Abstract
Objective
To investigate the efficacy and acceptability of virtual reality (VR) with time-dose-matched
conventional therapy (CT) in patients poststroke with upper limb dysfunction.
Data Sources
Cochrane, PubMed, Web of Science, Embase, and ProQuest were systematically searched
up to May 24, 2021.
Study Selection
Randomized controlled trials comparing VR with time-dose-matched CT in patients poststroke
with upper limb dysfunction were included.
Data Extraction
The extracted data included efficacy (mean change in structure/function, activity,
and participation scores), acceptability (dropouts for all reasons), adverse events,
and characteristics of the included studies. The Cochrane risk of bias assessment
tool was used to assess the risk of bias.
Data Synthesis
Thirty-one randomized controlled trails were included. VR was superior to time-dose-matched
CT in terms of the World Health Organization's International Classification of Functioning, Disability and Health structure/function, with a standardized mean difference (SMD) of 0.35, but not activity
and participation. Subgroup analyses demonstrated that virtual environment was superior
to CT in structure/function (SMD=0.38) and activity (SMD=0.27), whereas there were
no significant differences between commercial gaming and CT in any World Health Organization
International Classification of Functioning, Disability and Health domain. VR mixed with CT was more effective than time-dose-matched CT in structure/function
(SMD=0.56), whereas VR only was not significantly different from CT. There were no
significant differences in the incidence of adverse events and dropout rates between
VR and CT.
Conclusions
The results suggest that VR is superior to time-dose-matched CT in terms of recovery
of upper extremity motor function, especially when a virtual environment is used or
VR is mixed with CT. However, VR (VR only or mixed with CT) does not improve patients’
daily activity performance and participation compared with CT. Overall, VR appears
to be safe and acceptable as CT. Large-scale definitive trials are needed to verify
or refute these findings.
Keywords
List of abbreviations:
ARAT (Action Research Arm Test), BBT (Box and Block Test), BI (Barthel Index), CG (commercial gaming), CI (confidence interval), CT (conventional therapy), FMU (Upper Extremity Fugl-Meyer), GS (grip strength), JHFT (Jebsen Hand Function Test), ICF (International Classification of Functioning, Disability and Health), MAL-QOM (Motor Activity Log-Quality of Movement), MBI (Modified Barthel Index), MI (Motricity Index), OR (odds ratio), RCT (randomized controlled trial), SIS Strength (Stroke Impact Scale Strength), SMD (standardized mean difference), VE (virtual environment), VR (virtual reality), WMFT (Wolf Motor Function Test)To read this article in full you will need to make a payment
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References
- Heart disease and stroke statistics–2011 update: a report from the American Heart Association.Circulation. 2011; 123: e18-209
- Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study.Arch Phys Med Rehabil. 1994; 75: 394-398
- Motor recovery after stroke: a systematic review of the literature.Arch Phys Med Rehabil. 2002; 83: 1629-1637
- Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling.Lancet Neurol. 2009; 8: 345-354
- Functional neuroimaging studies of early upper limb recovery after stroke: a systematic review of the literature.Neurorehabil Neural Repair. 2010; 24: 589-608
- Factors influencing stroke survivors’ quality of life during subacute recovery.Stroke. 2005; 36: 1480-1484
- Repetitive task training for improving functional ability after stroke.Stroke. 2009; 40: e98-e99
- Interventions for improving upper limb function after stroke.Cochrane Database Syst Rev. 2014; CD010820
- A critical review of the concept of patient motivation in the literature on physical rehabilitation.Soc Sci Med. 2000; 50: 495-506
- Virtual environments for motor rehabilitation: review.Cyberpsychol Behav. 2005; 8 (discussion 212-189): 187-211
- Virtual reality in stroke rehabilitation: a systematic review of its effectiveness for upper limb motor recovery.Top Stroke Rehabil. 2007; 14: 52-61
- Eliciting upper extremity purposeful movements using video games: a comparison with traditional therapy for stroke rehabilitation.Neurorehabil Neural Repair. 2014; 28: 733-739
- Counting repetitions: an observational study of video game play in people with chronic poststroke hemiparesis.J Neurol Phys Ther. 2013; 37: 105-111
- Clinical application of virtual reality for upper limb motor rehabilitation in stroke: review of technologies and clinical evidence.J Clin Med. 2020; 9: 3369
- Non-immersive virtual reality for post-stroke upper extremity rehabilitation: a small cohort randomized trial.Brain Sci. 2020; 10: 655
- Emergence of virtual reality as a tool for upper limb rehabilitation: incorporation of motor control and motor learning principles.Phys Ther. 2015; 95: 415-425
- Effect of specific over nonspecific VR-based rehabilitation on poststroke motor recovery: a systematic meta-analysis.Neurorehabil Neural Repair. 2019; 33: 112-129
- What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes.J Neuroeng Rehabil. 2018; 15: 29
- The effectiveness of reinforced feedback in virtual environment in the first 12 months after stroke.Neurol Neurochir Pol. 2011; 45: 436-444
- Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial.J Neuroeng Rehabil. 2013; 10: 85
- Efficacy of a virtual reality commercial gaming device in upper limb recovery after stroke: a randomized, controlled study.Top Stroke Rehabil. 2016; 23: 333-340
- Commercial head-mounted display virtual reality for upper extremity rehabilitation in chronic stroke: a single-case design study.J Neuroeng Rehabil. 2020; 17: 154
World Health Organization. Classifications: international classification of functioning, disability and health (ICF). Available at: http://www.who.int/classifications/icf/en/. Accessed September 21, 2018.
