Haptic Glove Systems in Combination with Semi-Immersive Virtual Reality for Upper Extremity Motor Rehabilitation after Stroke: A Systematic Review and Meta-Analysis

Abstract

Background: The effectiveness of the virtual reality (VR) for the upper extremity (UE) motor rehabilitation after stroke has been widely studied. However, the effectiveness of the combination between rehabilitation gloves and semi-immersive VR (SVR) compared to conventional treatment has not yet been studied. Methods: A systematic search was conducted in Pubmed, Web of Science, PEDRo, and Scopus, Cochrane, CINHAAL databases from inception to May 2022. Randomized controlled trials were included if patients were under rehabilitation with haptic gloves combined with SVR intervention focused on the UE rehabilitation in stroke patients. Risk of bias and methodological quality were evaluated with the Physiotherapy Evidence Database (PEDro), and the modified Cochrane library criteria. A random effects model was used for the quantitative assessment of the included studies using the standard mean difference with a 95% confidence interval. Heterogeneity among the included studies was assessed using Cochran’s Q test and the incoherence index (I2). Results: After a first screening, seven studies were included. Significant differences with a 95% confidence interval were obtained in favor of the rehabilitation glove combined with SVR in the short term (SMD—standardized mean differences = 0.38, 95% CI—confidence interval = 0.20; 0.56; Z: 4.24; p =< 0.001). In the long term, only the studies that performed an intervention based in rehabilitation glove combined with SVR with also included rehabilitation were able to maintain the improvements (SMD = 0.71, 95% CI = 0.40; 1.02; Z: 4.48; p =< 0.001). Conclusions: The combined use of rehabilitation haptic gloves and SVR with conventional rehabilitation produces significant improvements with respect to conventional rehabilitation treatment alone in terms of functionality of the UE in stroke patients.

The Application of Soft Robotic Gloves in Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…In another study, Luo et al published a systemic review and meta-analysis evaluating the synergistic effect of combined mirror therapy on the upper extremities in patients with stroke, with one of the experimental groups going through intervention involving mirror therapy with a mesh glove [ 22 ]. Fernández-Vázquez et al published a systematic review and meta-analysis in 2022, but the study focused on intervention involving Haptic Glove Systems in combination with semi-immersive virtual reality (SVR) for use in upper extremity motor rehabilitation after stroke [ 23 ]. The study we have performed was the first systematic review and meta-analysis which has purely discussed the effect of SRGs on stroke patients, with the included studies all being randomized controlled trials.…”

Virtual Reality in Stroke Recovery: A meta-review of Systematic Reviews

“…15 with PROSPERO (41,48,55,59,63,64,66,70,71,75,77,78,79,81,33) and one with the Cochrane database (20). The search strategy was judged to be comprehensive in over 60% of the reviews while the rest were partially comprehensive.…”

“…Outcomes from the high and moderate quality reviews (2,20,38,41,47,62,63,64,66,71,75,77,33) were extracted and summarized, as the con dence in these reviews' results was moderate to high.…”

“…Hence, there is evidence to suggest rehabilitation is more effective in the subacute and acute stages of stroke than the chronic stage, however, outcomes such as quality of life improve greatly when rehabilitation is done more than 6 months after stroke. (77), there were 2 studies that showed signi cant improvement in UL functionality with having done less than 15 hours. This was most likely due to the higher intensity of VR applied in these studies (5 sessions per week in consecutive days).…”

“…However, those who received trial lengths of 2 weeks to 1 month showed greater improvements in quality of life than those for whom trial lengths were > 1 month (75). Additionally, Laver et al (20) concluded that at least 15 hours of rehabilitation was needed to achieve signi cant improvements in UL functionality, however in the review by Fernández-Vázquez et al (77), there were 2 studies that showed signi cant improvement in UL functionality with having done less than 15 sessions. This was most likely due to the higher intensity of VR applied in these studies (5 sessions per week in consecutive days).…”