Effectiveness of Virtual Reality in Occupational Therapy for Post-Stroke Adults: A Systematic Review
Abstract
:1. Introduction
2. Methods
2.1. Protocol and Registration
2.2. Eligibility
2.3. Inclusion Criteria
- Study Design: RCTs with pre- and postintervention assessments. Only original research articles reporting primary data were included.
- Population: Studies involving human participants diagnosed with CVA and sequelae, with a mean age of 18 years or older, and with no discrimination based on gender. The focus should be on adults with sequelae from CVA.
- Interventions: Interventions utilizing VR specifically for recovery after CVA for a duration of six weeks. The interventions can be VR alone or VR combined with conventional rehabilitation.
- Outcome Measures: Studies that report at least one evaluation related to quality of life, routine activities, or functional performance.
- Comparison: Interventions should include a control group, with or without the use of VR.
2.4. Exclusion Criteria
- Publication Type: Reviews, editorials, commentaries, conference abstracts, books, book chapters, letters to the editor, protocols, trials, and case studies.
- Data Quality: Studies lacking detailed information on outcomes of interest, methodological clarity, or with insufficient initial data and/or lack of further monitoring.
- Study Design: Non-randomized controlled trials, retrospective studies, cross-sectional studies, and prospective studies.
- Animal Studies: Studies conducted on animal models.
- Duplicate Publications: Duplicate studies reporting data from the same cohort or dataset.
- Comparison: Absence of a control group in the study.
2.5. Database Search Process
2.6. Study Selection and Data Collection Process
2.7. Methodological Quality Assessment
2.8. Data Synthesis
2.9. Risk of Bias Assessment
2.10. Measures for Meta-Analysis
2.11. Certainty of Evidence
3. Results
3.1. Study Selection
3.2. Methodological Quality Evaluation
3.3. Risk of Bias within Studies
3.4. Characteristics of the Studies
3.5. Sample Characteristics
3.6. Dosage and Interventions Performed
3.7. Data Collection Instruments
3.8. Adverse Effects and Adherence
3.9. Certainty of Evidence
4. Discussion
4.1. Data Collection Instruments Used
4.2. Types of Interventions
4.3. Outcomes Reported and GRADE Assessment
4.4. Strengths and Future Directions
4.5. Limitations
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Criteria | Inclusion | Exclusion |
---|---|---|
Population | Adults with sequelae after a CVA considered as participants, with a mean age of 18 years or older, and with no discrimination based on gender | Adults with pathologies other than stroke or people younger than 18 years old |
Intervention | Interventions used VR for recovery for six weeks after CVA | Method did not contain VR interventions for recovery after a stroke |
Comparison | Interventions included a CG, with or without the use of VR | Absence of CG |
Outcomes | At least one evaluation of quality of life, routine activities, or functional performance | Insufficient initial data and/or further monitoring |
Study design | RCT with pre- and post-assessment | Non-RCT, retrospective, cross-sectional and prospective studies |
References | Name of Study | Type of Study | Level of Evidence According to Oxford Classification |
---|---|---|---|
[15] | Can specific virtual reality combined with conventional rehabilitation improve poststroke hand motor function? A randomized clinical trial | RCT | 1a |
[16] | Canoe game-based virtual reality training to improve trunk postural stability, balance, and upper limb motor function in subacute stroke patients: A randomized controlled pilot study | RCT | 1a |
[17] | Effects of game-based virtual reality on health-related quality of life in chronic stroke patients: A randomized, controlled study | RCT | 1a |
[18] | Effects of Specific Virtual Reality-Based Therapy for the Rehabilitation of the Upper Limb Motor Function Post-Ictus: Randomized Controlled Trial | RCT | 1a |
[19] | Effects of virtual reality-based motor control training on inflammation, oxidative stress, neuroplasticity and upper limb motor function in patients with chronic stroke: a randomized controlled trial | RCT | 1a |
[20] | Effects of virtual reality-based planar motion exercises on upper extremity function, range of motion, and health-related quality of life: A multicenter, single-blinded, randomized, controlled pilot study | RCT | 1a |
[21] | Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: A single-blinded, randomized controlled trial | RCT | 1a |
[22] | Effects of virtual reality-based therapy on quality of life of patients with subacute stroke: A three-month follow-up randomized controlled trial | RCT | 1a |
