JMIR Publications

ABSTRACT

Background:

In the field of physiotherapy, it is essential to acquire updated and comprehensive knowledge of the effectiveness of virtual reality (VR) methods in improving balance and walking among individuals with stroke. These are main prerequisites for successful transitions which still may enable independent participation in one’s own everyday life and society activities in terms of movement. The effectiveness of VR training as part of the therapeutic exercise treatment has not yet been extensively studied by focusing only on persons with persons with chronic stroke. There is lack of information on balance and walking outcomes at the level of activity and participation according to the International Classification of Functioning, Disability, and Health framework and how intervention-related factors influence rehabilitation outcomes.

Objective:

The aim of this systematic review, meta-analysis and meta regression of randomized controlled trials (RCTs) was to study the effectiveness of therapeutic exercise interventions VR training on balance and walking at the level of activity and participation among persons with chronic stroke compared to control groups: no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without the use of VR.

Methods:

The inclusion criteria were developed based on the PICOS-framework. Participants: Adults with a stroke diagnosis for more than six months. Intervention: Therapeutic exercises in the VR environment, with VR glasses or using interactive games. Outcome measures: Berg’s Balance Scale (BBS), Functional Reach Test (FRT), Activities-specific Balance Confidence Scale (ABC), Six-minute walk test (6MWT), Two-minute walk test (2MWT), 10 metre walk test (10mWT) and cadence. Covariates of metaregression related to the content of the experimental and control groups, primary outcomes, and the levels of immersion of VR.

Results:

43 RCT studies and 1,136 persons were included in this review. The use of VR training in therapeutic exercise interventions had a large effect on balance (0.51; 95 % CI: 0.29 to 0.72, p < 0.001) and moderate effect on walking (0.31; 95 % CI: 0.09 to 0.53, p = 0.006) in persons with chronic stroke compared to pooled control groups. According to meta-regression findings, content of VR interventions or control groups, nor used immersion level of VR were not significantly related to the pooled balance or walking outcomes. The GRADE (the grading of recommendations, assessment, development and evaluations) was moderate on balance and low on walking.

Conclusions:

Therapeutic exercise training with VR in physiotherapy, had positive, but moderate effect on balance and low effect on walking in level of activity (capacity), even in chronic state of stroke, without serious side effects. The results are applicable on working aged stroke rehabilitees with the ability to walk without assistance. More research is needed with determined VR methods and with outcomes that measure performance at the level of real-life participation. Clinical Trial: The protocol of our systematic review has been published in Prospero’s International Registry Impact Research (CRD42020184572).