Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Multiple sclerosis (MS) is one of the most common causes of neurological progressive disease and can lead to loss of mobility, walk impairment, and balance disturbance. Among several rehabilitative approaches proposed, exergaming and virtual reality (VR) have been studied in the recent years. Active video game therapy could reduce the boredom of the rehabilitation process, increasing patient motivation, providing direct feedback, and enabling dual-task training. Aim of this systematic review was to assess the efficacy of exergaming and VR for balance recovery in patients with MS. PubMed, Scopus, and Web of Science were systematically searched from the inception until May 14, 2021 to identify randomized controlled trials (RCTs) presenting: patients with MS as participants, exergaming and VR as intervention, conventional rehabilitation as comparator, and balance assessment [Berg Balance Scale (BBS)] as outcome measure. We also performed a meta-analysis of the mean difference in the BBS via the random-effects method. Out of 93 records, this systematic review included and analyzed 7 RCTs, involving a total of 209 patients affected by MS, of which 97 patients performed exergaming or VR and 112 patients underwent conventional rehabilitation. The meta-analysis reported a significant overall ES of 4.25 (p < 0.0001), showing in the subgroup analysis a non-significant ES of 1.85 (p = 0.39) for the VR and a significant ES of 4.49 (p < 0.0001) for the exergames in terms of the BBS improvement. Taken together, these findings suggested that balance rehabilitation using exergames appears to be more effective than conventional rehabilitation in patients affected by MS.

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Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis

Sensors ◽

10.3390/s21217389 ◽

2021 ◽

Vol 21 (21) ◽

pp. 7389

Author(s):

Irene Cortés-Pérez ◽

Marcelina Sánchez-Alcalá ◽

Francisco Antonio Nieto-Escámez ◽

Yolanda Castellote-Caballero ◽

Esteban Obrero-Gaitán ◽

...

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Systematic Review ◽

Virtual Reality ◽

Meta Analysis ◽

Simple Observation ◽

High Level ◽

The Impact ◽

Better Than

Patients with multiple sclerosis (PwMS) have a high level of fatigue and a reduced quality of life (QoL) due to the impact of multiple sclerosis (MS). Virtual reality-based therapy (VRBT) is being used to reduce disability in PwMS. The aim of this study was to assess the effect of VRBT on fatigue, the impact of MS, and QoL in PwMS. Methods: A systematic review with meta-analysis was conducted through a bibliographic search on PubMed, Scopus, Web of Science, and PEDro up to April 2021. We included randomized controlled trials (RCTs) with PwMS that received VRBT in comparison to conventional therapy (CT) including physiotherapy, balance and strength exercises, and stretching or physical activity, among others; or in comparison to simple observation; in order to assess fatigue, MS-impact, and QoL. The effect size was calculated using Cohen’s standardized mean difference with a 95% confidence interval (95% CI). Results: Twelve RCTs that provided data from 606 PwMS (42.83 ± 6.86 years old and 70% women) were included. The methodological quality mean, according to the PEDro Scale, was 5.83 ± 0.83 points. Our global findings showed that VRBT is effective at reducing fatigue (SMD −0.33; 95% CI −0.61, −0.06), lowering the impact of MS (SMD −0.3; 95% CI −0.55, −0.04), and increasing overall QoL (0.5; 95% CI 0.23, 0.76). Subgroup analysis showed the following: (1) VRBT is better than CT at reducing fatigue (SMD −0.4; 95% CI −0.7, −0.11), as well as in improving the mental dimension of QoL (SMD 0.51; 95% CI 0.02, 1); (2) VRBT is better than simple observation at reducing the impact of MS (SMD −0.61; 95% CI −0.97, −0.23) and increasing overall QoL (SMD 0.79; 95% CI 0.3, 1.28); and (3) when combined with CT, VRBT is more effective than CT in improving the global (SMD 0.6, 95% CI 0.13, 1.07), physical (SMD 0.87; 95% CI 0.3, 1.43), and mental dimensions (SMD 0.6; 95% CI 0.08, 1.11) of QoL. Conclusion: VRBT is effective at reducing fatigue and MS impact and improving QoL in PwMS.

