Gianola Silvia, Stucovitz Elena, Castellini Greta, Mascali Mariangela, Vanni Francesco, Tramacere Irene, Banfi Giuseppe, Tornese Davide
IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology.
IRCCS Istituto Ortopedico Galeazzi, Motion Analysis Laboratory.
Medicine (Baltimore). 2020 Feb;99(7):e19136. doi: 10.1097/MD.0000000000019136.
Virtual reality (VR)-based rehabilitation is a promising approach for improving recovery in many conditions to optimize functional results, enhancing the clinical and social benefits of surgery.
To assess the efficacy of an early rehabilitation performed by the VR-based rehabilitation versus the traditional rehabilitation provided by physical therapists after primary total knee arthroplasty (TKA).
In this randomized controlled clinical trial, 85 subjects met the inclusion criteria and were randomized 3 to 4 days after TKA to an inpatient VR-based rehabilitation and a traditional rehabilitation. Participants in both groups received 60 minutes/day sessions until discharge (around 10 days after surgery). The primary outcome was the pain intensity. The secondary outcomes were: the disability knee, the health related quality of life, the global perceived effect, the functional independent measure, the drugs assumption, the isometric strength of quadriceps and hamstrings, the flexion range of motion, and the ability to perform proprioception exercises. Outcomes were assessed at baseline (3-4 days after TKA) and at discharge.
VR-based or traditional rehabilitation, with 13% of dropout rate, shown no statistically significant pain reduction between groups (P = .2660) as well as in all other outcomes, whereas a statistically significant improvement was present in the global proprioception (P = .0020), in favor of the VR-based rehabilitation group.
VR-based rehabilitation is not superior to traditional rehabilitation in terms of pain relief, drugs assumptions and other functional outcomes but seems to improve the global proprioception for patients received TKA.
Therapy, level 1b. CONSORT-compliant.
http://www.clinicaltrials.gov, ClinicalTrials.gov, NCT02413996.
基于虚拟现实（VR）的康复是一种很有前景的方法，可改善多种情况下的恢复情况，以优化功能结果，增强手术的临床和社会效益。
评估在初次全膝关节置换术（TKA）后，基于VR的康复早期康复与物理治疗师提供的传统康复的疗效。
在这项随机对照临床试验中，85名受试者符合纳入标准，并在TKA后3至4天被随机分为住院基于VR的康复组和传统康复组。两组参与者每天接受60分钟的治疗，直至出院（手术后约10天）。主要结局是疼痛强度。次要结局包括：膝关节残疾程度、健康相关生活质量、整体感知效果、功能独立性测量、药物使用情况、股四头肌和腘绳肌的等长肌力、屈曲活动范围以及进行本体感觉锻炼的能力。在基线（TKA后3 - 4天）和出院时评估结局。
基于VR的康复或传统康复，脱落率为13%，两组之间在疼痛减轻方面以及所有其他结局上均无统计学显著差异（P = 0.2660），而在整体本体感觉方面有统计学显著改善（P = 0.0020），有利于基于VR的康复组。
在缓解疼痛、药物使用情况和其他功能结局方面，基于VR的康复并不优于传统康复，但似乎能改善接受TKA患者的整体本体感觉。
治疗，1b级。符合CONSORT标准。
http://www.clinicaltrials.gov，ClinicalTrials.gov，NCT02413996。
