‘gamification’[MeSH Terms] OR ‘gamification’[All Fields]) OR ‘CAREN’[All Fields] OR ((‘computability’[All Fields] OR ‘computable’[All Fields] OR ‘computating’[All Fields] OR ‘computation’[All Fields] OR ‘computational’[All Fields] OR ‘computations’[All Fields] OR ‘compute’[All Fields] OR ‘computed’[All Fields] OR ‘computer s’[All Fields] OR ‘computers’[MeSH Terms] OR ‘computers’[All Fields] OR ‘computer’[All Fields] OR ‘computes’[All Fields] OR ‘computing’[All Fields] OR ‘computional’[All Fields]) AND (‘assistances’[All Fields] OR ‘assistant s’[All Fields] OR ‘assistants’[All Fields] OR ‘assisted’[All Fields] OR ‘assisting’[All Fields] OR ‘assistive’[All Fields] OR ‘dental assistants’[MeSH Terms] OR (‘dental’[All Fields] AND ‘assistants’[All Fields]) OR ‘dental assistants’[All Fields] OR ‘assistant’[All Fields] OR ‘helping behavior’[MeSH Terms] OR (‘helping’[All Fields] AND ‘behavior’[All Fields]) OR ‘helping behavior’[All Fields] OR ‘assist’[All Fields] OR ‘assistance’[All Fields] OR ‘assists’[All Fields]) AND (‘rehabilitant’[All Fields] OR ‘rehabilitants’[All Fields] OR ‘rehabilitate’[All Fields] OR ‘rehabilitated’[All Fields] OR ‘rehabilitates’[All Fields] OR ‘rehabilitating’[All Fields] OR ‘rehabilitation’[MeSH Terms] OR ‘rehabilitation’[All Fields] OR ‘rehabilitations’[All Fields] OR ‘rehabilitative’[All Fields] OR ‘rehabilitation’[MeSH Subheading] OR ‘rehabilitation s’[All Fields] OR ‘rehabilitational’[All Fields] OR ‘rehabilitator’[All Fields] OR ‘rehabilitators’[All Fields]) AND (‘environ’[All Fields] OR ‘environment’[MeSH Terms] OR ‘environment’[All Fields] OR ‘environments’[All Fields] OR ‘environment s’[All Fields] OR ‘environs’[All Fields])) OR ((‘external’[All Fields] OR ‘externally’[All Fields] OR ‘externals’[All Fields]) AND (‘wood des focus’[Journal] OR ‘focus’[Journal] OR ‘focus ohio dent’[Journal] OR ‘focus madison’[Journal] OR ‘focus am psychiatr publ’[Journal] OR ‘focus’[All Fields])))
#3: CKC	Squat, biomechan^a, functional movement	(((‘close’[All Fields] OR ‘closed’[All Fields] OR ‘closely’[All Fields] OR ‘closeness’[All Fields] OR ‘closes’[All Fields] OR ‘closing’[All Fields] OR ‘closings’[All Fields]) AND (‘kinetical’[All Fields] OR ‘kinetically’[All Fields] OR ‘kinetics’[MeSH Terms] OR ‘kinetics’[All Fields] OR ‘kinetic’[All Fields]) AND (‘chain’[All Fields] OR ‘chain s’[All Fields] OR ‘chains’[All Fields])) OR ‘squat’[All Fields] OR ‘biomechan’[All Fields] OR ((‘functional’[All Fields] OR ‘functional s’[All Fields] OR ‘functionalities’[All Fields] OR ‘functionality’[All Fields] OR ‘functionalization’[All Fields] OR ‘functionalizations’[All Fields] OR ‘functionalize’[All Fields] OR ‘functionalized’[All Fields] OR ‘functionalizes’[All Fields] OR ‘functionalizing’[All Fields] OR ‘functionally’[All Fields] OR ‘functionals’[All Fields] OR ‘functioned’[All Fields] OR ‘functioning’[All Fields] OR ‘functionings’[All Fields] OR ‘functions’[All Fields] OR ‘physiology’[MeSH Subheading] OR ‘physiology’[All Fields] OR ‘function’[All Fields] OR ‘physiology’[MeSH Terms]) AND (‘movement’[MeSH Terms] OR ‘movement’[All Fields] OR ‘movements’[All Fields] OR ‘movement s’[All Fields])))
#4: #1 AND #2 AND #3
#5: #4 with filters of randomized controlled trial, clinical trial, english language, and publication date of 2009–2024

Muscle activity (EMG)

Lead author	Intervention	Muscle	Baseline	Final	Change
Hwangbo [48]	Visual EMG feedback^a	VM	46.94 ± 5.36	50.51 ± 4.78	+3.57 ± 2.28
	No feedback	VM	43.40 ± 4.98	45.85 ± 6.95	+2.45 ± 3.26
	Visual EMG feedback^a	VL	60.84 ± 6.54	61.75 ± 7.72	+0.91 ± 3.40
	No feedback^a	VL	58.37 ± 5.72	62.43 ± 7.18	+4.06 ± 3.66