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Effect of dual-task training on balance in patients with multiple sclerosis: A systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/02692155211010372 ◽

2021 ◽

pp. 026921552110103

Author(s):

Alex Martino Cinnera ◽

Alessio Bisirri ◽

Enza Leone ◽

Giovanni Morone ◽

Angela Gaeta

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Dual Task ◽

Dynamic Balance ◽

Meta Analysis ◽

Berg Balance Scale ◽

P Value ◽

Balance Scale ◽

Task Training ◽

Dual Task Training

Objective: To evaluate the effects of dual-task training on static and dynamic balance in patients with multiple sclerosis. Data sources: PubMed/MEDLINE, EMBASE, Scopus, and PEDro databases were searched from inception to March 1, 2021. Methods: This study was conducted in agreement with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers assessed studies for inclusion and extracted data. We used the Physiotherapy Evidence Database scale to evaluate the methodological quality and the risk-of-bias. Randomized clinical trial data were pooled for the meta-analysis. The effect sizes and 95% confidence interval (CI) were calculated by random-effect models. Egger regression and Begg-Mazumdar rank correlation test were used for publication bias. Results: A total of 13 studies involving 584 patients (42.3 ± 9 years mean ± SD; 377 females) met the inclusion criteria for the systematic review, while nine were included in the meta-analysis. People who received dual-task training interventions showed significant improvements in the Timed Up & Go test 0.44 [(95% CI = 0.22; 0.65), P-value<0.001], and in the Berg Balance scale 0.46 [(95% CI = 0.07; 0.85), P-value = 0.02]. Low and moderate heterogeneity between the studies was found for the Timed Up & Go test and the Berg Balance scale, respectively. Conclusion: The findings from the current meta-analysis support dual-task training as a beneficial therapy for improving dynamic balance and functional mobility in patients with multiple sclerosis. The limited number of studies that investigated static balance performance after dual-task training do not currently allow us to draw a conclusion about any possible improvements in this ability.

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Effectiveness of Virtual Reality Rehabilitation in Persons with Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Multiple Sclerosis and Related Disorders ◽

10.1016/j.msard.2021.103128 ◽

2021 ◽

pp. 103128

Author(s):

Andréia Santos Nascimento ◽

Cindy Vieira Fagundes ◽

Felipe Augusto dos Santos Mendes ◽

Josevan Cerqueira Leal

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Virtual Reality ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Virtual Reality Rehabilitation

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Effectiveness of virtual reality training for balance and gait rehabilitation in people with multiple sclerosis: a systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215518768084 ◽

2018 ◽

Vol 32 (9) ◽

pp. 1220-1234 ◽

Cited By ~ 20

Author(s):

María Jesús Casuso-Holgado ◽

Rocío Martín-Valero ◽

Ana F Carazo ◽

Esther M. Medrano-Sánchez ◽

M. Dolores Cortés-Vega ◽

...

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Virtual Reality ◽

Systematic Reviews ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Gait Rehabilitation ◽

Virtual Reality Training ◽

Standard Mean Difference ◽

Gait Impairments

Objective: To evaluate the evidence for the use of virtual reality to treat balance and gait impairments in multiple sclerosis rehabilitation. Design: Systematic review and meta-analysis of randomized controlled trials and quasi-randomized clinical trials. Methods: An electronic search was conducted using the following databases: MEDLINE (PubMed), Physiotherapy Evidence Database (PEDro), Cochrane Database of Systematic Reviews (CDSR) and (CINHAL). A quality assessment was performed using the PEDro scale. The data were pooled and a meta-analysis was completed. This systematic review was conducted in accordance with the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guideline statement. It was registered in the PROSPERO database (CRD42016049360). Results: A total of 11 studies were included. The data were pooled, allowing meta-analysis of seven outcomes of interest. A total of 466 participants clinically diagnosed with multiple sclerosis were analysed. Results showed that virtual reality balance training is more effective than no intervention for postural control improvement (standard mean difference (SMD) = −0.64; 95% confidence interval (CI) = −1.05, −0.24; P = 0.002). However, significant overall effect was not showed when compared with conventional training (SMD = −0.04; 95% CI = −0.70, 0.62; P = 0.90). Inconclusive results were also observed for gait rehabilitation. Conclusion: Virtual reality training could be considered at least as effective as conventional training and more effective than no intervention to treat balance and gait impairments in multiple sclerosis rehabilitation.

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Effects on gait and balance of home-based active video game interventions in persons with multiple sclerosis: a systematic review

Multiple Sclerosis and Related Disorders ◽

10.1016/j.msard.2021.102928 ◽

2021 ◽

pp. 102928

Author(s):

Marion Dalmazane ◽

Matthieu Gallou-Guyot ◽

Maxence Compagnat ◽

Laurent Magy ◽

Alexis Montcuquet ◽

...