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.Open Med. 2009; 3: e123-e130
- The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance.Scand J Rehabil Med. 1975; 7: 13-31
- Psychometric comparisons of the Stroke Impact Scale 3.0 and Stroke-Specific Quality of Life Scale.Qual Life Res. 2010; 19: 435-443
- Motor evaluation in vascular hemiplegia.Eur Neurol. 1980; 19: 382-389
- Adult norms for the Box and Block Test of manual dexterity.Am J Occup Ther. 1985; 39: 386-391
- A performance test for assessment of upper limb function in physical rehabilitation treatment and research.Int J Rehabil Res. 1981; 4: 483-492
- Assessing Wolf Motor Function Test as outcome measure for research in patients after stroke.Stroke. 2001; 32: 1635-1639
- Development of the Korean version of Modified Barthel Index (K-MBI): multi-center study for subjects with stroke.Journal of the Korean Academy of Rehabilitation Medicine. 2007; 31: 283-297
- An objective and standardized test of hand function.Arch Phys Med Rehabil. 1969; 50: 311-319
- The functional independence measure: a new tool for rehabilitation.Adv Clin Rehabil. 1987; 1: 6-18
- Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: a randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system.Restor Neurol Neurosci. 2011; 29: 287-298
- Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use.Stroke. 2005; 36: 2493-2496
- Outcome measures in stroke rehabilitation.Handb Clin Neurol. 2013; 110: 105-111
- Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.BMC Med Res Methodol. 2014; 14: 135
- Meta-analyses in mental health research: a practical guide. Pim Cuijpers Uitgeverij, Amsterdam, The Netherlands2016
- Virtual reality games as an adjunct in improving upper limb function and general health among stroke survivors.Int J Environ Res Public Health. 2019; 16: 5144
- Virtual reality training for upper extremity in subacute stroke (VIRTUES): a multicenter RCT.Neurology. 2017; 89: 2413-2421
- Effects of virtual reality based therapeutic exercise on the upper extremity function and activities of daily living in patients with acute stroke: a pilot randomized controlled trial.Medico Legal Update. 2021; 21: 676-682
- Mobile game–based virtual reality rehabilitation program for upper limb dysfunction after ischemic stroke.Restor Neurol Neurosci. 2016; 34: 455-463
- Virtual reality in the rehabilitation of the arm after hemiplegic stroke: a randomized controlled pilot study.Clin Rehabil. 2012; 26: 798-806
- Retraining and assessing hand movement after stroke using the MusicGlove: comparison with conventional hand therapy and isometric grip training.J Neuroeng Rehabil. 2014; 11: 76
- Comparison of Kinect2Scratch game-based training and therapist-based training for the improvement of upper extremity functions of patients with chronic stroke: a randomized controlled single-blinded trial.Eur J Phys Rehabil Med. 2019; 55: 542-550
- Virtual reality reflection therapy improves motor recovery and motor function in the upper extremities of people with chronic stroke.J Phys Ther Sci. 2012; 24: 339-343
- Reinforced feedback in virtual environment for rehabilitation of upper extremity dysfunction after stroke: preliminary data from a randomized controlled trial.Biomed Res Int. 2014; 2014752128
- Virtual reality for upper limb rehabilitation in subacute and chronic stroke: a randomized controlled trial.Arch Phys Med Rehabil. 2018; 99 (834-42.e834)
- Gaming and conventional exercises for improvement of arm function after stroke: a randomized controlled pilot study.Games Health J. 2014; 3: 184-191
- Rehabilitation of the upper arm early after stroke: Video games versus conventional rehabilitation. A randomized controlled trial.Ann Phys Rehabil Med. 2020; 63: 173-180
