Table 1.
Examples of recent systematic reviews and meta-analyses demonstrating the effects of VR in neurorehabilitation of stroke, PD and CP.
Author and year | Study aims | Studies included and sample (n) | Study outcomes | Points of discussion |
---|---|---|---|---|
Stroke | ||||
Laver et al. (2015) | Compared the effects of virtual reality on arm function, walking speed and independence in managing daily activities after stroke versus an alternative intervention or no intervention. | 37 studies (n = 1019) | 12 studies found improved arm function. | Low sample size in most studies. |
4 studies found improved walking speed. | Some studies reported pain, headaches or dizziness in small number of participants, but no adverse events overall. | |||
8 studies found slight improvements in activities of daily living. | Low quality evidence for arm function. | |||
Very low quality evidence for walking ability, global motor function and independence in performing daily activities. | ||||
The quality of the evidence for each outcome was limited due to small numbers of study participants, inconsistent results across studies and poor reporting of study details. | ||||
Corbetta et al. (2015) | Compared the effects of VR-based rehabilitation on gait, balance and mobility versus standard therapy. | 15 studies (n = 341) | Significant improvements in walking speed, balance, and mobility. | Substituting some or all of a standard rehabilitation regimen with VR training provides greater benefits in walking speed, balance, and mobility. |
Significant improvements in mobility if VR training was combined with standard therapy. | Although the benefits are small, the cost of administering VR is also small particularly when patient demand is high in a clinic setting. | |||
Insufficient evidence to support to use of combined VR and standard therapy on balance and walking speed. | ||||
Luque-Moreno et al. (2015) | Compared the effects of VR interventions on lower extremity rehabilitation. | 11 studies (n = 231) | High heterogeneity in study designs. | VR interventions (more than 10 sessions) may have a positive impact on lower limb function. |
Small sample sizes. Mean sample size of 20 per study. | Multimodal approach (i.e., a combination of VR and conventional therapy) may elicit greater results. | |||
Studies were ranked between 4 and 7 points (out of 10) on the PEDro scale. | Adaptability of software seemed to adapt better to patient’s requirements, allowing for individualized treatments. | |||
Lohse et al. (2014) | Compared the effects of custom built virtual games and commercially available gaming systems. | 26 studies (n = ?) | Only 4 studies used commercial games while 20 studies used custom built virtual games. | VR intervention improves outcomes compared to conventional therapies. |
Mean PEDro score for all studies was 5.42 ± 1.6 (out of 10). | Small samples and few number of studies in commercial games limits the assessment of potential benefits. | |||
Methodological limitations of studies include subject, experimenter and therapist blinding, small sample size, and difficulty in determining a dose-response effect. | ||||
Significant improvements in body function and activity outcomes. | ||||
Parkinson’s disease | ||||
Harris et al. (2015) | Compared the effects of exergaming on static and dynamic balance in older adults and PD. | 11 studies (n = 325 healthy older adults, 56 PD) | 9 studies showed a significant improvement in static balance and postural control in healthy aging individuals. | Few studies in PD and small sample size limits the interpretation of the effectiveness of exergaming in PD. |
2 studies found a significant improvement in static balance and postural control people with PD. | Evidence found in this meta-analysis supports the use of exergaming as an adjunctive tool to improve balance and postural control. | |||
Studies were ranked between 4 and 8 points (out of 10) on the PEDro scale. | ||||
Barry et al. (2014) | Examined the safety, feasibility and effectiveness of exergaming in people with PD. | 7 studies (n = 110) | Only 2 studies addressed patient safety. No objective measures (such as falls or near falls) or subjective measures (patient’s perception) were recorded in any studies. | While the effectiveness and feasibility are often measured, more research is required to establish the safety, particularly in home-based VR therapy. |
Only 1 study recorded gameplay experience. Good levels of motivation during game play were reported although difficulties with the fast pace and cognitive complexity of some games were raised. | The use of commercial games may be too difficult for some people with PD, and exergames that tailor specifically to the needs and capabilities of patients may be more effective. | |||
Exergaming was found to be just as effective as standard physical therapy for improving clinical measures of balance and cognition even up to 60 days post-intervention. | ||||
Cerebral Palsy | ||||
Dewar et al. (2015) | Systematic review of various interventions to improve postural control in children with CP | 45 studies (n = ?) | 4 studies investigated the use of VR on postural control. | The systematic review provided conflicting evidence of VR on postural control and gait. |
2 studies were rated weak in study conduct while 2 had a strong study design. | Due to the preliminary nature of these studies, it is difficult to truly ascertain if indeed the use of VR had any effects on postural control and gait. | |||
3 studies showed improvements in balance, while 2 study showed improvements in walking capacity. | ||||
Chen et al. (2014) | Examined the effects of virtual gaming on upper extremity function in children with CP | 14 studies (n = 122) | 3 RCTs, 2 cohort studies, 7 case studies and 2 single-subject design studies. | The use of VR may be highly applicable in a pediatric population. |
For 3 RCTs, no difference was found between VR therapy and conventional therapy. | Small sample size and the lack of large RCT is a limiting factor in interpreting the results. | |||
Overall upper extremity function was significantly improved after VR therapy. | ||||
Strongest effects of VR was shown in younger children, custom-built systems in the home or laboratory setting. | ||||
PEDro, physiotherapy evidence database (PEDro); RCT, Randomized controlled trials; PD, parkinson’s disease; CP, cerebral palsy; VR, virtual reality.