Digital rehabilitation using immersive Virtual Reality for Post-COVID fatigue: a double-blind randomized controlled trial 2026 Lange et al

[Andy]

Background
Post-COVID fatigue is a common and disabling condition with few proven treatments. Immersive virtual reality (VR) exercise therapy may offer a novel rehabilitation approach. We evaluated its efficacy and safety.

Methods
In this single-center, double-blind, parallel-group trial, German adults meeting WHO criteria for Post-COVID syndrome, with moderate-to-severe fatigue (Fatigue Severity Scale [FSS] ≥36) and no comorbidities better explaining fatigue were randomly assigned (1:1) to a supervised VR exercise therapy or to a supervised conventional exercise therapy. Both interventions comprised 12 sessions of 45min over 6 weeks. The primary endpoint was change in FSS from baseline to post-intervention, analyzed in the intention-to-treat population (DRKS00032059), follow-ups took place after 3 and 12 months post-treatment.

Findings
Between March 2023, and May 2024, 100 participants were randomized (1:1) to a VR exercise group (VR-EG); or a conventional exercise group (Con-EG). Fatigue severity improved in both groups (VR-EG -8·29; Con. EG -5·27), with no significant between-group difference (mean difference 3·03; 95% CI -1·02 to 7·06). Only the VR-EG exceeded the established minimal important difference (≥6·3 points). Symptom worsening was less frequent with VR-EG than with Con-EG (9% vs 22%). Patient Global Impression of Change ratings favored VR-EG (overall improvement: 76·7% vs 56·5%). Improvements were sustained at 3 and 12 months. Adverse events were mild and transient.

Interpretation
Immersive VR exercise therapy did not significantly outperform an active comparator on the primary endpoint. However, the VR-EG reached the minimal important difference for fatigue at the group level, showed fewer cases of symptom worsening, and reported more favorable global improvement. Considering the limited treatment options available for Post-COVID fatigue, these findings indicate a promising clinical signal warranting confirmation in larger, multicenter trials.

Open access

 

[Sean]

How is this double-blind?

 

[Turtle]

How is this double-blind?

The BPS, rehab way, one eye closed?

 

[rvallee]

Post-COVID fatigue is a common and disabling condition with few proven treatments. Immersive virtual reality (VR) exercise therapy may offer a novel rehabilitation approach.

There is no way to describe this other than as a mad hallucination. It just spits in the face of all reason, ignores all of reality and simply makes stuff up without a care for what's real. These people obviously know that this is exactly what is meant when people say there are no treatments, that they are trying exactly what has already been tried too many times, that it has no plausible way of being a real thing. And they do it anyway.

But unlike AI hallucinations, they cannot and will not ever admit to it. It's actually easy to get an AI model to admit that it fabricated something. They might do it again but they will then also admit to it. Not these people. They will find googol excuses to throw back, even absolutely ridiculous ones. Because they actually care even less whether what they say is true than any LLM before this year.

Also they know it's not double-blind. They know it's not even single-blind. But unlike AIs, they are rewarded when they simply pretend otherwise. And this is why they are already far less useful and valuable, and why their work is of negative value. Oddly enough, this is another reason why AIs will be far more trusted in the future, because human expert systems and institutions play too loose with facts, politics and accountability, to the point where they make their own claim to expertise suspicious.

They know it's crap. They all know. They do it anyway. Because it brings them material benefits. Somehow.

 

[rvallee]

This might be the strongest contender for bullshit excuse I have ever seen. This is their explanation for blinding:

To further reduce the risk of unblinding, training sessions for the VR group were conducted in a separate area, and participants were instructed not to discuss their training modality with other participants. Outcome assessors remained blinded by conducting all evaluations in a dedicated assessment room, and participants were repeatedly asked to refrain from sharing details of their training experience. In cases of partial unblinding (n= 3), such events were documented (e.g., participants inferring their group allocation), and sensitivity analyses were performed excluding these participants.

Basically they seem to use the literal meaning of blinding, in that putting a wall so that you can't see the thing with your own eyes is what blinding means. The fact that this passes peer review is a deep shame on the entire premise of the system, it just completely beclowns it.

 

[Eleanor]

Looks quite fun though. I'd like to have a go if I were well enough.

 

[Utsikt]

Outcome assessors remained blinded by conducting all evaluations in a dedicated assessment room, and participants were repeatedly asked to refrain from sharing details of their training experience.

This is beyond satire.

 

[Utsikt]

The fact that this passes peer review is a deep shame on the entire premise of the system, it just completely beclowns it.

They spent half a year assessing the article.

Received:
March 26 2026
Accepted:
September 16 2026

According to wikipedia, the journal is the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy.

 

[wallfish]

I think the more import part of their blinding strategy is the choice to withhold the hypothesis from patients. The study protocol says this is an attempt at "the best alternative to a double blind [...] intervention":

To minimize potential bias due to expectancy and reporting bias, this study is randomized-controlled and blinded in accordance with current recommendations for conducting nonpharmacological trials [22, 57]. By withholding information about the exact content of the interventions and the hypothesis of our study, we attempt to provide the best alternative to a double-blind nonpharmacologic intervention study.

A bit weird that the paper calls the study double-blind then.

