Effectiveness of Virtual Reality on Functional Performance after Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

<jats:p>A spinal cord injury (SCI) usually results in a significant limitation in the functional outcomes, implying a challenge to the performance of activities of daily living. The main aim of this study is to analyze the effectiveness of virtual reality to improve functional performance in patients with SCI. The search was performed between October and December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Web of Science, and Embase. The methodological quality of the studies was evaluated through the PEDro scale, and the risk of bias was evaluated with the Cochrane collaboration’s tool. Seven articles were included in this systematic review, and five of them in the meta-analysis. Statistical analysis showed favorable results for functional performance in control group performing conventional therapy, measured by the functional independence measure (standardized mean difference (SMD)= −0.70; 95% confidence interval: −1.25 to −0.15). Results were inconclusive for other outcomes. Most studies have not shown beneficial effects on functional performance compared with conventional physical therapy. The results obtained showed that virtual reality may not be more effective than conventional physical therapy in improving functional performance in patients with SCI.</jats:p>

Virtual Reality Systems for Upper Limb Motor Function Recovery in Patients With Spinal Cord Injury: Systematic Review and Meta-Analysis

“…These results match with those obtained in our previous meta-analysis [ 29 ] on functional performance recovery in patients with SCI. Furthermore, from the 6 studies included in this review, 5 [ 3 , 8 , 33 - 35 ] analyzed the effects of VR therapy on functional performance and none of them showed significant results.…”

“…A structured review performed by Yeo et al [ 28 ] concluded that VR therapy provides benefits on balance and posture. Conversely, a recent meta-analysis published by our group [ 29 ] suggested that VR interventions mat not be effective to improve the functional performance after SCI. Nevertheless, the previous reviews were not restricted specifically to the assessment of ULMF.…”

Is Virtual Reality Effective for Balance Recovery in Patients with Spinal Cord Injury? A Systematic Review and Meta-Analysis

“…Furthermore, our results match with those obtained by de Araújo et al [ 29 ] and Abou et al [ 30 ], who suggested that VR-based rehabilitation may lead to positive effects on balance in patients with SCI. Conversely, the present findings do not match with those obtained by our previous meta-analysis [ 3 ], performed to assess the effects of VR interventions on functional performance in patients with SCI. However, it should be noted that the only studies [ 22 , 37 ] that provided benefits on functional performance are also the only studies that obtained significant results on balance.…”

“…Spinal cord injury (SCI) involves an alteration of the spinal cord that causes a disorder or loss of proprioception, mobility, or autonomous function [ 1 , 2 ]. The neurological rehabilitation of patients with SCI is focused on recovering functional performance, mobility, and balance, among others [ 3 ]. To achieve balance, the coordination and integration of different body system are needed [ 4 ].…”

Go Virtual to Get Real: Virtual Reality as a Resource for Spinal Cord Treatment

“…An aspect common in research that makes use of non-standard procedures and different devices is the results that may be discordant with each other and difficult to compare and reproduce. Concerning SCI, De Miguel-Rubio and colleagues [ 72 ] reported that an improvement in functional performance was identified in only a part of the studies analyzed in their meta-analysis. The introduction of VR in neurologic rehabilitation brings to light a wide range of unresolved issues: design concerns, undesirable effects (e.g., headache and nausea), and the use of devices (i.e., VR) not designed for use in the rehabilitation field [ 73 , 74 ].…”