[23] | Efficacy of Virtual Reality Combined with Real Instrument Training for Patients with Stroke: A Randomized Controlled Trial | RCT | 1a |
[24] | Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: Evidence from a randomized controlled | RCT | 1a |
[25] | Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke? An analysis of treatment intensity and content | RCT | 1a |
[26] | Mobile game-based virtual reality program for upper extremity stroke rehabilitation | RCT | 1a |
[27] | Telehealth-Guided Virtual Reality for Recovery of Upper Extremity Function Following Stroke | RCT | 1a |
[28] | Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke | RCT | 1a |
[29] | Virtual reality training for upper extremity in subacute stroke (VIRTUES): Study protocol for a randomized controlled multicenter trial | RCT | 1a |
[30] | Virtual reality training with cognitive load improves walking function in chronic stroke patients | RCT | 1a |
References | Study Design | Population Settings | Type of Virtual Technology Used | Main Aim | Intervention | Main Findings |
---|---|---|---|---|---|---|
[15] | RCT | Total: 43, EG: 23, CG: 20, Middle age: 60, Women: 30, Men: 13 | Specific virtual reality | To improve hand motor function post-CVA using CT and VR | 15 OT sessions over 3 weeks, 150 min each | Improved motor function using SVR compared to CT |
[16] | RCT | Total: 10, EG: 5, CG: 5, Middle age: 62, Women: 7, Men: 3 | Canoe game- based VR | To improve trunk stability and UUEE function post-CVA using VR | 12 OT sessions over 4 weeks, 30 min/day | Positive impact on trunk stability and motor function using VR |
[17] | RCT | Total: 32, EG: 16, CG: 16, Middle age: 57, Women: 20, Men: 12 | Rehab Master system VR | To improve HRQoL, depression, and UUEE function using VR and OT | 20 OT sessions over 4 weeks, 30 min/day | Enhanced quality of life and UUEE function using VR + OT compared to OT |
[18] | RCT | Total: 43, EG: 23, CG: 20, Middle age: 59, Women: 30, Men: 13 | Virtual reality | To improve UUEE motor function post-CVA using physical therapy + OT + SVR | 15 OT sessions over 3 weeks, 150 min each | Significant improvement in motor function using physical therapy + OT + SVR compared to physical therapy + OT |
[19] | RCT | Total: 30, EG: 15, CG: 15, Middle age: 59, Women: 20, Men: 10 | Immersive VR | To enhance motor control and reduce inflammation post-CVA using VR | 16 OT sessions, 60 min/day, 2–3 days/week, in addition to attending regular occupational therapy | Improved motor control and reduced inflammation |
[20] | RCT | Total: 25, EG: 12, CG: 13, Middle age: 65, Women: 20, Men: 5 | Planar motion VR | To evaluate feasibility for UUEE intervention using VR | 20 OT sessions over 4 weeks, 30 min/day | Promising feasibility for UUEE rehabilitation using VR + OT compared to OT |
[21] | RCT | Total: 33, EG: 20, CG: 13, Middle age: 60, Women: 20, Men: 13 | VR-based OT | To improve distal UUEE function and HRQoL using VR + OT in CVA survivors | 20 OT sessions over 4 weeks, 30 min/day | Better distal function and quality of life using VR + OT compared to OT |
[22] | RCT | Total: 43, EG: 23, CG: 20, Middle age: 63, Women: 31, Men: 12 | Virtual reality | To enhance post-CVA HRQoL using CT + VR | 15 OT sessions over 3 weeks, 150 min each | Improved health-related quality of life using CT + VR |
[23] | RCT | Total: 31, EG: 17, CG: 14, Middle age: 59, Women: 11, Men: 10 | Joystim VR | To improve cognitive and UUEE function post-CVA using VR | 18 OT sessions over 6 weeks, 30 min/day | Positive impact on cognitive and motor functions using VR |
[24] | RCT | Total: 21, EG: 10, CG: 11, Middle age: 63, Women: 5, Men: 16 | Elements VR | Rehabilitate motor and cognitive functions using VR | 12 OT sessions over 4 weeks, 30–40 min each | Effective for motor and cognitive rehabilitation using VR |
[25] | RCT | Total: 50, EG: 25, CG: 25, Middle age: 62, Women: 31, Men: 29 | YouGrabber system VR | To compare VR training intensity with CT | 16 OT sessions over 4 weeks, 45–60 min/day | Comparable intensity with CT |
[26] | RCT | Total: 24, EG: 12, CG: 12, Middle age: 61, Women: 12, Men: 12 | Mobile game VR | To develop mobile game-based VR program | 10 OT sessions over 2 weeks | Promising for upper-extremity rehabilitation using a mobile game-based VRprogram |
[27] | RCT | Total: 18, EG: 9, CG: 9, Middle age: 67, Women: 17, Men: 11 | GRASP system VR | To evaluate home-based VR program for UUEE recovery post-CVA | 16 OT sessions over 8 weeks, 4 sessions/week | Home-based VR program resulted in effective UUEE recovery post-CVA |