Summary of study interventions, outcomes and key findings

Lead author	Intervention	Comparator	Outcomes	Total follow-up period	Key findings	Risk of bias
Hwangbo [48]	Squat exercises with EMG VF	Squat exercises without VF	Muscle Activity (EMG): VM, VL	6 weeks	↑ VM activity in both groups; VL: mixed results, significantly greater ↑ in No-VF group	High
Rabelo [49]	MC&S with mirror VF	Strengthening only	Pain: NPRS Function: AKPS Kinematics: Trunk lean	4 weeks (kinematics) 6 months (NPRS, AKPS)	NPRS: both groups improved; no significant between-group difference AKPS: greater improvement in MC&S group Trunk lean reduced more in MC&S group	Some concerns
Kernozek [50]	Post-training squatting with 3D motion capture analysis VF	Pre-training squatting without VF	Joint Forces/Moments: PFJ force, knee & hip ext. moment, quad force Joint Angles: hip, knee, ankle	Immediate	↓ PFJ and quad force with VF ↓ hip/knee flexion angles with VF Ankle DF: No significant change with VF	Moderate

j_advrehab-2026-0003_tab_008

Lead author	Risk of bias tool	Study design	Key domains	Overall risk of bias
Rabelo [49]	RoB 2	RCT	Randomisation: Low Deviations: Some concerns Missing data: Low Measurement: Some concerns Reporting: Some concerns	Some concerns
Hwangbo [48]	RoB 2	RCT	Randomisation: Some concerns Deviations: Some concerns Missing data: Some concerns Measurement: Low Reporting: Some concerns	High
Kernozek [50]	ROBINS-I	NRSI	Confounding: Moderate Selection: Low Intervention: Low Deviations: Low Missing data: Low Measurement: Low Reporting: Moderate	Moderate

Study and participant characteristics

	Hwangbo [48]	Rabelo [49]	Kernozek [50]
Population	N: 20	N: 34	N: 20
	Age: 22–23 years	Age: 18–30 years	Age: 18–25 years
	Sex: not reported	Sex: All female	Sex: 17 females, 3 males

Inclusion criteria	Increased quadriceps (Q) angles	Clinical diagnosis of PFP; symptoms ≥3 months; pain with squatting/stairs	Clinical criteria for PFP; NPRS ≥3 during activity

Study design	RCT	RCT	NRSI

Experimental group	Squat exercises with EMG VF	Motor control and strengthening with mirror VF	Squatting with 3D motion capture analysis VF (post-training)

Comparator group	Squat exercises with no VF	Strengthening only	Squatting with no VF (pre-training)

Outcomes	VL and VM EMG	Function, pain intensity, strength, trunk and lower limb kinematics	Joint and muscle forces, joint angles

Pain and functional outcomes

Lead author	Intervention	Outcome measure	Baseline	Final	Between-group difference (95% CI)	p-value
Rabelo [49]	MC&S	NPRS	6.1 ± 1.4	1.3 ± 1.8	−0.3 (−1.7 to 1.0)	>0.05
	Strengthening only	NPRS	6.6 ± 1.0	2.2 ± 1.6	−0.3 (−1.7 to 1.0)	>0.05
	MC&S	AKPS (0–100)	67.1 ± 7.6	89.0 ± 8.2	−8.5 (−16.8 to −0.3)	0.04^a
	Strengthening only	AKPS (0–100)	67.5 ± 11.3	84.8 ± 9.8	−8.5 (−16.8 to −0.3)	0.04^a

Joint angles (degrees)

Lead author	Intervention	Joint angle	Baseline	Final	Change	p-value
Kernozek [50]	Squatting with 3D motion capture analysis VF (post-training)	Hip flexion	91.99 ± 14.60	86.20 ± 15.05	−5.79	0.001^a
		Knee flexion	102.96 ± 16.55	97.26 ± 17.11	−5.70	0.001^a
		Ankle dorsiflexion	35.63 ± 6.95	34.77 ± 7.28	−0.86	0.07
Rabelo [49]	MC&S with mirror VF	Trunk ipsilateral lean	5.0 ± 3.7	3.9 ± 2.3	−1.1	0.02^b
Rabelo [49]	Strengthening only	Trunk ipsilateral lean	4.4 ± 1.7	3.2 ± 1.6	−1.2	0.02^b

References

Authors

Metrics

Articles in this issue

DOI: https://doi.org/10.2478/advrehab-2026-0003 | Journal eISSN: 1734-4948

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Language: English

Page range: 36 - 53

Submitted on: May 30, 2025

Accepted on: Nov 4, 2025

Published on: Mar 31, 2026

Published by: University of Physical Education in Warsaw

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

closed kinetic chain,

exercise therapy,

motor activity,

patellofemoral pain syndrome,

visual feedback

Related subjects:

Medicine,

Clinical medicine,

Physical and rehabilitation medicine,

Rheumatology,

Cardiology,

Sports and recreation,

Sports and recreation, other

© 2026 Margaret R. Klausing et al., published by Józef Piłsudski University of Physical Education in Warsaw
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Volume 40 (2026): Issue 1 (March 2026)

Limited evidence examining visual feedback in rehabilitation for generalised knee pain: a scoping review and call for further research

Figures & Tables

Figure 1.

Joint and muscle forces and moments