Table 3.
Summary of studies on digital therapeutics as physical rehabilitation in stroke patients
| Study | Study design | Sample size (n) | Intervention | Study description | Stage of stroke | Frequency of intervention | Follow-up | Outcome measures | Results |
|---|---|---|---|---|---|---|---|---|---|
| Subramanian et al. (2013) [55] | RCT | IG: 16 | VR training CAREN | IG: VR training | Chronic | 45 min, 3 day/wk | 4 wk intervention | RPSS | Both groups showed a significant improvement post-intervention, a greater improvement was seen in shoulder adduction and flexion in IG compared to CG. |
| CG: 16 | CG: conventional training—targeting reaching and pointing movements similar to the VR training | WMFT | |||||||
| MAL-AS | |||||||||
| McEwen et al. (2014) [54] | RCT | IG: 30 | VR training IREX | IG: standard rehab+VR training (in standing) | Chronic | 30 min, 10–12 sessions/day, | 3 wk intervention | TUG | IG showed a greater effect on TUG and TMWT. |
| CG: 29 | CG: standard rehab+VR training without the challenge (in sitting) | 1-mo post-intervention | TMWT | More individuals in IG than in CG showed a decreased impairment in the lower extremity, measured by CMSA. | |||||
| CMSA | |||||||||
| Broeren et al. (2004) [56] | Single case study | 1 | VR training with haptic device | Changes in the pre-posttraining assessments and follow-up assessments were evaluated | Unspecified | 90 min/session, 12 sessions in 4 wk | 4 wk intervention | Purdue Pegboard Test | Improvements were seen in fine manual dexterity, grip force, and motor control of the affected upper extremity. |
| 20 wk post-intervention | Dynamometer handgrip strength | ||||||||
| Cannell et al. (2018) [52] | RCT | IG: 35 | VR training JRS | IG: JRS WAVE | Subacute | 1 hr/wk | 8 wk intervention | MMAS, FRT, ST, 10 MWT, TUG | Both groups improved on standing balance after training. No difference was seen between the two groups in primary or secondary outcomes. |
| CG: 38 | WAVE | CG: usual care—individualised and group physical exercise program | Sitting balance test | ||||||
| Ikbali Afsar et al. (2018) [57] | RCT | IG: 19 | VR training with | IG: conventional physical rehab+VR | Unspecified | 30 min/session, 5 times/wk | 4 wk intervention | BBT | The functional measures showed a significant improvement post-treatment in both groups. IG showed a significantly higher result in the Brunnstrom stage and in BBT compared to CG. |
| CG: 16 | Microsoft Xbox | CG: conventional rehab only | Brunnstorm stage | ||||||
| 360 Kinect system | FMA | ||||||||
| Emmerson et al. (2017) [58] | RCT | IG: 30 | iPad-based home exercise program | IG: iPad program | Chronic | Unspecified, completion of program in 4 wk | 4 wk intervention | WMFT | There was no difference between IG and CG. |
| CG: 32 | CG: standard program | ||||||||
| Carabeo et al. (2014) [59] | Cohort study | - | Android-based game app FINDEX | 3 | Chronic | 30 min/session, total 9 sessions | 6 wk intervention | Performance on FINDEX | Improvement in patients’ dexterity |
| Schneider et al. (2007) [63] | Clinical controlled study | IG: 20 | MST | IG: conventional therapy+MST | Chronic | 15 sessions, 30 min/session | 3 wk intervention | ARAT | Patients showed an improvement in speed and precision of movements. IG showed an improvement in motor control. |
| CG: 20 | CG: conventional therapy only. | BBT | |||||||
| 9HPT |
RCT, randomized controlled trial; IG, intervention group; CG, control group; VR, virtual reality; CAREN, computer-assisted rehabilitation environment; RPSS, Reaching Performance Scale for Stroke; WMFT, Wolf Motor Function Test; MAL-AS, Motor Activity Log Amount Scale; IREX, Interactive Rehabilitation Exercise software; TUG, Timed Up and Go test; TMWT, Two-Minute Walk Test; CMSA, Chedoke-McMaster Stroke Assessment; JRS, Jintronix Rehabilitation System; MMAS, Modified Motor Assessment Scale; FRT, Functional Reach test; ST, step test; 10 MWT, 10-m walk test; BBT, Box & Block Test; FMA, Fugl-Meyer assessment; MST, musicsupported therapy; ARAT, Action Research Arm Test; 9HPT, 9 Hole Pegboard Test.