Virtual reality for stroke rehabilitation

Virtual reality (VR) applications have emerged as a treatment approach in stroke rehabilitation.

Different types of studies have been used from non‐immersive, non‐customised, interactive game‐based applications to immersive applications specifically designed for rehabilitation settings.

Objectives

Primary objective: to assess the effects of VR compared with an alternative intervention or no intervention for upper limb function and activity in people after stroke.

Secondary objectives: to assess the effects of VR compared with an alternative intervention or no intervention on gait and balance, global motor function, cognitive function, activity limitation, participation restriction and quality of life, and adverse events in people after stroke.

Methods

This study included 190 trials involving a total of 7188 participants. The majority of studies were small, with only 36 (19%) studies involving more than 50 participants, and the largest study recruiting 152 participants.

Results

When comparing virtual reality with alternative therapy approaches, results suggest that virtual reality may be beneficial in slightly improving upper limb function and activity (SMD 0.20, 95% CI 0.12 to 0.28; 67 studies, 2830 participants; low‐certainty evidence).

The addition of virtual reality to usual care or rehabilitation (resulting in an increased amount of time spent in therapy for those in the intervention group) probably increases upper limb function and activity compared to usual care alone (SMD 0.42, 95% CI 0.26 to 0.58; 21 studies, 689 participants; moderate‐certainty evidence).

Conclusion

We found moderate‐ to low‐certainty evidence that the use of virtual reality and interactive video gaming is slightly more beneficial than alternative therapy approaches in improving upper limb function, balance, and activity limitation. Furthermore, greater benefits were seen for upper limb function when virtual reality was used in addition to usual care (to increase overall therapy time). There was mixed evidence on the effects on mobility outcomes including gait speed, and insufficient evidence to reach any conclusions about the effect of virtual reality and interactive video gaming on participation restriction and quality of life.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008349.pub5/full#CD008349-abs-0002