Department of Physical Medicine and Rehabilitation, Division of Rehabilitation Psychology, The Ohio State University, Columbus, Ohio.
Department of Occupational Therapy, University of Missouri, Columbia, Missouri.
Arch Phys Med Rehabil. 2020 May;101(5):885-896. doi: 10.1016/j.apmr.2019.10.195. Epub 2019 Dec 7.
To investigate the efficacy of virtual reality (VR)- and gaming-based interventions for improving upper extremity function poststroke, and to examine demographic and treatment-related factors that may moderate treatment response.
A comprehensive search was conducted within the PubMed, CINAHL/EBSCO, SCOPUS, Ovid MEDLINE, and EMBASE databases for articles published between 2005 and 2019.
Articles investigating gaming and VR methods of treatment for upper extremity weakness were collected with the following study inclusion criteria: (1) participants aged 18 years or older with upper extremity deficits; (2) randomized controlled trials or prospective study design; (3) Downs-Black rating score of ≥18; and (4) outcome measure was the Wolf Motor Functioning Test, the Fugl-Meyer, or the Action Research Arm Test.
Thirty-eight articles met inclusion criteria. The primary outcome was proportional improvement on the Wolf Motor Functioning Test, Fugl-Meyer, or Action Research Arm Test. The following individual or treatment factors were extracted: VR or gaming dose, total treatment dose, chronicity (> or <6mo), severity of motor impairment, and presence of a gaming component.
Random effects meta-analysis models were utilized to quantify (1) the proportional recovery that occurs after VR or gaming; (2) the comparative treatment effect of VR or gaming vs conventional physiotherapy; and (3) whether the benefit of virtual reality differed based on participant characteristics or elements of the treatment.
On average, VR or gaming interventions produced an improvement of 28.5% of the maximal possible improvement. Dose and severity of motor impairment did not significantly influence rehabilitation outcomes. Treatment gains were significantly larger overall (10.8%) when the computerized training involved a gaming component vs just visual feedback. VR or gaming interventions showed a significant treatment advantage (10.4%) over active control treatments.
Overall, VR- or gaming-based upper extremity rehabilitation poststroke appears to be more effective than conventional methods. Further in-depth study of variables affecting improvement, such as individual motor presentation, treatment dose, and the relationship between them, are needed.
研究虚拟现实（VR）和游戏为基础的干预措施对上肢功能的疗效脑卒中后，并检查人口统计学和治疗相关因素可能调节治疗反应。
全面检索了 PubMed、CINAHL/EBSCO、SCOPUS、Ovid MEDLINE 和 EMBASE 数据库，以获取 2005 年至 2019 年发表的文章。
收集了使用以下研究纳入标准的治疗上肢无力的游戏和 VR 方法的文章：（1）年龄在 18 岁或以上，上肢有缺陷的参与者；（2）随机对照试验或前瞻性研究设计；（3）唐斯-布莱克评分≥18；（4）结局测量是 Wolf 运动功能测试、Fugl-Meyer 或动作研究臂测试。
38 篇文章符合纳入标准。主要结果是 Wolf 运动功能测试、Fugl-Meyer 或动作研究臂测试的比例改善。提取了以下个人或治疗因素：VR 或游戏剂量、总治疗剂量、慢性（> 6mo）、运动障碍严重程度和游戏组件的存在。
使用随机效应荟萃分析模型来量化（1）VR 或游戏后发生的比例恢复；（2）VR 或游戏与常规物理治疗的比较治疗效果；（3）虚拟现实的益处是否基于参与者的特征或治疗的要素而有所不同。
平均而言，VR 或游戏干预产生了最大可能改善的 28.5%的改善。剂量和运动障碍的严重程度并没有显著影响康复结果。当计算机训练涉及游戏组件而不仅仅是视觉反馈时，治疗增益总体上显著更大（10.8%）。VR 或游戏干预与主动对照治疗相比具有显著的治疗优势（10.4%）。
总体而言，VR 或基于游戏的脑卒中后上肢康复似乎比传统方法更有效。需要进一步深入研究影响改善的变量，如个体运动表现、治疗剂量以及它们之间的关系。
