Y. Chen, MS, Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; and Key Laboratory of Rehabilitation Medicine of Sichuan Province, Chengdu, Sichuan Province, China.
Q. Gao, PhD, Department of Rehabilitation Medicine, West China Hospital, Sichuan University; and Key Laboratory of Rehabilitation Medicine of Sichuan Province.
Phys Ther. 2020 Jun 23;100(6):933-945. doi: 10.1093/ptj/pzaa042.
Virtual reality (VR) is a frequently used intervention for the rehabilitation of individuals with neurological disorders.
The aims of this review were to identify the short-term effect of VR on balance and to compare it with the effect of active interventions in individuals with Parkinson disease (PD).
Searches for relevant articles available in English were conducted using the MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL, PsycINFO, and Physiotherapy Evidence Database databases from inception until March 2019.
All randomized controlled trials comparing the effect of training with VR and the effect of training without VR on balance in individuals with PD were included.
Two authors independently extracted data, assessed the methodological quality, and evaluated the evidence quality of the studies.
Fourteen randomized controlled trials including 574 individuals were eligible for qualitative analyses, and 12 of the studies involving 481 individuals were identified as being eligible for meta-analyses. Compared with active interventions, the use of VR improved the Berg Balance Scale score (mean difference = 1.23; 95% CI = 0.15 to 2.31; I2 = 56%). The Dynamic Gait Index and Functional Gait Assessment results were also significant after the sensitivity analyses (mean difference = 0.69; 95% CI = 0.12 to 1.26; I2 = 0%). Both provided moderate statistical evidence. However, the Timed "Up & Go" Test and the Activities-Specific Balance Confidence Scale did not differ significantly.
Publication bias and diversity in the interventions were the main limitations.
Existing moderate evidence of the effectiveness of VR with the Berg Balance Scale, Dynamic Gait Index, and Functional Gait Assessment for individuals with PD was promising. Although the differences did not reach the clinically important change threshold, VR was comparable to active interventions and could be considered an adjuvant therapy for balance rehabilitation in individuals with PD.
虚拟现实（VR）是一种常用于神经障碍康复的干预手段。
本综述旨在确定 VR 对平衡的短期影响，并将其与帕金森病（PD）患者的主动干预效果进行比较。
通过 MEDLINE（PubMed）、EMBASE、CENTRAL、CINAHL、PsycINFO 和 Physiotherapy Evidence Database 数据库，从建库开始检索至 2019 年 3 月，查找关于 VR 对 PD 患者平衡影响的相关英文文献。
纳入所有比较 VR 训练与无 VR 训练对 PD 患者平衡影响的随机对照试验。
两位作者独立提取数据、评估研究方法学质量并评价研究证据质量。
14 项随机对照试验（共纳入 574 名患者）纳入定性分析，12 项研究（共纳入 481 名患者）符合纳入标准，可进行荟萃分析。与主动干预相比，VR 组在 Berg 平衡量表评分上有显著改善（平均差值=1.23；95%置信区间=0.15 至 2.31；I²=56%）。在敏感性分析后，动态步态指数和功能性步态评估结果也具有显著差异（平均差值=0.69；95%置信区间=0.12 至 1.26；I²=0%），具有中等统计学证据。然而，计时“站起-行走”测试和活动特异性平衡信心量表结果没有显著差异。
主要的局限性在于发表偏倚和干预措施的多样性。
针对 PD 患者，现有 VR 与 Berg 平衡量表、动态步态指数和功能性步态评估的有效性具有中等证据水平，结果较为乐观。虽然差异未达到临床重要变化阈值，但 VR 与主动干预相当，可考虑作为 PD 患者平衡康复的辅助治疗方法。
