Effectiveness of Virtual Reality on Functional Performance after Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

A spinal cord injury (SCI) usually results in a significant limitation in the functional outcomes, implying a challenge to the performance of activities of daily living. The main aim of this study is to analyze the effectiveness of virtual reality to improve functional performance in patients with SCI. The search was performed between October and December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Web of Science, and Embase. The methodological quality of the studies was evaluated through the PEDro scale, and the risk of bias was evaluated with the Cochrane collaboration’s tool. Seven articles were included in this systematic review, and five of them in the meta-analysis. Statistical analysis showed favorable results for functional performance in control group performing conventional therapy, measured by the functional independence measure (standardized mean difference (SMD)= −0.70; 95% confidence interval: −1.25 to −0.15). Results were inconclusive for other outcomes. Most studies have not shown beneficial effects on functional performance compared with conventional physical therapy. The results obtained showed that virtual reality may not be more effective than conventional physical therapy in improving functional performance in patients with SCI.

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Is Virtual Reality Effective for Balance Recovery in Patients with Spinal Cord Injury? A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9092861 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2861

Author(s):

Amaranta De Miguel-Rubio ◽

M. Dolores Rubio ◽

Alejandro Salazar ◽

Jose A. Moral-Munoz ◽

Francisco Requena ◽

...

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Virtual Reality ◽

Confidence Interval ◽

Meta Analysis ◽

Cochrane Central Register ◽

Cord Injury ◽

Functional Reach Test ◽

Evidence Database

Virtual reality (VR) is an emerging tool used in the neurological rehabilitation of patients with spinal cord injury (SCI), focused on recovering balance, mobility, and motor function, among other functional outcomes. The main objective of this study was to analyze the effectiveness of VR systems to recover balance in patients with SCI. The literature search was performed between October and December 2019 in the following databases: Embase, Web of Science, CINAHL, Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and the Cochrane Central Register of Controlled Trials. The methodological quality of each study was assessed using the Spinal Cord Injury Rehabilitation Evidence (SCIRE) system and the PEDro scale, while the risk of bias was analyzed by the Cochrane Collaboration’s tool. A total of 12 studies, involving 188 participants, were included in the systematic review, of which two were included in the meta-analysis. Statistical analysis showed favorable results for balance measured by the modified Functional Reach Test (standardized mean difference (SMD) = 3.42; 95% confidence interval: 2.54 to 4.29) and by the t-shirt test (SMD= −2.29; 95% confidence interval: −3.00 to −1.59). The results showed that VR interventions provided potential benefits, in addition to conventional physical therapy, to recover balance in patients with SCI.

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Virtual Reality Systems for Upper Limb Motor Function Recovery in Patients With Spinal Cord Injury: Systematic Review and Meta-Analysis (Preprint)

10.2196/preprints.22537 ◽

2020 ◽

Author(s):

Amaranta De Miguel-Rubio ◽

M Dolores Rubio ◽

Alvaro Alba-Rueda ◽

Alejandro Salazar ◽

Jose A Moral-Munoz ◽

...

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Virtual Reality ◽

Physical Therapy ◽

Motor Function ◽

Upper Limb ◽

Meta Analysis ◽

Current Evidence ◽

Cord Injury

BACKGROUND Patients with spinal cord injury (SCI) usually present with different motor impairments, including a deterioration of upper limb motor function (ULMF), that limit their performance of activities of daily living and reduce their quality of life. Virtual reality (VR) is being used in neurological rehabilitation for the assessment and treatment of the physical impairments of this condition. OBJECTIVE A systematic review and meta-analysis was conducted to evaluate the effectiveness of VR on ULMF in patients with SCI compared with conventional physical therapy. METHODS The search was performed from October to December 2019 in Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and Cochrane Central Register of Controlled Trials. The inclusion criteria of selected studies were as follows: (1) comprised adults with SCI, (2) included an intervention with VR, (3) compared VR intervention with conventional physical therapy, (4) reported outcomes related to ULMF, and (5) was a controlled clinical trial. The Cochrane Collaboration’s tool was used to evaluate the risk of bias. The RevMan 5.3 statistical software was used to obtain the meta-analysis according to the standardized mean difference (SMD) and 95% CIs. RESULTS Six articles were included in this systematic review. Four of them contributed information to the meta-analysis. A total of 105 subjects were analyzed. All of the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed nonsignificant results for the Nine-Hole Peg Test (SMD –0.93, 95% CI –1.95 to 0.09), muscle balance test (SMD –0.27, 95% CI –0.82 to 0.27), Motricity Index (SMD 0.16, 95% CI −0.37 to 0.68), Jebsen-Taylor Hand Function Test (JTHFT) subtests (writing, SMD –0.10, 95% CI –4.01 to 3.82; simulated page turning, SMD –0.99, 95% CI –2.01 to 0.02; simulated feeding, SMD –0.64, 95% CI –1.61 to 0.32; stacking checkers, SMD 0.99, 95% CI –0.02 to 2.00; picking up large light objects, SMD –0.42, 95% CI –1.37 to 0.54; and picking up large heavy objects, SMD 0.52, 95% CI –0.44 to 1.49), range of motion of shoulder abduction/adduction (SMD –0.23, 95% CI –1.48 to 1.03), shoulder flexion/extension (SMD 0.56, 95% CI –1.24 to 2.36), elbow flexion (SMD –0.36, 95% CI –1.14 to 0.42), elbow extension (SMD –0.21, 95% CI –0.99 to 0.57), wrist extension (SMD 1.44, 95% CI –2.19 to 5.06), and elbow supination (SMD –0.18, 95% CI –1.80 to 1.44). Favorable results were found for the JTHFT subtest picking up small common objects (SMD –1.33, 95% CI –2.42 to –0.24). CONCLUSIONS The current evidence for VR interventions to improve ULMF in patients with SCI is limited. Future studies employing immersive systems to identify the key aspects that increase the clinical impact of VR interventions are needed, as well as research to prove the benefits of the use of VR in the rehabilitation of patients with SCI in the clinical setting.

