scholarly journals Virtual Reality in Neurorehabilitation: An Umbrella Review of Meta-Analyses

2021 ◽  
Vol 10 (7) ◽  
pp. 1478
Author(s):  
Alexandra Voinescu ◽  
Jie Sui ◽  
Danaë Stanton Fraser
Keyword(s):  
Virtual Reality ◽  
Cerebral Palsy ◽  
Brain Injury ◽  
Upper Limb ◽  
Umbrella Review ◽  
High Quality ◽  
Quality Of Evidence ◽  
Upper Limb Function ◽  
Meta Analyses

Neurological disorders are a leading cause of death and disability worldwide. Can virtual reality (VR) based intervention, a novel technology-driven change of paradigm in rehabilitation, reduce impairments, activity limitations, and participation restrictions? This question is directly addressed here for the first time using an umbrella review that assessed the effectiveness and quality of evidence of VR interventions in the physical and cognitive rehabilitation of patients with stroke, traumatic brain injury and cerebral palsy, identified factors that can enhance rehabilitation outcomes and addressed safety concerns. Forty-one meta-analyses were included. The data synthesis found mostly low- or very low-quality evidence that supports the effectiveness of VR interventions. Only a limited number of comparisons were rated as having moderate and high quality of evidence, but overall, results highlight potential benefits of VR for improving the ambulation function of children with cerebral palsy, mobility, balance, upper limb function, and body structure/function and activity of people with stroke, and upper limb function of people with acquired brain injury. Customization of VR systems is one important factor linked with improved outcomes. Most studies do not address safety concerns, as only nine reviews reported adverse effects. The results provide critical recommendations for the design and implementation of future VR programs, trials and systematic reviews, including the need for high quality randomized controlled trials to test principles and mechanisms, in primary studies and in meta-analyses, in order to formulate evidence-based guidelines for designing VR-based rehabilitation interventions.

scholarly journals An umbrella review of systematic reviews and meta-analyses of observational investigations of obstructive sleep apnea and health outcomes

2021 ◽  
Author(s):  
Weiwei Chen ◽  
Yuting Li ◽  
Liliangzi Guo ◽  
Chenxing Zhang ◽  
Shaohui Tang
Keyword(s):  
Obstructive Sleep Apnea ◽  
Health Outcomes ◽  
Systematic Reviews ◽  
Coronary Revascularization ◽  
Umbrella Review ◽  
High Quality ◽  
Quality Of Evidence ◽  
Obstructive Sleep ◽  
Meta Analyses

Abstract Purpose The previous analysis of systematic reviews and meta-analyses have illustrated that obstructive sleep apnea (OSA) is correlated with multiple health outcomes. In the present research, our main aim was to execute an umbrella review to assess the available evidence for the associations between OSA and health outcomes. Methods Herein, a meta-analysis of previous observational investigations that have reported associations between OSA and health outcomes in all human populations and settings was performed. We used these studies to execute an umbrella review of available meta-analyses and systematic reviews. Results Sixty-six articles comprising 136 unique outcomes were enrolled in this analysis. Of the 136 unique outcomes, 111 unique outcomes had significant associations (p < 0.05). Only 7 outcomes (coronary revascularization after PCI, postoperative respiratory failure, steatosis, alaninetrans aminase (ALT) elevation, metabolic syndrome (MS), psoriasis, and Parkinson’s disease) had a high quality of evidence. Twenty-four outcomes had a moderate quality of evidence, and the remaining 80 outcomes had a weak quality of evidence. Sixty-nine outcomes exhibited significant heterogeneity. Twenty-five outcomes exhibited publication bias. Sixty-three (95%) studies showed critically low methodological quality. Conclusion Among the 66 meta-analyses exploring 136 unique outcomes, only 7 statistically significant outcomes were rated as high quality of evidence. OSA may correlate with an increased risk of coronary revascularization after PCI, postoperative respiratory failure, steatosis, ALT elevation, MS, psoriasis, and Parkinson’s disease.

scholarly journals Effects of virtual reality therapy on upper limb function after stroke and the role of neuroimaging as a predictor of a better response

