Oxford Paediatric and Adolescent Rheumatology Centre

One-stop multidisciplinary clinic for patients with fibromyalgia


The Virtual Paediatric Gym at the Nuffield Orthopaedic Centre, Oxford is an easy to set up innovation designed to engage children in exercise despite the pain, fatigue and stiffness that they may be experiencing as part of their condition. By creating a fun, competitive experience, children enthusiastically engage in the rehabilitation process that is designed to allow them to resume their everyday lives, particularly returning to school.
  • £50k setup costs with no ongoing maintenance costs, making the gym a cheap, effective component of the multidisciplinary rehabilitation process 
  • Potential for personal and wider societal benefits related to improving school attendance 
Download a printable pdf of the case study 

The Challenge

  • Roughly 40% of children attending OxPARC were suffering from chronic pain, including many young children. These children experience pain, stiffness and fatigue as a result of chronic conditions such as juvenile idiopathic arthritis (JIA). These symptoms can make it hard for children to concentrate on anything but their pain and even harder for them to exercise, a key part of managing inflammatory and chronic pain conditions.

The Solution

  • OxPARC set up multi-disciplinary rehabilitation pathways for children with chronic pain, including outpatient as well as intensive day-case treatment, through the OXCYPP service. The Virtual Paediatric Gym (2015), designed to engage children aged 5 years or older is part of this multi-disciplinary programme
  • Each child has their own ‘avatar’, or character, which is shown on large touchscreen displays and mimics the actions of that child whilst running, rowing, cross-training and cycling on gym equipment suitable for children. The gym also includes a ‘CardioWall’ that has illuminated, interactive pads to be touched in particular sequences to help children develop functionality, balance and stamina.
  • The gym creates a competitive but friendly environment to motivate children. They can race other avatars, or their own avatar from a previous session, which is motivational for the patient and a useful progress indicator for the clinical team.
  • The gym is used for outpatients, as well as part of a 2-week intensive multidisciplinary rehabilitation programme for children run by OXCYPP
  • Gym programmes are set by a band 7 physiotherapist, with a band 5 assistant physiotherapist supervising up to two children on a gym programme at any one time.

Service Performance and Outcomes

  • The Virtual Paediatric Gym aims to make rehabilitation more fun. Gym exercises help to increase children’s strength and help them to manage their condition, as well as increase their confidence and enable participation in normal activities.
  • The patient experience has been greatly enhanced by the integration of technology. The use of avatars allows users to focus on what their ‘character’ is achieving.
  • The benefits of virtual reality have been assessed and published, and include focussing on the task rather than situation, functionally relevant therapy, fun and motivational, being able to take control.
  • Returning to school is a very important goal. The service works with schools to try and maximise school attendance both by educating the school about the child’s needs and by structuring rehabilitation at the gym to focus on making a return to school more achievable.
  • Outcomes being assessed by the team since the gym launched in 2015 include health-related quality of life (Peds-QL), gym outcomes, outpatient/primary care appointments and A&E attendance for future evaluation of programmes using the gym. All of which improve in the short and longer term.

Financial Performance and Outcomes

  • The initial gym setup costs were only £50k funded by the Children’s Charitable Fund at Oxford University Hospitals. Maintenance costs were included in the initial setup cost so there are no ongoing maintenance costs.
  • No staff costs are incurred as the band 7 physiotherapist and band 5 assistant physiotherapists were already funded.

Patient Focus and Satisfaction

  • Initial feedback from patients using the Virtual Paediatric Gym shows that patients enjoyed using the gym, felt able to stay focussed and achieve more, and felt more motivated to continue therapy.
  • Parents are regularly seen separately from their children to receive advice about how to support their children most effectively.

Commissioning Implications

The Virtual Paediatric Gym is an example of emerging best practice in rheumatology and meets a number of priorities for commissioners, policy-makers and patients:


  • Managing ambulatory care-sensitive conditions – the Virtual Paediatric Gym will enable patients to lead more regular lives including attending school, and should also help to avoid secondary care and A&E attendance.
  • Improving the management of patients with both mental and physical health needs– although chronic pain conditions have a mainly physical discomfort they can be isolating causing sadness and frustration, especially in children.
  • Secondary prevention– the gym builds patients’ confidence exercising, despite the presence of pain, and both exercise and increased participation in every-day life improves well-being and reduces longer-term problems, such as joint damage.

The service is an emerging best practice model for all services that use gym equipment as part of rehabilitation, showing that innovative technology can be adopted with minimal investment, and making a big difference to patients and their families.