## 4 Discussion
The GRoC scale is a self-reported measure used to assess patients' perceptions of changes in symptoms or function, notable for its simplicity and clinical applicability [73]. However, its validity has been questioned, as the correlation with objective functional changes tends to weaken over prolonged follow-up periods, suggesting that the perception of change may be primarily influenced by the patient's current status [74]. Despite this, it remains a valuable tool as a prognostic indicator and for establishing cut-off points in response to interventions [75; 76]. In our study, the GRoC scale showed a significantly greater favorable change in the group that incorporated AVGs; however, this result should be interpreted with caution, given that this scale reflects subjective perception at a specific moment, and its use should be complementary to other instruments that better objectify treatment effectiveness [74]. One of the present study's main strengths is implementing an RCT with concealed allocation and ITT analysis, which ensures the internal validity of the results and minimizes the risk of bias. Additionally, considering a CG that received a well-structured intervention with a volume equivalent to the EG allowed for an equitable comparison of the additional effects of AVGs as a complementary therapy. Furthermore, selecting clinically relevant outcome measures, such as WOMAC and GRoC, reinforces the clinical applicability of the findings. The study has certain limitations that must be taken into account. (i) A group that received only AVGs was not included, limiting the ability to evaluate the isolated effect of this intervention modality compared to CPT. (ii) The sample size does not allow for detailed subgroup analyses by age, sex, or clinical characteristics, restricting the ability to identify variations in treatment response. (iii) The follow-up period after the intervention was four weeks, limiting the assessment of the long-term sustainability of the benefits obtained. (iv) This study was conducted in a community rehabilitation center and involved older adults with mild to moderate knee or hip OA, which hinders the extrapolation of the results to other clinical settings or populations with more specific clinical characteristics. (v) The lack of specific measures related to the enjoyment of AVGs implies that participants' motivation and engagement are only indirectly reflected in the results, which could overlook crucial psychosocial factors that influence adherence and intervention effectiveness. (vi) Certain factors, such as participants' preferences toward different exercise modalities, were not assessed, which could also influence commitment and effort in the intervention program. (vii) Although AVGs were selected and implemented according to the clinical characteristics of the population, they are not specifically designed for rehabilitation, which could affect their effectiveness compared to systems developed exclusively for this purpose. To address these limitations, future research should consider groups receiving only AVGs to analyze their isolated effect. It is proposed to conduct analyses of subgroups based on age, sex, and clinical characteristics to identify variations in treatment response. Additionally, extending the follow-up period is necessary to assess the sustainability of outcomes over a longer term and to explore applicability in diverse clinical settings beyond a single community center. It is also recommended to include specific measures of AVG enjoyment to capture relevant motivational and psychosocial factors. Finally, it would be valuable to investigate the impact of personal preferences related to different exercise modalities, as these may influence commitment and effort in the intervention program, and to develop AVGs specifically designed for OA rehabilitation, thus optimizing their suitability and effectiveness.