Effectiveness of Virtual Reality in the Rehabilitation of Motor Function of Patients With Subacute Stroke: A Meta-Analysis

Abstract

Stroke is a major cause of death and disability in adults. Conventional therapy (CT) has limited effectiveness, and therefore, various virtual reality (VR) rehabilitation programs have been designed. However, their efficacy in regaining motor function in patients with subacute stroke is questionable. Therefore, we conducted this meta-analysis to determine the efficacy of VR, compared to CT, in restoring motor function in this patient population. Up to October 10, 2020, nine electronic databases were searched for relevant articles reporting the effectiveness of VR in regaining motor function in patients with subacute stroke. This search was updated on March 7, 2021, with no additional added articles. The control group included CT, physical therapy, occupational therapy, or a combination of them. Effectiveness is defined as the positive change from baseline values to the last follow-up point. The Cochrane's revised risk-of-bias tool was used to determine the quality of included trials. A metaregression analysis was conducted to determine the effect of “time since last stroke” on reported outcomes. Publication bias and sensitivity analyses were also carried out. A total of 19 studies (17 randomized controlled trials, 1 cohort study, and 1 crossover trial) were included in the qualitative analysis, whereas 16 trials were meta-analyzed. A great improvement in motor function was noted in the VR group, when compared to preintervention values [standardized mean difference (SMD) = 1.14; 95% confidence interval (CI) = 0.77–1.52; I2 = 82%; P < 0.001]. When compared to CT, VR resulted in mild improvement in motor function (SMD = 0.47; 95% CI = 0.22–0.72; I2 = 75%; P < 0.001). However, upon trim-and-fill adjustment, this finding was deemed insignificant (SMD = 0.08; 95% CI = −0.16 to 0.33; I2 = 82.6%; P < 0.001). Ten studies had low risk, five had some concerns, three had high risk, and one had a moderate risk of bias. VR programs can be used jointly with CT for the rehabilitation of the motor function of patients with subacute stroke. However, more studies are still warranted to determine the effectiveness of these interventions in retaining the cognitive function and physical performance of such patients.

Kinect-Based Rehabilitation Systems for Stroke Patients: A Scoping Review

“…The results of this study show that the use of Kinect-based rehabilitation games improves motor function in the upper and lower limbs and balance and improves cognitive function in improving stroke patients. These results are in line with the results of other similar studies in the field of using Kinect-based rehabilitation in improving the motor function of the upper [ 69 ], lower limbs [ 70 ], balance [ 71 ], and cognition [ 72 ].…”

Virtual reality-based rehabilitation in patients following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

“…[ 12 ] The effectiveness of VR-based rehabilitation has been verified in Parkinson disease, stroke, and cerebral palsy. [ 11 , 13 , 14 ] In orthopedic rehabilitation, the advantage of VR-based rehabilitation has been explored in patients with osteoarthritis, low back pain, and anterior cruciate ligament injury. [ 6 , 15 , 16 ] Although some studies have investigated the effect of VR equipment on TKA patients, [ 17 , 18 ] there is insufficient evidence to demonstrate the advantage of VR.…”

“… [11] VR-based rehabilitation results in excellent outcomes for patients due to its ability to provide simulations of real environments [12] . The effectiveness of VR-based rehabilitation has been verified in Parkinson disease, stroke, and cerebral palsy [11,13,14] . In orthopedic rehabilitation, the advantage of VR-based rehabilitation has been explored in patients with osteoarthritis, low back pain, and anterior cruciate ligament injury [6,15,16] .…”

Overground Walking in a Fully Immersive Virtual Reality: A Comprehensive Study on the Effects on Full-Body Walking Biomechanics

“…There are several recently published studies, including systematic reviews and meta-analysis, which underpin the potential VR offers in gait rehabilitation. It was demonstrated that VR can support gait rehabilitation for patients with Parkinson’s Disease ( Mirelman et al, 2011 ; Lu et al, 2021 ), retrain gait symmetry ( Shideler et al, 2021 ), restore function after stroke ( Ahn and Hwang, 2019 ; Palacios-Navarro and Hogan, 2021 ; Peng et al, 2021 ), support neuro-psychomotor rehabilitation of children with cerebral palsy ( de Oliveira et al, 2016 ), improve balance and gait in older adults ( de Vries et al, 2020 ; Lee, 2020 ; Willaert et al, 2020 ; Delgado and Der Ananian, 2021 ), and is also being used to support gait training after amputation ( Darter and Wilken, 2011 ).…”