- Comparison of individualized virtual reality– and group-based rehabilitation in older adults with chronic stroke in community settings: a pilot randomized controlled trial.Eur J Integr Med. 2016; 8: 738-746
- Virtual reality versus conventional treatment of reaching ability in chronic stroke: clinical feasibility study.Neurol Ther. 2012; 1: 3
- Novel upper-limb rehabilitation system based on attention technology for post-stroke patients: a preliminary study.IEEE Access. 2017; 6: 2720-2731
- A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke.Ann N Y Acad Sci. 2021; 1493: 75-89
- Exercises for paretic upper limb after stroke: a combined virtual-reality and telemedicine approach.J Rehabil Med. 2009; 41: 1016-1102
- Motor learning principles for rehabilitation: a pilot randomized controlled study in poststroke patients.Neurorehabil Neural Repair. 2010; 24: 501-508
- Effects of specific virtual reality–based therapy for the rehabilitation of the upper limb motor function post-ictus: randomized controlled trial.Brain Sci. 2021; 11: 555
- Effect of a four-week virtual reality–based training versus conventional therapy on upper limb motor function after stroke: a multicenter parallel group randomized trial.PLoS One. 2018; 13e0204455
- Effects of game-based virtual reality on health-related quality of life in chronic stroke patients: a randomized, controlled study.Comput Biol Med. 2015; 63: 92-98
- Effects of virtual reality–based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial.J Neuroeng Rehabil. 2016; 13: 17
- Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke.J Neuroeng Rehabil. 2014; 11: 171
- Leap motion–based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients.Neural Regen Res. 2017; 12: 1823-1831
- Virtual reality for upper extremity rehabilitation in early stroke: a pilot randomized controlled trial.Clin Rehabil. 2014; 28: 1107-1114
- Home-based hand rehabilitation after chronic stroke: randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program.J Rehabil Res Dev. 2016; 53: 457-472
- Assessment of a virtual teacher feedback for the recovery of the upper limb after stroke.It J Physiother. 2011; 1: 101-106
- Does the use of Nintendo Wii Sports(TM) improve arm function? Trial of Wii(TM) in Stroke: a randomized controlled trial and economics analysis.Clin Rehabil. 2017; 31: 173-185
- Effectiveness of commercial gaming–based virtual reality movement therapy on functional recovery of upper extremity in subacute stroke patients.Ann Rehabil Med. 2014; 38: 485-493
- Improved intrinsic motivation and muscle activation patterns in reaching task using virtual reality training for stroke rehabilitation: a pilot randomized control trial.J Med Biol Eng. 2014; 34: 399-407
- Video-games used in a group setting is feasible and effective to improve indicators of physical activity in individuals with chronic stroke: a randomized controlled trial.Clin Rehabil. 2016; 30: 383-392
- Early rehabilitation after stroke.Curr Opin Neurol. 2016; 30: 1
- Game-based virtual reality canoe paddling training to improve postural balance and upper extremity function: a preliminary randomized controlled study of 30 patients with subacute stroke.Med Sci Monit. 2018; 24: 2590-2598
- Virtual reality for stroke rehabilitation.Cochrane Database Syst Rev. 2015; CD008349
- Applying principles of motor learning and control to upper extremity rehabilitation.J Hand Ther. 2013; 26 (quiz 103): 94-102
Article info
Publication history
Published online: October 04, 2021
Accepted:
September 5,
2021
Received in revised form:
August 18,
2021
Received:
June 19,
2021
Footnotes
Disclosures: None.
This work was supported by the National Natural Science Foundation of China (grant no. 82002396) and the Chongqing Municipal Health Commission Project (grant no. 2017ZDXM005).
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine.
