4. Discussion
’ functional movements
CARDIOPULMONARY
To our knowledge, this is the first study on physical therapeutic intervention using metaverse-based self-management rehabilitation that is aimed at assessing and comparing the effects of CPT and MPT on gross motor function, cardiopulmonary function, ADL, QOL, and the transmission risk of COVID-19 in patients with CP. As hypothesized, conventional-physical-therapy-combined MPT was as effective as CPT in terms of GMFM, HR, BRPE, FIM, QOL, and perceived risk of COVID-19 transmission. Most importantly, conventional-physical-therapy-combined MPT was better compared with CPT in terms of reducing the termination of COVID-19 and improving cardiopulmonary function.Gross motor analysis showed that improvement in the GMFM was significantly different between the MPT and CPT. This finding was consistent with the results of Arnoni et al. (2019), who reported a 1.45–23.32% increase in gait parameters and GMFM D and E scores after virtual reality (VR) rehabilitation compared with CPT in 15 children with CP [Improvements in gross motor function indicate the feasibility of task-oriented training using VR training strategies for gross motor skills in patients with CP. Our results suggest that a controlled virtual metaverse can simulate the components of the real (physical) world and provide functional motor gains. Indeed, following motor training in a virtual environment, patients’ functional movements could be adjusted based on environmental information by the exploration and selection of the most appropriate motor action [Cardiopulmonary function analysis revealed a significant improvement in HR and BRPE after metaverse rehabilitation compared to CPT. This finding was consistent with that by Chuang et al. (2006), who reported that the VR group had a greater increase in HR and metabolic target than the non-VR group among 20 patients with post-coronary artery bypass graft [Analysis of the perceived COVID-19 transmission risk indicated that improvement in the perceived COVID-19 transmission risk was significantly different after metaverse rehabilitation compared with CPT. These findings suggest that the smartphone application approach is more suitable for reducing the risk of potential COVID-19 transmission during a pandemic. Through remote rehabilitation via a metaverse, patients can learn to control their functional movements by modifying their behavior.Metaverse intervention with a user-friendly interface ensures that children in all sociocultural environments can be easily incorporated into the intervention program. Metaverse rehabilitation could make exercise more enjoyable, mainly because of the virtual environment, deep learning-based exercise, and audiovisual feedback.This study has several limitations, which should be considered in future research. First, the lack of follow-up evaluation might have had important effects on the sustainable physiotherapeutic effects of MPT in children with CP. Second, we did not compare the GMFCS (which influences the ability of children with CP to carry out ADLs) with gait ability. Third, there may be differences in movement recognition depending on the quality of the smartphone or tablet camera.