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Video Game ◽

Home Based ◽

Active Video Game ◽

Active Video

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Cybersickness in current-generation virtual reality head-mounted displays: systematic review and outlook

Virtual Reality ◽

10.1007/s10055-021-00513-6 ◽

2021 ◽

Author(s):

Polona Caserman ◽

Augusto Garcia-Agundez ◽

Alvar Gámez Zerban ◽

Stefan Göbel

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Meta Analysis ◽

Subjective Evaluation ◽

Future Research ◽

Current Generation ◽

Research Areas ◽

Head Mounted Displays ◽

Skin Response ◽

Golden Standard

AbstractCybersickness (CS) is a term used to refer to symptoms, such as nausea, headache, and dizziness that users experience during or after virtual reality immersion. Initially discovered in flight simulators, commercial virtual reality (VR) head-mounted displays (HMD) of the current generation also seem to cause CS, albeit in a different manner and severity. The goal of this work is to summarize recent literature on CS with modern HMDs, to determine the specificities and profile of immersive VR-caused CS, and to provide an outlook for future research areas. A systematic review was performed on the databases IEEE Xplore, PubMed, ACM, and Scopus from 2013 to 2019 and 49 publications were selected. A summarized text states how different VR HMDs impact CS, how the nature of movement in VR HMDs contributes to CS, and how we can use biosensors to detect CS. The results of the meta-analysis show that although current-generation VR HMDs cause significantly less CS ($$p<0.001$$ p < 0.001 ), some symptoms remain as intense. Further results show that the nature of movement and, in particular, sensory mismatch as well as perceived motion have been the leading cause of CS. We suggest an outlook on future research, including the use of galvanic skin response to evaluate CS in combination with the golden standard (Simulator Sickness Questionnaire, SSQ) as well as an update on the subjective evaluation scores of the SSQ.

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Serum Based miRNA as a Diagnostic Biomarker for Multiple Sclerosis: a Systematic Review and Meta-Analysis

Immunological Investigations ◽

10.1080/08820139.2021.1887888 ◽

2021 ◽

pp. 1-16

Author(s):

Samar A. Zailaie ◽

Jumana Jamal Siddiqui ◽

Rawan Mansour Al Saadi ◽

Dalia Mohammad Anbari ◽

Amani S. Alomari ◽

...

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Meta Analysis ◽

Diagnostic Biomarker

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Leap Motion Controller Video Game-Based Therapy for Upper Extremity Motor Recovery in Patients with Central Nervous System Diseases. A Systematic Review with Meta-Analysis

Sensors ◽

10.3390/s21062065 ◽

2021 ◽

Vol 21 (6) ◽

pp. 2065

Author(s):

Irene Cortés-Pérez ◽

Noelia Zagalaz-Anula ◽

Desirée Montoro-Cárdenas ◽

Rafael Lomas-Vega ◽

Esteban Obrero-Gaitán ◽

...

Keyword(s):

Systematic Review ◽

Central Nervous System ◽

Nervous System ◽

Motor Function ◽

Video Game ◽

Meta Analysis ◽

Leap Motion ◽

Motion Controller ◽

Motor Dexterity ◽

Quality Evidence

Leap Motion Controller (LMC) is a virtual reality device that can be used in the rehabilitation of central nervous system disease (CNSD) motor impairments. This review aimed to evaluate the effect of video game-based therapy with LMC on the recovery of upper extremity (UE) motor function in patients with CNSD. A systematic review with meta-analysis was performed in PubMed Medline, Web of Science, Scopus, CINAHL, and PEDro. We included five randomized controlled trials (RCTs) of patients with CNSD in which LMC was used as experimental therapy compared to conventional therapy (CT) to restore UE motor function. Pooled effects were estimated with Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI). At first, in patients with stroke, LMC showed low-quality evidence of a large effect on UE mobility (SMD = 0.96; 95% CI = 0.47, 1.45). In combination with CT, LMC showed very low-quality evidence of a large effect on UE mobility (SMD = 1.34; 95% CI = 0.49, 2.19) and the UE mobility-oriented task (SMD = 1.26; 95% CI = 0.42, 2.10). Second, in patients with non-acute CNSD (cerebral palsy, multiple sclerosis, and Parkinson’s disease), LMC showed low-quality evidence of a medium effect on grip strength (GS) (SMD = 0.47; 95% CI = 0.03, 0.90) and on gross motor dexterity (GMD) (SMD = 0.73; 95% CI = 0.28, 1.17) in the most affected UE. In combination with CT, LMC showed very low-quality evidence of a high effect in the most affected UE on GMD (SMD = 0.80; 95% CI = 0.06, 1.15) and fine motor dexterity (FMD) (SMD = 0.82; 95% CI = 0.07, 1.57). In stroke, LMC improved UE mobility and UE mobility-oriented tasks, and in non-acute CNSD, LMC improved the GS and GMD of the most affected UE and FMD when it was used with CT.

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