2018 ◽  
Vol 76 (10) ◽  
pp. 654-662 ◽  
Author(s):  
Maicon Gabriel Gonçalves ◽  
Mariana Floriano Luiza Piva ◽  
Carlos Leonardo Sacomani Marques ◽  
Rafael Dalle Molle da Costa ◽  
Rodrigo Bazan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Virtual Reality ◽  
Upper Limb ◽  
Internal Capsule ◽  
Functional Independence ◽  
Reality Therapy ◽  
Limb Function ◽  
Virtual Reality Therapy ◽  
Upper Limb Function

ABSTRACT Background: Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity. The aim was to evaluate the effects of VRT associated with conventional rehabilitation for an upper limb after stroke, and the neuroimaging predictors of a better response to VRT. Methods: Patients with stroke were selected, and clinical neurological, upper limb function, and quality of life were evaluated. Statistical analysis was performed using a linear model comparing pre- and post-VRT. Lesions were segmented in the post-stroke computed tomography. A voxel-based lesion-symptom mapping approach was used to investigate the relationship between the lesion and upper limb function. Results: Eighteen patients were studied (55.5 ± 13.9 years of age). Quality of life, functional independence, and dexterity of the upper limb showed improvement after VRT (p < 0.001). Neuroimaging analysis showed negative correlations between the internal capsule lesion and functional recovery. Conclusion: VRT showed benefits for patients with stroke, but when there was an internal capsule lesion, a worse response was observed.

scholarly journals Dietary Factors and Neurodegenerative Disorders: An Umbrella Review of Meta-Analyses of Prospective Studies

2020 ◽  
Vol 11 (5) ◽  
pp. 1161-1173
Author(s):  
Janett Barbaresko ◽  
Arno Werner Lellmann ◽  
Annemarie Schmidt ◽  
Andreas Lehmann ◽  
Anna Maria Amini ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Parkinson Disease ◽  
Prospective Studies ◽  
Neurodegenerative Disorders ◽  
Risk Of Bias ◽  
Dietary Factors ◽  
Umbrella Review ◽  
Quality Of Evidence ◽  
Meta Analyses

ABSTRACT Diet has been hypothesized to be associated with neurodegenerative disorders. The aim was to conduct an umbrella review to summarize and evaluate the current evidence of prospective associations between any dietary factors and the incidence of neurodegenerative disorders. We conducted a systematic search in PubMed, Embase, and the Cochrane library up to November 2019 to identify systematic reviews with meta-analyses of prospective studies investigating the association between dietary factors (dietary patterns, foods and beverages, nutrients, and phytochemicals) and neurodegenerative disorders (cognitive decline, cognitive impairment, Alzheimer disease, all-cause dementia, and Parkinson disease). Summary risk ratios (SRRs) and 95% CIs were recalculated using a random effects model. We evaluated the risk of bias of identified meta-analyses and the quality of evidence for all associations. In total, 20 meta-analyses including 98 SRRs were identified. All original meta-analyses were rated as being at high risk of bias. Methodological concerns related mainly to the inappropriate synthesis, assessment, and discussion of the risk of bias of primary studies. For the recalculated meta-analyses, quality of evidence was moderate for inverse associations between higher adherence to the Mediterranean diet (SRR: 0.63; 95% CI: 0.48, 0.82; n = 4 primary studies) and higher fish intake (SRR: 0.72; 95% CI: 0.59, 0.89; n = 6) and Alzheimer disease, as well as for tea consumption and all-cause dementia (SRR: 0.74; 95% CI: 0.63, 0.88; n = 2) and Parkinson disease (SRR per 2 cups/d: 0.69; 95% CI: 0.54, 0.87; n = 5). This umbrella review provides a comprehensive overview of the available evidence on dietary factors and neurodegenerative disorders. The results indicate that the Mediterranean diet, fish, and tea could be inversely associated with neurodegenerative disorders. However, the quality of evidence was generally low, suggesting that further studies are likely to change the overall estimates. Thus, more well-conducted research, also investigating other dietary factors in association with neurodegenerative disorders, is warranted.

scholarly journals Wake up and smell the coffee: caffeine supplementation and exercise performance—an umbrella review of 21 published meta-analyses

2019 ◽  
Vol 54 (11) ◽  
pp. 681-688 ◽  
Author(s):  
Jozo Grgic ◽  
Ivana Grgic ◽  
Craig Pickering ◽  
Brad J Schoenfeld ◽  
David J Bishop ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Systematic Reviews ◽  
Exercise Performance ◽  
Methodological Quality ◽  
Muscle Endurance ◽  
Umbrella Review ◽  
Caffeine Ingestion ◽  
Quality Of Evidence ◽  
Meta Analyses

