The use of virtual reality (VR) therapies for the rehabilitation of patients who have experienced a stroke has demonstrated promise in some instances, according to study findings published in the Journal of Stroke and Cerebrovascular Diseases.
The researchers conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effectiveness of various types of VR therapies — as either immersive virtual reality (IVR) or nonimmersive virtual reality (NIVR) —compared with conventional therapy (CT) for improving the status of patients who have experienced a stroke.
VR can be categorized as being either immersive or nonimmersive. IVR replaces a user’s real-world environment with a simulated, imaginary environment. In NIVR, the user interacts mainly with virtual objects displayed either in a two-dimensional or a three-dimensional environment that can be manipulated directly on a conventional graphics workstation with the use of a keyboard and a mouse.
Eligibility criteria for the articles included in the meta-analysis were as follows: (1) an RCT; (2) participants older than 18 years of age who were affected by a neurologic disorder; (3) comparison of computer-mediated treatments vs CT; (4) upper limb or lower limb motor functions evaluated; (5) or postural control evaluated. The comprehensive systematic search was initiated in May 2020. All of the articles selected were classified as low risk, moderate risk, or high risk for bias, based on the number of items that received a negative appraisal by the 2 review authors.
A total of 22 RCTs were included in the current review. Per Critical Appraisal Skills Programme (CASP) guidelines for an RCT, 2 of the studies were considered to be at a high risk for bias, 17 at a moderate risk for bias, and 3 at a low risk for bias.
Of all the RCTs, 7 trials had a sample size of more than 50 participants and 6 trials had less than 25 participants. The mean patient age in the majority of the studies included in the analysis was between 29 and 75 years, with most of the participants relatively young.
Overall, 3 RCTs showed that IVR improved upper limb activity, function, and activities of daily living (ADL) in a way that was comparable to that with CT. A total of 18 RCTs demonstrated that NIVR had similar benefits to CT with respect to upper limb activity and function, balance and mobility, participation, and ADL. A comparison among the different forms of VR demonstrated that IVR may be more beneficial than NIVR for upper limb training and ADL. No evidence was available, however, regarding the durability of IVR therapy.
Study limitations included the fact that high heterogeneity in the data rendered it difficult to perform a meta-analysis of results for some of the outcomes of interest. Further, a high diversity existed between the VR training scenarios, which made it difficult to compare results across the studies.
“We recommend larger studies in the future, with power calculations pointing to more than 25 participants per group,” the researchers stated, in order to explore the long-term efficacy and promising benefits of the IVR technology.
Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.
Mugisha S, Job M, Zoppi M, Testa M, Molfino R. Computer-mediated therapies for stroke rehabilitation: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis. Published online March 31, 2022. doi:10.1016/j.jstrokecerebrovasdis.2022.106454