Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta‐analysis

Abstract

Aims To explore the beneficial effects of virtual reality (VR) interventions on upper‐ and lower‐limb motor function, balance, gait, cognition and daily function outcomes in stroke patients. Design A systematic review and meta‐analysis of randomized controlled trials. Data Sources English databases (PubMed, EMBASE, the Cochrane Library, CINAHL, Web of Science, Physiotherapy Evidence Database, ProQuest Dissertations and Theses) and Chinese databases (Chinese BioMedical Literature Service System, WANFANG, CNKI) and the Clinical Trial Registry Platform were systematically searched from inception until December 2019. Additionally, reference lists of the included studies were manually searched. Review Methods The methodological quality of studies was scored with the Cochrane ‘risk‐of‐bias tool’ and PEDro scale from the Physiotherapy Evidence Database by two independent evaluators. Results In total, 87 studies with 3540 participants were included. Stroke patients receiving VR interventions showed significant improvements in Fugl‐Meyer assessment of Upper Extremity, Action Research Arm Test, Wolf Motor Function Test, Fugl‐Meyer Assessment of Lower Extremity, Functional Ambulation Classification, Berg Balance Scale, Time Up and Go, Velocity, Cadence, Modified Barthel Index and Functional Independence Measure. However, differences between VR intervention and traditional rehabilitation groups were not significant for Box‐Block Test, 10 m Walk Test, Auditory Continuous Performance Test, Mini‐Mental State Examination and Visual Continuous Performance Test. Conclusion This review suggests that VR interventions effectively improve upper‐ and lower‐limb motor function, balance, gait and daily function of stroke patients, but have no benefits on cognition. Impact This review identified the positive effects of VR‐assisted rehabilitation on upper‐ and lower‐limb motor function, balance, gait and daily function of stroke patients. And, we verified the duration of VR intervention affects some health benefits. The benefit of VR on cognitive function requires further investigation through large‐scale multicentre RCTs.

Impact of Virtual Reality-Based Therapies on Cognition and Mental Health of Stroke Patients: Systematic Review and Meta-analysis

“…However, our pooled results showed no significant benefits of VR in improving global cognitive function for patients with stroke. Our result was comparable to recently published meta-analysis reviews by Wiley et al [ 39 ] and Zhang et al [ 40 ], who reported that VR therapy is not superior to control interventions in improving global cognition in individuals with stroke. This result differs from another systematic review [ 25 ], which only included 4 studies published in 2018.…”

“…However, current evidence fails to support the effects of VR-based therapies in improving global cognitive function, attention, verbal fluency, depression, and the QoL. Unlike prior systematic reviews [ 8 , 25 ] primarily focused more on either one type of VR, such as exercise-based VR, or one aspect of cognition indicators, such as only global cognitive function, our review [ 40 ] comprehensively evaluated the effect of VR-based therapies on global and domain-specific cognition and mental health outcomes.…”

“…However, their conclusions were also merely based on data from 2 studies, resulting in insufficient statistical power. A systematic review by Zhang et al [ 40 ], only focusing on global cognitive function, also supported no benefits of VR for cognition. Furthermore, the psychological benefits of VR have also received more attention recently.…”

Effects of Virtual Reality-Based Intervention on Cognition, Motor Function, Mood, and Activities of Daily Living in Patients With Chronic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Recently, many clinical studies favored VR-based intervention for motor function, balance, gait, and activities of daily living (ADL) in patients with stroke. Although multiple systematic reviews and meta-analyses have indicated that VR-based training was useful for upper limb motor function, lower limb motor function, balance, gait, and activities of daily living (ADL) in stroke ( Henderson et al, 2007 ; Laver et al, 2011 ; Saposnik et al, 2011 ; Lohse et al, 2014 ; Laver et al, 2015 ; de Rooij et al, 2016 ; Li et al, 2016 ; Silver, 2016 ; Yates et al, 2016 ; Laver et al, 2017 ; Aminov et al, 2018 ; Al-Whaibi et al, 2021 ; Fang et al, 2021 ; Peng et al, 2021 ; Zhang et al, 2021 ), two recent articles published in The Lancet Neurology by Saposnik et al (2016) and Silver (2016) argued that the methodological issues that existed in some of the studies ( Broeren et al, 2008 ; Kwon et al, 2012 ) were the comparison of VR combined with conventional rehabilitation vs. conventional rehabilitation alone without active control. Such study design ( Saposnik et al, 2011 ; Lohse et al, 2014 ; Laver et al, 2015 ) might create an imbalance in the total rehabilitation time, and the effect might be induced by any active intervention and might not be explained by VR ( Saposnik et al, 2016 ; Silver, 2016 ).…”

Virtual Reality-Based Therapy Reduces the Disabling Impact of Fibromyalgia Syndrome in Women: Systematic Review with Meta-Analysis of Randomized Controlled Trials

“…Non-immersive VR (niVR) is considered more accessible and inexpensive than iVR and enables patients to visualize virtual environments in 2D projected onto a screen and interact with them through the use of a mouse, keyboard or joysticks [33,34]. VRBT is considered a useful intervention along with CT for neurological [35] or musculoskeletal disorders [36] that can be used at home, thereby favoring patient accessibility to physiotherapy protocols (telephysiotherapy), which has been especially important during the COVID-19 pandemic [37].…”