Withholding the hypothesis aims to eliminate researcher-induced expectancy bias. Randomisation should eliminate the difference in bias from patient's own expectations.

I'm not sure if it is really possible to accurately measure people's expectations, but if it were, and the researchers showed that the randomisation uniformly distributed the bias across arms, would this not be a reasonable blinding strategy?

 

[ScoutB]

I think the powerful thing about the double blind design is that it eliminates many possible biases we don't even know about. Like maybe there's something different about the way one of the arms is receiving their treatment that nobody is really thinking of as part of the treatment (and that wouldn't be rolled out in a real application of it in real life) but affects the outcome. Maybe the people administering the treatments behave a little differently for one arm vs the other and it cues the patients (clever hans style). I'm a little foggy so these might not be the best examples, but I've read some very interesting articles on how easy it can be to introduce subtle bias in trials that are not completely double-blinded.

 

[wallfish]

I don't think reading the paper is worth my time, but this snippet caught my eye on skimming:

Given ongoing concerns regarding physical activation in patients with severe Post-COVID fatigue, these findings provide reassurance regarding the safety of both immersive VR and conventional supervised activation programs. This pattern is consistent with recent systematic reviews
reporting no evidence of consistent harm from exercise-based interventions in Post-COVID populations [46,47] and one recent scoping review that found VR-exercise in Post-COVID to be safe, enjoyable and motivating [48]

Reference 46 is the Cochrane review on exercise for CFS. S4me thread for reference 47.

 

[Eleanor]

I think the more import part of their blinding strategy is the choice to withhold the hypothesis from patients. The study protocol says this is an attempt at "the best alternative to a double blind [...] intervention":

To minimize potential bias due to expectancy and reporting bias, this study is randomized-controlled and blinded in accordance with current recommendations for conducting nonpharmacological trials [22, 57]. By withholding information about the exact content of the interventions and the hypothesis of our study, we attempt to provide the best alternative to a double-blind nonpharmacologic intervention study.

It's too much for me to copy and paste, but have a look at the Supplementary Material pdf which includes the participant information given both before and after randomisation, featuring many paragraphs about the supposed scientific basis for the exercise therapy and the positive results to be expected, and decide if you think this meets any reasonable definition of blinding.

 

[wallfish]

have a look at the Supplementary Material pdf

Yes, that doesn't sound very impartial. Two snippets before I gave up:

New neuromuscular training techniques that stimulate both the body and the brain with minimal physical and psychological stress are a promising solution. This allows the brain to gradually relearn its capabilities without having to exceed individual limits. The overall goal of this study is therefore to investigate the influence of a personalized neuromuscular training program on post-COVID symptoms

Will I benefit personally? If you participate in the above-mentioned therapy, you will receive more intensive and personalized treatment compared to standard outpatient care. It can therefore be assumed that you will benefit personally.

Somewhere else they write:

Explore any remaining fears and evaluate and, if necessary, reinforce a positive attitude toward the training program

 

[MrMagoo]

Exercise, but make it cool, modern and VR.

 

[SugarSquared]

Exercise, but make it cool, modern and VR.

They should have made people play Beat Saber. I loved that as a teenager and would go to my local VR arcade to play.

 

[MrMagoo]

They should have made people play Beat Saber. I loved that as a teenager and would go to my local VR arcade to play.

They should let people lie down and have a rest, without worrying about food, work, shelter, hygiene, money.
See what sort of impact that has after 12 weeks.
Fairly sure there won’t be any negative effects and the patients will report it’s enjoyable and avoids any low mood.

 

[rvallee]

Exercise, but make it cool, modern and VR.

And, of course, more expensive, and, because they use specialized equipment, almost impossible to actually use. The perfect con: it doesn't work, it's expensive, and, no, you can't try it.

Honestly I don't know why the alternative medicine industry spent all this time trying to legitimize themselves when all they had to do was make it more entertaining and make the entertainment factor part of its success. Or even be more creative: get ripped dudes with impeccable manners for the women, and beautiful topless women for the men, and see all evaluations perform better than 9/10, as long as actual efficacy is just a small (1/10) part of it.

They did it. The madlads actually did a more ridiculous, but absolutely real, version of Mitchell & Webb's homeopathic emergency department.

 

[MrMagoo]

And, of course, more expensive, and, because they use specialized equipment, almost impossible to actually use. The perfect con: it doesn't work, it's expensive, and, no, you can't try it.

Honestly I don't know why the alternative medicine industry spent all this time trying to legitimize themselves when all they had to do was make it more entertaining and make the entertainment factor part of its success. Or even be more creative: get ripped dudes with impeccable manners for the women, and beautiful topless women for the men, and see all evaluations perform better than 9/10, as long as actual efficacy is just a small (1/10) part of it.

They did it. The madlads actually did a more ridiculous, but absolutely real, version of Mitchell & Webb's homeopathic emergency department.

It’s enough to make you drink one drip of beer in a pint of water

 

[Sean]

It’s enough to make you drink one drip of beer in a pint of water

Too risky. Better make it two drops to keep it to a safe level to start with. Can always up the dilution later if needed.

 

[MrMagoo]

Has anyone tried putting a VR headset on people with no legs and seeing if it gets them up and moving?