ObjectiveTo systematically review, summarise and appraise findings of published meta-analyses that examined the effects of caffeine on exercise performance.DesignUmbrella review.Data sourcesTwelve databases.Eligibility criteria for selecting studiesMeta-analyses that examined the effects of caffeine ingestion on exercise performance.ResultsEleven reviews (with a total of 21 meta-analyses) were included, all being of moderate or high methodological quality (assessed using the Assessing the Methodological Quality of Systematic Reviews 2 checklist). In the meta-analyses, caffeine was ergogenic for aerobic endurance, muscle strength, muscle endurance, power, jumping performance and exercise speed. However, not all analyses provided a definite direction for the effect of caffeine when considering the 95% prediction interval. Using the Grading of Recommendations Assessment, Development and Evaluation criteria the quality of evidence was generally categorised as moderate (with some low to very low quality of evidence). Most individual studies included in the published meta-analyses were conducted among young men.Summary/conclusionSynthesis of the currently available meta-analyses suggest that caffeine ingestion improves exercise performance in a broad range of exercise tasks. Ergogenic effects of caffeine on muscle endurance, muscle strength, anaerobic power and aerobic endurance were substantiated by moderate quality of evidence coming from moderate-to-high quality systematic reviews. For other outcomes, we found moderate quality reviews that presented evidence of very low or low quality. It seems that the magnitude of the effect of caffeine is generally greater for aerobic as compared with anaerobic exercise. More primary studies should be conducted among women, middle-aged and older adults to improve the generalisability of these findings.

scholarly journals Evidence-based umbrella review of cognitive effects of prefrontal tDCS

2020 ◽  
Author(s):  
Luis C Farhat ◽  
Andre F Carvalho ◽  
Marco Solmi ◽  
Andre R Brunoni
Keyword(s):  
Systematic Reviews ◽  
Meta Analysis ◽  
Measurement Tool ◽  
Affective Neuroscience ◽  
Umbrella Review ◽  
Quality Of Evidence ◽  
Neuroscience Research ◽  
Cochrane Database ◽  
Meta Analyses

Abstract Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique, which has been increasingly used as an investigational tool in neuroscience. In social and affective neuroscience research, the prefrontal cortex has been primarily targeted, since this brain region is critically involved in complex psychobiological processes subserving both ‘hot’ and ‘cold’ domains. Although several studies have suggested that prefrontal tDCS can enhance neuropsychological outcomes, meta-analyses have reported conflicting results. Therefore, we aimed to assess the available evidence by performing an umbrella review of meta-analyses. We evaluated the effects of prefrontal active vs sham tDCS on different domains of cognition among healthy and neuropsychiatric individuals. A MeaSurement Tool to Assess Systematic Reviews 2 was employed to evaluate the quality of meta-analyses, and the GRADE system was employed to grade the quality of evidence of every comparison from each meta-analysis. PubMed/MEDLINE, PsycINFO and the Cochrane Database of Systematic Reviews were searched, and 11 meta-analyses were included resulting in 55 comparisons. Only 16 comparisons reported significant effects favoring tDCS, but 13 of them had either very low or low quality of evidence. Of the remaining 39 comparisons which reported non-significant effects, 38 had either very low or low quality of evidence. Meta-analyses were rated as having critically low and low quality. Among several reasons to explain these findings, the lack of consensus and reproducibility in tDCS research is discussed.

The Combined Effect of Dynamic Splinting and Neuromuscular Electrical Stimulation in Reducing Wrist and Elbow Contractures in Six Children with Cerebral Palsy

2010 ◽  
Vol 34 (1) ◽  
pp. 10-19 ◽  
Author(s):  
Neil Postans ◽  
Philip Wright ◽  
Will Bromwich ◽  
Ingrid Wilkinson ◽  
Sybil E. Farmer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cerebral Palsy ◽  
Electrical Stimulation ◽  
Range Of Motion ◽  
Upper Limb ◽  
Neuromuscular Electrical Stimulation ◽  
Limb Function ◽  
Upper Limb Function ◽  
Dynamic Splinting