[28] | RCT | Total: 14, EG: 7, CG: 7, Middle age: 60, Women: 8, Men: 6 | Mechatronic VR system | To improve fine motor control post-CVA using a mobile game-based VR program | 18 OT sessions over 6 weeks, 60 min/day | Improved fine motor control post-CVA |
[29] | RCT | Total: 106, EG: 53, CG: 53, Middle age: 62, Women: 50, Men: 56 | Virtual reality | To compare VR + CT vs. CT to improve arm motor function after CVA | 20 OT sessions over 4 weeks, 45–60 min/day | Improve arm motor function post-CVA using VR + CT compared to CT |
[30] | RCT | Total: 22, EG: 11, CG: 11, Middle age: 60, Women: 10, Men: 12 | Virtual reality | Compare VR vs. conventional physical therapy and OT | 30 OT sessions over 6 weeks, 30 min/day | Significant improvement in walking function using VR |
Certainty of Evidence | No. of Patients | Effect | Certainty | Importance | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
References | Study Design | Risk Assessment | Inconsistency | Indirect Evidence | Vagueness | Other Considerations | [Conventional Therapy plus Virtual Reality] | [Conventional Therapy] | Relative (95% CI) | ||
Rodríguez et al. [15] | RCT | Not serious | Not serious | Not serious | Not serious | None | 23/46 (50%) | 23/46 (50%) | Not estimable | ++++ High | IMPORTANT |
Lee et al. [16] | RCT | Not serious | Not serious | Not serious | Not serious | None | 5/10 (50%) | 5/10 (50%) | Not estimable | ++++ High | IMPORTANT |
Shin et al. [17] | RCT | Not serious | Not serious | Not serious | Not serious | None | 8/16 (50%) | 8/16 (50%) | Not estimable | ++++ High | IMPORTANT |
Rodríguez et al. [18] | RCT | Serious a | Serious | Not serious | Not serious | Publication bias seriously suspected a | 23/43 (53.5%) | 20/43 (46.5%) | Not estimable | + Very low | IMPORTANT |
Huang et al. [19] | RCT | Not serious | Not serious | Not serious | Not serious | None | 15/30 (50%) | 15/30 (50%) | Not estimable | ++++ High | IMPORTANT |
Park et al. [20] | RCT | Not serious | Not serious | Not serious | Not serious | None | 12/25 (48%) | 13/25 (52%) | Not estimable | ++++ High | IMPORTANT |
Shin et al. [21] | RCT | Not serious | Not serious | Not serious | Not serious | None | 23/46 (50%) | 23/46 (50%) | Not estimable | ++++ High | IMPORTANT |
Rodríguez et al. [22] | RCT | Not serious | Not serious | Not serious | Not serious | None | 23/46 (50%) | 23/46 (50%) | Not estimable | ++++ High | IMPORTANT |
Oh et al. [23] | RCT | Not serious | Not serious | Not serious | Not serious | None | 17/31 (54.8%) | 14/31 (45.2%) | Not estimable | ++++ High | IMPORTANT |
Rogers et al. [24] | RCT | Very serious b | Serious b | Serious b | Not serious | None | 10/21 (47.6%) | 11/21 (52.4%) | Not estimable | + Very low | IMPORTANT |
Brunner et al. [25] | RCT | Not serious | Not serious | Not serious | Not serious | None | 25/50 (50%) | 25/50 (50%) | Not estimable | ++++ High | IMPORTANT |
Choi et al. [26] | RCT | Not serious | Not serious | Not serious | Not serious | None | 12/24 (50%) | 12/24 (50%) | Not estimable | ++++ High | IMPORTANT |
Adams et al. [27] | RCT | Not serious | Not serious | Not serious | Not serious | None | 9/18 (50%) | 9/18 (50%) | Not estimable | ++++ High | IMPORTANT |
Thielbar et al. [28] | RCT | Serious c | Not serious | Serious | Not serious | None | 8/16 (50%) | 8/16 (50%) | Not estimable | ++ Low | IMPORTANT |
Brunner et al. [29] | RCT | Not serious | Not serious | Not serious | Not serious | None | 60/120 (50%) | 60/120 (50%) | Not estimable | ++++ High | IMPORTANT |
Cho et al. [30] | RCT | Not serious | Not serious | Not serious | Not serious | None | 12/24 (50%) | 12/24 (50%) | Not estimable | ++++ High | IMPORTANT |
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Share and Cite
Landim, S.F.; López, R.; Caris, A.; Castro, C.; Castillo, R.D.; Avello, D.; Magnani Branco, B.H.; Valdés-Badilla, P.; Carmine, F.; Sandoval, C.; et al. Effectiveness of Virtual Reality in Occupational Therapy for Post-Stroke Adults: A Systematic Review. J. Clin. Med. 2024, 13, 4615. https://doi.org/10.3390/jcm13164615
Landim SF, López R, Caris A, Castro C, Castillo RD, Avello D, Magnani Branco BH, Valdés-Badilla P, Carmine F, Sandoval C, et al. Effectiveness of Virtual Reality in Occupational Therapy for Post-Stroke Adults: A Systematic Review. Journal of Clinical Medicine. 2024; 13(16):4615. https://doi.org/10.3390/jcm13164615
Chicago/Turabian StyleLandim, Síbila Floriano, Roberto López, Antonia Caris, Constanza Castro, Ramon D. Castillo, Daniela Avello, Braulio Henrique Magnani Branco, Pablo Valdés-Badilla, Florencia Carmine, Cristian Sandoval, and et al. 2024. "Effectiveness of Virtual Reality in Occupational Therapy for Post-Stroke Adults: A Systematic Review" Journal of Clinical Medicine 13, no. 16: 4615. https://doi.org/10.3390/jcm13164615