Revant Rehabilitation Centres, Breda, the Netherlands.
Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
Phys Ther. 2021 May 4;101(5). doi: 10.1093/ptj/pzab051.
OBJECTIVE: After stroke, people experience difficulties with walking that lead to restrictions in participation in daily life. The purpose of this study was to examine the effect of virtual reality gait training (VRT) compared to non-virtual reality gait training (non-VRT) on participation in community-living people after stroke. METHODS: In this assessor-blinded, randomized controlled trial with 2 parallel groups, people were included between 2 weeks and 6 months after stroke and randomly assigned to the VRT group or non-VRT group. Participants assigned to the VRT group received training on the Gait Real-time Analysis Interactive Lab (GRAIL), and participants assigned to the non-VRT group received treadmill training and functional gait exercises without virtual reality. Both training interventions consisted of 12 30-minute sessions during 6 weeks. The primary outcome was participation measured with the restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) 3 months postintervention. Secondary outcomes included subjective physical functioning, functional mobility, walking ability, dynamic balance, walking activity, fatigue, anxiety and depression, falls efficacy, and quality of life. RESULTS: Twenty-eight participants were randomly assigned to the VRT group and 27 to the non-VRT group, of whom 25 and 22 attended 75% or more of the training sessions, respectively. No significant differences between the groups were found over time for the USER-P restrictions subscale (1.23; 95% CI = -0.76 to 3.23) or secondary outcome measures. Patients' experiences with VRT were positive, and no serious adverse events were related to the interventions. CONCLUSIONS: The effect of VRT was not statistically different from non-VRT in improving participation in community-living people after stroke. IMPACT: Although outcomes were not statistically different, treadmill-based VRT was a safe and well-tolerated intervention that was positively rated by people after stroke. VR training might, therefore, be a valuable addition to stroke rehabilitation. LAY SUMMARY: VRT is feasible and was positively experienced by people after stroke. However, VRT was not more effective than non-VRT for improving walking ability and participation after stroke.
目的：中风后，患者会出现行走困难，从而限制其日常生活的参与度。本研究旨在探讨虚拟现实步态训练（VRT）与非虚拟现实步态训练（non-VRT）对中风后社区居住人群参与度的影响。
方法：这是一项采用 2 个平行组、评估者设盲的随机对照试验，纳入中风后 2 周至 6 个月的患者，并将其随机分配到 VRT 组或 non-VRT 组。分配到 VRT 组的患者接受 Gait Real-time Analysis Interactive Lab（GRAIL）训练，分配到 non-VRT 组的患者接受跑步机训练和无虚拟现实的功能性步态练习。两组训练干预均包含 6 周内的 12 次 30 分钟的课程。主要结局指标为干预后 3 个月时使用 Utrecht 康复参与评估量表（USER-P）的限制子量表评估的参与度。次要结局指标包括主观身体功能、功能性移动能力、行走能力、动态平衡、行走活动、疲劳、焦虑和抑郁、跌倒效能和生活质量。
结果：28 名患者被随机分配到 VRT 组，27 名患者被随机分配到 non-VRT 组，其中分别有 25 名和 22 名患者参加了 75%或更多的训练课程。两组在 USER-P 限制子量表或次要结局指标方面均未随时间出现显著差异（1.23；95%CI=-0.76 至 3.23）。患者对 VRT 的体验为积极，且无与干预相关的严重不良事件。
结论：VRT 在改善中风后社区居住人群的参与度方面的效果与 non-VRT 无统计学差异。
意义：尽管结局无统计学差异，但基于跑步机的 VRT 是一种安全且可耐受的干预措施，受到中风患者的积极评价。因此，VR 训练可能是中风康复的有价值的补充。
概述：VRT 是可行的，并且中风后患者对此持积极态度。然而，VRT 在改善中风后患者的行走能力和参与度方面并不优于 non-VRT。
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