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Can virtual reality-assisted therapy offer additional benefits to patients with vestibular disorders compared with conventional vestibular physical therapy? A meta-analysis

  • Author Footnotes
    † These authors contributed equally to this work and shared the co-first authorship.
    Hong-Yuan Chu
    Footnotes
    † These authors contributed equally to this work and shared the co-first authorship.
    Affiliations
    Department of Neurology, Peking University Aerospace School of Clinical Medicine (Aerospace Center Hospital), Beijing 100049, China
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  • Author Footnotes
    † These authors contributed equally to this work and shared the co-first authorship.
    Ning Song
    Footnotes
    † These authors contributed equally to this work and shared the co-first authorship.
    Affiliations
    Department of Neurology, Peking University Aerospace School of Clinical Medicine (Aerospace Center Hospital), Beijing 100049, China
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  • Zhi-Fei Li
    Affiliations
    Department of Neurology, Peking University Aerospace School of Clinical Medicine (Aerospace Center Hospital), Beijing 100049, China
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  • Author Footnotes
    † These authors contributed equally to this work and shared the co-first authorship.
    Zhi-Rui Zhou
    Correspondence
    Corresponding author: Xu Yang,, Aerospace Center Hospital, No.15, Yuquan Road, Haidian District, Beijing 100049, China
    Footnotes
    † These authors contributed equally to this work and shared the co-first authorship.
    Affiliations
    Radiation Oncology Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
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  • Author Footnotes
    † These authors contributed equally to this work and shared the co-first authorship.
    Xu Yang
    Correspondence
    Corresponding author: Xu Yang,, Aerospace Center Hospital, No.15, Yuquan Road, Haidian District, Beijing 100049, China
    Footnotes
    † These authors contributed equally to this work and shared the co-first authorship.
    Affiliations
    Department of Neurology, Peking University Aerospace School of Clinical Medicine (Aerospace Center Hospital), Beijing 100049, China
    Search for articles by this author
  • Author Footnotes
    † These authors contributed equally to this work and shared the co-first authorship.
Published:October 17, 2022DOI:https://doi.org/10.1016/j.apmr.2022.08.972

      Abstract

      Objective: To determine whether virtual reality-assisted therapy (VRAT) significantly improves the treatment of peripheral or central vestibular disorders when compared with conventional vestibular physical therapy (CVPT) alone. Indicators of vestibular symptoms are used to determine this.
      Data sources: Two reviewers independently searched PubMed, EMBASE, ClinicalTrials.gov, Web of Science, and the Cochrane Collaboration database from January 2010 to January 2022 for studies reporting on VRAT in vestibular disorders.
      Study selection: Randomized controlled trials (RCTs) were included that mainly focused on the following measures: the Dizziness Handicap Inventory (DHI), Simulator Sickness Questionnaire, visual analog scale, and balance measures such as the Activities-specific Balance Confidence Scale (ABC), Timed Up And Go test, sensory organization test, and center of pressure. The primary outcome was assessment of symptomatic changes before and after VRAT.
      Data extraction: Two authors independently conducted the literature search and selection. After screening, meta-analyses were performed on the RCTs using RevMan 5.3 software.
      Data synthesis: The results showed that VRAT produced significantly greater improvement than CVPT alone in scores of DHI-Total (standardized mean difference [SMD]: −7.09, 95% confidence interval [CI]: [−12.17, −2.00], P=0.006), DHI-Functional (SMD=−3.66, 95% CI: [−6.34, −0.98], P=0.007), DHI-Physical (SMD=−3.14, 95% CI: [−5.46, −0.83], P=0.008), and DHI-Emotional (SMD=−3.10, 95% CI: [−5.13, −1.08], P=0.003). ABC scores did not show improvement (SMD: 0.58, 95% CI: [−3.69, 4.85], P=0.79). Subgroup analysis showed that DHI-Total between-group differences were insignificant for central vestibular disorders (SMD=−1.47, 95% CI: [−8.71, −5.78], P=0.69), although peripheral disorders showed significant improvements (SMD=−9.58, 95% CI: [−13.92, −5.25], P<0.0001). However, the included studies showed high heterogeneity (I²>75%).
      CONCLUSION: VRAT may offer additional benefits for rehabilitation from vestibular diseases, especially peripheral disorders, when compared with CVPT alone. However, because of high heterogeneity and limited data, additional studies with a larger sample size and more sensitive and specific measurements are required to conclusively determine the evidence-based utility of virtual reality.

      Keywords

      List of abbreviations:

      VPT (vestibular physical therapy), CVPT (conventional VPT), VRAT (virtual reality-assisted therapy), VR (virtual reality), PPPD (persistent postural-perceptual dizziness), MS (multiple sclerosis), mTBI (mild traumatic brain injury), RCTs (randomized controlled trials), DHI (Dizziness Handicap Inventory), SSQ (Simulator Sickness Questionnaire), TUG (Timed Up And Go test), VAS (visual analog scale), ABC (Activities-specific Balance Confidence Scale), SOT (sensory organization test), COP (center of pressure), TREND (Transparent Reporting of Evaluations with Nonrandomized Designs statement), SMD (standardized mean difference), CI (confidence intervals), VVAS (Visual Vertigo Analog Scale), VRDQ (Vision-related Dizziness Questionnaire)
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