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Virtual Reality Systems for Upper Limb Motor Function Recovery in Patients With Spinal Cord Injury: Systematic Review and Meta-Analysis

JMIR mhealth and uhealth ◽

10.2196/22537 ◽

2020 ◽

Vol 8 (12) ◽

pp. e22537

Author(s):

Amaranta De Miguel-Rubio ◽

M Dolores Rubio ◽

Alvaro Alba-Rueda ◽

Alejandro Salazar ◽

Jose A Moral-Munoz ◽

...

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Virtual Reality ◽

Physical Therapy ◽

Motor Function ◽

Upper Limb ◽

Meta Analysis ◽

Current Evidence ◽

Cord Injury

Background Patients with spinal cord injury (SCI) usually present with different motor impairments, including a deterioration of upper limb motor function (ULMF), that limit their performance of activities of daily living and reduce their quality of life. Virtual reality (VR) is being used in neurological rehabilitation for the assessment and treatment of the physical impairments of this condition. Objective A systematic review and meta-analysis was conducted to evaluate the effectiveness of VR on ULMF in patients with SCI compared with conventional physical therapy. Methods The search was performed from October to December 2019 in Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and Cochrane Central Register of Controlled Trials. The inclusion criteria of selected studies were as follows: (1) comprised adults with SCI, (2) included an intervention with VR, (3) compared VR intervention with conventional physical therapy, (4) reported outcomes related to ULMF, and (5) was a controlled clinical trial. The Cochrane Collaboration’s tool was used to evaluate the risk of bias. The RevMan 5.3 statistical software was used to obtain the meta-analysis according to the standardized mean difference (SMD) and 95% CIs. Results Six articles were included in this systematic review. Four of them contributed information to the meta-analysis. A total of 105 subjects were analyzed. All of the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed nonsignificant results for the Nine-Hole Peg Test (SMD –0.93, 95% CI –1.95 to 0.09), muscle balance test (SMD –0.27, 95% CI –0.82 to 0.27), Motricity Index (SMD 0.16, 95% CI −0.37 to 0.68), Jebsen-Taylor Hand Function Test (JTHFT) subtests (writing, SMD –0.10, 95% CI –4.01 to 3.82; simulated page turning, SMD –0.99, 95% CI –2.01 to 0.02; simulated feeding, SMD –0.64, 95% CI –1.61 to 0.32; stacking checkers, SMD 0.99, 95% CI –0.02 to 2.00; picking up large light objects, SMD –0.42, 95% CI –1.37 to 0.54; and picking up large heavy objects, SMD 0.52, 95% CI –0.44 to 1.49), range of motion of shoulder abduction/adduction (SMD –0.23, 95% CI –1.48 to 1.03), shoulder flexion/extension (SMD 0.56, 95% CI –1.24 to 2.36), elbow flexion (SMD –0.36, 95% CI –1.14 to 0.42), elbow extension (SMD –0.21, 95% CI –0.99 to 0.57), wrist extension (SMD 1.44, 95% CI –2.19 to 5.06), and elbow supination (SMD –0.18, 95% CI –1.80 to 1.44). Favorable results were found for the JTHFT subtest picking up small common objects (SMD –1.33, 95% CI –2.42 to –0.24). Conclusions The current evidence for VR interventions to improve ULMF in patients with SCI is limited. Future studies employing immersive systems to identify the key aspects that increase the clinical impact of VR interventions are needed, as well as research to prove the benefits of the use of VR in the rehabilitation of patients with SCI in the clinical setting.

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