Virtual Reality for Stroke Rehabilitation
2018; Lippincott Williams & Wilkins; Volume: 49; Issue: 4 Linguagem: Inglês
10.1161/strokeaha.117.020275
ISSN1524-4628
AutoresKate Laver, Belinda Lange, Stacey George, Judith E. Deutsch, Gustavo Saposnik, Maria Crotty,
Tópico(s)Cerebral Palsy and Movement Disorders
ResumoHomeStrokeVol. 49, No. 4Virtual Reality for Stroke Rehabilitation Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBVirtual Reality for Stroke Rehabilitation Kate E. Laver, BAppSc (OT), MClinRehab, PhD, Belinda Lange, BSc, BPhysio, PhD, Stacey George, BAppSc (OT), MHSc (OT), PhD, Judith E. Deutsch, BA, MS (PT), PhD, FAPTA, Gustavo Saposnik, MD, FRCPC, PhDc, MSc and Maria Crotty, BA, BMed, MPH, PhD, FAFRM Kate E. LaverKate E. Laver From the College of Medicine and Public Health (K.E.L., M.C.), College of Nursing and Health Sciences (B.L., S.G.), Flinders University, Adelaide, Australia; Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ (J.E.D.); and Department of Medicine, University of Toronto, ON, Canada (G.S.). , Belinda LangeBelinda Lange From the College of Medicine and Public Health (K.E.L., M.C.), College of Nursing and Health Sciences (B.L., S.G.), Flinders University, Adelaide, Australia; Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ (J.E.D.); and Department of Medicine, University of Toronto, ON, Canada (G.S.). , Stacey GeorgeStacey George From the College of Medicine and Public Health (K.E.L., M.C.), College of Nursing and Health Sciences (B.L., S.G.), Flinders University, Adelaide, Australia; Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ (J.E.D.); and Department of Medicine, University of Toronto, ON, Canada (G.S.). , Judith E. DeutschJudith E. Deutsch From the College of Medicine and Public Health (K.E.L., M.C.), College of Nursing and Health Sciences (B.L., S.G.), Flinders University, Adelaide, Australia; Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ (J.E.D.); and Department of Medicine, University of Toronto, ON, Canada (G.S.). , Gustavo SaposnikGustavo Saposnik From the College of Medicine and Public Health (K.E.L., M.C.), College of Nursing and Health Sciences (B.L., S.G.), Flinders University, Adelaide, Australia; Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ (J.E.D.); and Department of Medicine, University of Toronto, ON, Canada (G.S.). and Maria CrottyMaria Crotty From the College of Medicine and Public Health (K.E.L., M.C.), College of Nursing and Health Sciences (B.L., S.G.), Flinders University, Adelaide, Australia; Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ (J.E.D.); and Department of Medicine, University of Toronto, ON, Canada (G.S.). Originally published2 Mar 2018https://doi.org/10.1161/STROKEAHA.117.020275Stroke. 2018;49:e160–e161Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2018: Previous Version 1 The use of virtual reality programs specifically designed for stroke rehabilitation is increasing as is the use of commercial video game devices in clinical settings. This review is an update of our review published first in 2011 and then in 2015.1ObjectivesThe primary objective of this review was to examine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. Our secondary objective was to examine the efficacy on gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events.MethodsWe searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and 7 additional databases as well as trials registries. We included randomized and quasi-randomized trials of virtual reality in adults after stroke. The primary outcome of interest was upper limb function and activity. Two review authors independently selected trials, extracted data, and assessed risk of bias with input from a third author to moderate disagreements when required.Main ResultsA total of 72 trials (with 2470 participants) were included in the review. This review includes 35 new studies in addition to the studies included in the previous version of this review (published in 2015). Most studies involved small sample sizes and interventions varied in terms of both the goals of treatment and the virtual reality program or device used. Although there are a relatively large number of randomized controlled trials, the evidence remains mostly low quality when rated using the GRADE system because of the risk of bias in the studies and inconsistent findings between studies. Control groups in the included studies usually received either no therapy or conventional therapy which was provided by an occupational therapist or physiotherapist. Primary outcome: when virtual reality was compared with the same dose of conventional therapy the results were not statistically significant for upper limb function (standardized mean difference, 0.07; 95% confidence interval, −0.05–0.20; 22 studies, 1038 participants, low-quality evidence). However, when virtual reality was used to supplement usual care (thereby providing participants in the intervention group with a higher dose of therapy), there was a statistically significant difference between groups (standardized mean difference, 0.49; 95% confidence interval, 0.21–0.77, 10 studies, 210 participants, low-quality evidence). Secondary outcomes: when compared with conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living outcome (standardized mean difference, 0.25; 95% confidence interval, 0.06–0.43; 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. There were few adverse events experienced in the 23 studies which reported on this and adverse events were relatively mild. There was a trend suggesting that customized virtual reality programs were preferable to commercial game products, however, these findings were not statistically significant (Figure).Download figureDownload PowerPointFigure. Virtual reality versus conventional therapy: upper limb function: subgroup analyses, specialized, or gaming program. CI indicates confidence interval.Implications for PracticeWe found that virtual reality therapy may not be more effective than conventional therapy for upper limb outcomes, but there is low-quality evidence that virtual reality may be used to improve outcomes in the absence of other therapy interventions after stroke. Clinicians who currently have access to virtual reality programs should be reassured that their use as part of a comprehensive rehabilitation program seems reasonable, taking into account the patient's goals, abilities, and preferences.Sources of FundingDr Laver is supported by a National Health and Medical Research Council-Australian Research Council fellowship. Dr Saposnik is supported by the 2017 to 2021 Heart and Stroke Foundation of Canada Career Award following an open and peer-reviewed competition. He also served as the Topic Editor for the Emerging Therapies Section (Stroke Journal).DisclosuresNone.FootnotesThis paper is based on a Cochrane Review published in The Cochrane Library 2017, Issue 11 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.Correspondence to Kate E. Laver, BAppSc (OT), MClinRehab, PhD, Department of Rehabilitation Aged and Extended Care, Flinders University, GPO Box 2100, Adelaide 5001, Australia. E-mail [email protected].Reference1. Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation.Cochrane Database Syst Rev. 2017; 11:CD008349. doi: 10.1002/14651858.CD008349.pub4.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hsieh Y, Lee M, Chen C, Hsu F and Wu C (2022) Development and user experience of an innovative multi-mode stroke rehabilitation system for the arm and hand for patients with stroke, Scientific Reports, 10.1038/s41598-022-05314-8, 12:1, Online publication date: 1-Dec-2022. Mo J, Vickerstaff V, Minton O, Tavabie S, Taubert M, Stone P and White N (2022) How effective is virtual reality technology in palliative care? 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Vardhan M, Shi H, Gounley J, James Chen S, Kahn A, Leopold J and Randles A (2019) Investigating the Role of VR in a Simulation-Based Medical Planning System for Coronary Interventions Medical Image Computing and Computer Assisted Intervention – MICCAI 2019, 10.1007/978-3-030-32254-0_41, (366-374), . Lin D, Finklestein S and Cramer S (2018) New Directions in Treatments Targeting Stroke Recovery, Stroke, 49:12, (3107-3114), Online publication date: 1-Dec-2018. April 2018Vol 49, Issue 4 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.117.020275 Manuscript receivedDecember 13, 2017Manuscript acceptedDecember 21, 2017Originally publishedMarch 2, 2018Manuscript revisedDecember 13, 2017 Keywordsstrokevirtual realityrehabilitationvideo gamesactivities of daily livingPDF download Advertisement SubjectsCerebrovascular Disease/StrokeHealth ServicesRehabilitation
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