The aim of this pilot study was to investigate the feasibility of applying the combination of Dynamic splinting (DS) and Neuromuscular electrical stimulation (NMES) in order to improve wrist and elbow function, and range of motion, in children with upper limb contractures due to Cerebral palsy (CP). Six children aged seven to 16, with contractures at the wrist or elbow, were recruited. Following a 12-week baseline period all participants underwent a 12-week treatment period where DS was used for one hour per day and combined with NMES for the second half of the 1-h treatment. A 12-week follow-up period then ensued. Upper limb function was assessed with the Melbourne assessment, physical disability with the Paediatric Evaluation of Disability Index and the Activity Scale for Kids, and quality of life with the Pediatric Quality of Life Scale. Passive and active range of motion at the wrist and elbow were measured using manual and electrical goniometers. The technique of using combined NMES and DS was demonstrated to be feasible and compliance with the intervention was good. There was an increase in passive elbow extension in two participants treated for elbow contractures, although no accompanying change in upper limb function was demonstrated. Wrist range of movement improved in one participant treated for wrist contracture.

scholarly journals Evidence on Virtual Reality–Based Therapies for Psychiatric Disorders: Meta-Review of Meta-Analyses

10.2196/20889 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e20889
Author(s):  
Laura Dellazizzo ◽  
Stéphane Potvin ◽  
Mimosa Luigi ◽  
Alexandre Dumais
Keyword(s):  
Virtual Reality ◽  
Psychiatric Disorders ◽  
Skills Training ◽  
Neurocognitive Disorders ◽  
Evidence Based ◽  
Quality Of Evidence ◽  
Meta Review ◽  
Evidence Based Treatments ◽  
Meta Analyses

Background Among all diseases globally, mental illnesses are one of the major causes of burden. As many people are resistant to conventional evidence-based treatments, there is an unmet need for the implementation of novel mental health treatments. Efforts to increase the effectiveness and benefits of evidence-based psychotherapy in psychiatry have led to the emergence of virtual reality (VR)–based interventions. These interventions have shown a wide range of advantages over conventional psychotherapies. Currently, VR-based interventions have been developed mainly for anxiety-related disorders; however, they are also used for developmental disorders, severe mental disorders, and neurocognitive disorders. Objective This meta-review aims to summarize the current state of evidence on the efficacy of VR-based interventions for various psychiatric disorders by evaluating the quality of evidence provided by meta-analytical studies. Methods A systematic search was performed using the following electronic databases: PubMed, PsycINFO, Web of Science, and Google Scholar (any time until February 2020). Meta-analyses were included as long as they quantitatively examined the efficacy of VR-based interventions for symptoms of a psychiatric disorder. To avoid overlap among meta-analyses, for each subanalysis included within this meta-review, only one analysis provided from one meta-analysis was selected based on the best quality of evidence. Results The search retrieved 11 eligible meta-analyses. The quality of evidence varied from very low to moderate quality. Several reasons account for the lower quality evidence, such as a limited number of randomized controlled trials, lack of follow-up analysis or control group, and the presence of heterogeneity and publication bias. Nonetheless, evidence has shown that VR-based interventions for anxiety-related disorders display overall medium-to-large effects when compared with inactive controls but no significant difference when compared with standard evidence-based approaches. Preliminary data have highlighted that such effects appear to be sustained in time, and subjects may fare better than active controls. Neurocognitive disorders also appear to improve with VR-based approaches, with small effects being found for various clinical outcomes (eg, cognition, emotion). Finally, there are insufficient data to classify VR-based interventions as an evidence-based practice for social skills training in neurodevelopmental disorders and compliance among patients with schizophrenia. Conclusions VR provides unlimited opportunities by tailoring approaches to specific complex problems and individualizing the intervention. However, VR-based interventions have not shown superiority compared with usual evidence-based treatments. Future VR-based interventions should focus on developing innovative approaches for complex and treatment-resistant symptoms that are difficult to address with traditional treatments. Future research should also aim to gain a better understanding of the potential factors that may mediate VR outcomes to improve treatment.

scholarly journals A randomized controlled trial to compare two methods of constraint-induced movement therapy to improve functional ability in the affected upper limb in pre-school children with hemiplegic cerebral palsy: CATCH TRIAL

