Abstract
Objective
To investigate the efficacy of virtual reality (VR)- and gaming-based interventions
for improving upper extremity function poststroke, and to examine demographic and
treatment-related factors that may moderate treatment response.
Data Sources
A comprehensive search was conducted within the PubMed, CINAHL/EBSCO, SCOPUS, Ovid
MEDLINE, and EMBASE databases for articles published between 2005 and 2019.
Study Selection
Articles investigating gaming and VR methods of treatment for upper extremity weakness
were collected with the following study inclusion criteria: (1) participants aged
18 years or older with upper extremity deficits; (2) randomized controlled trials
or prospective study design; (3) Downs-Black rating score of ≥18; and (4) outcome
measure was the Wolf Motor Functioning Test, the Fugl-Meyer, or the Action Research
Arm Test.
Data Extraction
Thirty-eight articles met inclusion criteria. The primary outcome was proportional
improvement on the Wolf Motor Functioning Test, Fugl-Meyer, or Action Research Arm
Test. The following individual or treatment factors were extracted: VR or gaming dose,
total treatment dose, chronicity (> or <6mo), severity of motor impairment, and presence
of a gaming component.
Data Analysis
Random effects meta-analysis models were utilized to quantify (1) the proportional
recovery that occurs after VR or gaming; (2) the comparative treatment effect of VR
or gaming vs conventional physiotherapy; and (3) whether the benefit of virtual reality
differed based on participant characteristics or elements of the treatment.
Results
On average, VR or gaming interventions produced an improvement of 28.5% of the maximal
possible improvement. Dose and severity of motor impairment did not significantly
influence rehabilitation outcomes. Treatment gains were significantly larger overall
(10.8%) when the computerized training involved a gaming component vs just visual
feedback. VR or gaming interventions showed a significant treatment advantage (10.4%)
over active control treatments.
Conclusions
Overall, VR- or gaming-based upper extremity rehabilitation poststroke appears to
be more effective than conventional methods. Further in-depth study of variables affecting
improvement, such as individual motor presentation, treatment dose, and the relationship
between them, are needed.
Keywords
List of abbreviations:
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Article info
Publication history
Published online: December 07, 2019
Footnotes
Clinical Trial Registration No.: PROSPERO 95052.
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
