Department of Nursing, People's Hospital of Deyang, Deyang, Sichuan, China.
School of Nursing, Southwest Medical University, Luzhou, Sichuan, China.
PLoS One. 2019 Nov 7;14(11):e0224819. doi: 10.1371/journal.pone.0224819. eCollection 2019.
In recent years, virtual reality (VR) has been tested as a therapeutic tool in neurorehabilitation research. However, the impact effectiveness of VR technology on for Parkinson's Disease (PD) patients is still remains controversial unclear. In order to provide a more scientific basis for rehabilitation of PD patients' modality, we conducted a systematic review of VR rehabilitation training for PD patients and focused on the improvement of gait and balance.
An comprehensive search was conducted using the following databases: PubMed, Web of Science, Cochrane Library, CINHAL, Embase and CNKI (China National Knowledge Infrastructure).Articles published before 30 December 2018 and of a randomized controlled trial design to study the effects of VR for patients with PD were included. The study data were pooled and a meta-analysis was completed. This systematic review was conducted in accordance with the PRISMA guideline statement and was registered in the PROSPERO database (CRD42018110264).
A total of sixteen articles involving 555 participants with PD were included in our analysis. VR rehabilitation training performed better than conventional or traditional rehabilitation training in three aspects: step and stride length (SMD = 0.72, 95%CI = 0.40,1.04, Z = 4.38, P<0.01), balance function (SMD = 0.22, 95%CI = 0.01,0.42, Z = 2.09, P = 0.037), and mobility(MD = -1.95, 95%CI = -2.81,-1.08, Z = 4.41, P<0.01). There was no effect on the dynamic gait index (SMD = -0.15, 95%CI = -0.50,0.19, Z = 0.86, P = 0.387), and gait speed (SMD = 0.19, 95%CI = -0.03,0.40, Z = 1.71, P = 0.088).As for the secondary outcomes, compared with the control group, VR rehabilitation training demonstrated more significant effects on the improvement of quality of life (SMD = -0.47, 95%CI = -0.73,-0.22, Z = 3.64, P<0.01), level of confidence (SMD = -0.73, 95%CI = -1.43,-0.03, Z = 2.05, P = 0.040), and neuropsychiatric symptoms (SMD = -0.96, 95%CI = -1.27,-0.65, Z = 6.07, P<0.01), while it may have similar effects on global motor function (SMD = -0.50, 95%CI = -1.48,0.48, Z = 0.99, P = 0.32), activities of daily living (SMD = 0.25, 95%CI = -0.14,0.64, Z = 1.24, P = 0.216), and cognitive function (SMD = 0.21, 95%CI = -0.28,0.69, Z = 0.84, P = 0.399).During the included interventions, four patients developed mild dizziness and one patient developed severe dizziness and vomiting.
According to the results of this study, we found that VR rehabilitation training can not only achieve the same effect as conventional rehabilitation training. Moreover, it has better performance on gait and balance in patients with PD. Taken together, when the effect of traditional rehabilitation training on gait and balance of PD patients is not good enough, we believe that VR rehabilitation training can at least be used as an alternative therapy. More rigorous design of large-sample, multicenter randomized controlled trials are needed to provide a stronger evidence-based basis for verifying its potential advantages.
近年来，虚拟现实（VR）已被测试作为神经康复研究中的一种治疗工具。然而，VR 技术对帕金森病（PD）患者的影响效果仍存在争议。为了为 PD 患者的康复模式提供更科学的依据，我们对 VR 康复训练对 PD 患者的影响进行了系统评价，重点关注步态和平衡的改善。
我们使用以下数据库进行全面搜索：PubMed、Web of Science、Cochrane Library、CINHAL、Embase 和 CNKI（中国国家知识基础设施）。纳入的研究为随机对照试验设计，旨在研究 VR 对 PD 患者的影响，且研究数据需在 2018 年 12 月 30 日之前发表。使用荟萃分析完成研究数据的汇总。本系统评价符合 PRISMA 指南声明，并在 PROSPERO 数据库（CRD42018110264）中进行了注册。
我们的分析共纳入了 16 篇涉及 555 名 PD 患者的文章。与常规或传统康复训练相比，VR 康复训练在以下三个方面表现更好：步幅和步长（SMD=0.72，95%CI=0.40,1.04，Z=4.38，P<0.01）、平衡功能（SMD=0.22，95%CI=0.01,0.42，Z=2.09，P=0.037）和活动能力（MD=-1.95，95%CI=-2.81，-1.08，Z=4.41，P<0.01）。但对动态步态指数（SMD=-0.15，95%CI=-0.50，0.19，Z=0.86，P=0.387）和步态速度（SMD=0.19，95%CI=-0.03，0.40，Z=1.71，P=0.088）没有影响。对于次要结局，与对照组相比，VR 康复训练在改善生活质量（SMD=-0.47，95%CI=-0.73，-0.22，Z=3.64，P<0.01）、信心水平（SMD=-0.73，95%CI=-1.43，-0.03，Z=2.05，P=0.040）和神经精神症状（SMD=-0.96，95%CI=-1.27，-0.65，Z=6.07，P<0.01）方面表现出更显著的效果，而在整体运动功能（SMD=-0.50，95%CI=-1.48，0.48，Z=0.99，P=0.32）、日常生活活动（SMD=0.25，95%CI=-0.14，0.64，Z=1.24，P=0.216）和认知功能（SMD=0.21，95%CI=-0.28，0.69，Z=0.84，P=0.399）方面可能具有相似的效果。在纳入的干预措施中，有 4 名患者出现轻度头晕，1 名患者出现严重头晕和呕吐。
根据本研究的结果，我们发现 VR 康复训练不仅可以达到与常规康复训练相同的效果，而且在 PD 患者的步态和平衡方面表现更好。综上所述，当传统康复训练对 PD 患者的步态和平衡效果不佳时，我们认为 VR 康复训练至少可以作为一种替代治疗方法。需要进行更多设计严谨、样本量大、多中心的随机对照试验，以提供更有力的循证依据，验证其潜在优势。