2018 ◽  
Vol 32 (7) ◽  
pp. 909-918 ◽  
Author(s):  
Pauline M Christmas ◽  
Catherine Sackley ◽  
Max G Feltham ◽  
Carole Cummins
Keyword(s):  
Randomized Controlled Trial ◽  
Cerebral Palsy ◽  
Upper Limb ◽  
Controlled Trial ◽  
Movement Therapy ◽  
Randomized Controlled ◽  
Upper Limb Function ◽  
Constraint Induced Movement Therapy ◽  
Hemiplegic Cerebral Palsy

Objective: To determine the feasibility and short-term efficacy of caregiver-directed constraint-induced movement therapy to improve upper limb function in young children with hemiplegic cerebral palsy. Design: Randomized controlled trial with masked assessment. Setting: Community paediatric therapy services. Subjects: Pre-school children with hemiplegic cerebral palsy. Interventions: Caregiver-directed constraint-induced movement therapy administered using either 24-hour short-arm restraint device (prolonged) or intermittent holding restraint during therapy (manual). Main measures: Primary measures include Assisting Hand Assessment (AHA) at 10 weeks. Secondary measures include adverse events, Quality of Upper Extremity Skills Test and Pediatric Quality of Life Inventory. Feasibility measures include recruitment, retention, data completeness and adherence. Results: About 62/81 (72%) of eligible patients in 16 centres were randomized (prolonged restraint n = 30; manual restraint n = 32) with 97% retention at 10 weeks. The mean change at 10 weeks on the AHA logit-based 0–100 unit was 9.0 (95% confidence interval (CI): 5.7, 12.4; P < 0.001) for prolonged restraint and 5.3 (95% CI: 1.3, 9.4; P = 0.01) for manual restraint with a mean group difference of 3.7 (95% CI: −1.5, 8.8; P = 0.156) (AHA smallest detectable difference = 5 units). No serious related adverse events were reported. There were no differences in secondary outcomes. More daily therapy was delivered with prolonged restraint (60 vs 30 minutes; P < 0.001). AHA data were complete at baseline and 10 weeks. Conclusion: Caregiver-directed constraint-induced movement therapy is feasible and associated with improvement in upper limb function at 10 weeks. More therapy was delivered with prolonged than with manual restraint, warranting further testing of this intervention in a longer term trial.

scholarly journals Effects of virtual reality training on upper limb function, balance, and walking ability in stroke patients: a systematic review and meta-meta analysis (Preprint)

2021 ◽  
Author(s):  
Jinlong Wu ◽  
Aihua Zeng ◽  
Ziyan Chen ◽  
Ye Wei ◽  
Kunlun Huang ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Upper Limb ◽  
Meta Analysis ◽  
Walking Ability ◽  
Stroke Patients ◽  
High Quality ◽  
Limb Function ◽  
Upper Limb Function ◽  
Vr Training ◽  
The Impact

BACKGROUND Virtual reality (VR) training is a promising intervention strategy, which has been utilized in healthcare fields like stroke rehabilitation and psychotherapy. The current study suggests that, VR training is effective in improving the locomotor ability of individuals with stroke patients. OBJECTIVE This is the first meta-meta-analysis of the effects of virtual reality on motor function in stroke patients. This study aimed to systematically summarize and quantify the present meta-analyses results of VR training, and produce high-quality meta-meta-analysis results to obtain a more accurate prediction. METHODS We searched four online databases (Web of Science, Scopus, PubMed, and Chinese National Knowledge Infrastructure) for the meta-analysis studies. After accounting for the overlap, ten studies (almost 550 stroke patients) were obtained. Based on the meta-meta-analysis of these patients, this study quantified the impact of VR training on stroke patients’ motor performance, mainly including upper limb function, balance, and walking ability. We combined the effects under the random effect model and pooled the estimates as standardized mean differences (SMD). RESULTS The results of the meta-meta analysis showed that VR intervention effectively improved the upper limb function (SMD= 4.606, 95% confidence interval (Cl): 2.733-6.479, P< 0.05) and balance (SMD=2.101, 95%Cl：0.202-4.000, P< 0.05) of stroke patients. However, the results showed considerable heterogeneity, and thus, may need to be treated with caution. Due to the limited research, the meta-meta-analysis of walking ability was not performed. CONCLUSIONS These findings represent a comprehensive body of high-quality evidence that, VR interventions were more effective at improving the upper limb function and balance of stroke patients.

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