A VR-Based Approach to Diagnosis and Rehabilitation of Carpal Tunnel Syndrome: Integrating the Boston Carpal Tunnel Questionnaire

Abstract

Background: Carpal Tunnel Syndrome (CTS) is a common entrapment neuropathy caused by compression of the median nerve, leading to pain, numbness, and reduced hand function. Traditional treatments include splinting, physiotherapy, and surgery, but recent advances highlight the potential of virtual reality (VR) as a rehabilitation tool.
Objective: This study aimed to design and evaluate a VR-based rehabilitation game for CTS patients, integrating the Boston Carpal Tunnel Questionnaire (BCTQ) for diagnosis and progress monitoring.
Methods: A VR rehab game was developed using Visual Novel Maker, comprising three stages: awareness, diagnosis, and management. The BCTQ was embedded within the game to classify symptom severity into mild, moderate, or severe. Based on classification, patients accessed VR-guided therapeutic exercises including flexion–extension, flexed grip, straight grip, and thumb extension. A total of ten participants with moderate CTS symptoms (6 males, 4 females) were recruited. User expectations and evaluations were assessed using the House of Quality (HOQ) framework.
Results: The VR rehab game consistently met or exceeded user expectations across most criteria. Evaluation scores were higher than expectation scores in usability, graphics, clarity of instructions, motivation, and immersive experience. Clear exercise instructions received the highest improvement (evaluation 4.8 vs. expectation 4.1). However, VR wearable comfort scored lower than expected (3.8 vs. 4.1), suggesting an area for improvement. HOQ analysis highlighted compatibility, game adaptation, and VR headset integration as top priorities (21.8%, 22.1%, and 22%, respectively).
Conclusion: The VR-based CTS rehab game demonstrated significant potential as both a diagnostic and rehabilitative tool. By incorporating the BCTQ, it allowed real-time symptom classification and progress tracking, while VR-based exercises improved user engagement and hand mobility. Future research should focus on optimizing VR wearable comfort and testing the system on larger populations to establish long-term clinical efficacy.