Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 23, 2024
Date Accepted: Jan 6, 2025
Virtual Reality Enhanced Exercise Training in Upper Limb Function of Patients with Stroke: A Meta-Analytic Study
ABSTRACT
Background:
Recovery of upper limb function after stroke is vital for patients’ independent daily living and quality of life. VR is a promising computer technology designed to reinforce the impact of rehabilitation, but the equivocal results of VR-based interventions are apparent.
Objective:
The study aimed to review the plausible factors that would have influenced VR’s therapeutic effects on improving upper limb function in post-stroke patients, with the goal of synthesizing an optimal VR intervention protocol.
Methods:
The databases PubMed, EMBASE, Web of Science, and Cochrane Library were queried for English-language papers published between the beginning of May 2022. Two reviewers independently extracted the data from the included papers. Discrepancies in the content between the two reviewers were resolved by reaching a consensus in joint meetings. The bias risk was assessed using the Physiotherapy Evidence Database (PEDro) Scale and the Methodological Index for Non-randomised Studies (MINORS).
Results:
The final sample consisted of 15 articles with 1,243 participants (mean age range 48.6 to 75.59). Participants in the virtual reality therapy group (VRT, n=455) showed significantly more improvement than those in the conventional therapy group (CON, n=301) on the recovery of upper limb function and independence of activities of daily living. The younger patients (MD=5.34, 95% CI=[2.18 to 8.5]; P < .001), greater than 15 hours of intervention (MD=9.67, 95% CI=[4.19 to 15.15]; P < .001), trial length > 4 weeks (MD=4.02, 95%CI=[1.39 to 6.65]; P < .001), and > 4 sessions/week (MD=3.48, 95%CI=[0.87 to 6.09]; P < .001) were the significant factors contributing to greater improvements in upper limb function, whereas the design of the VR content in terms of the number of features did not show significant effects.
Conclusions:
Larger VR effects on improving post-stroke patients’ upper limb function were associated with higher training dosage (longer than 15 hours) delivered within four to six weeks, and shorter sessions (around one hour) scheduled for four or more times in one week. Besides, younger patients may benefit more from the VR protocol than older patients.
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