Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Chin Med J (Engl). 2021 Dec 13;135(2):153-163. doi: 10.1097/CM9.0000000000001847.
Physical therapy is regarded as an essential aspect in achieving optimal outcomes following total knee arthroplasty (TKA). The coronavirus disease 2019 (COVID-19) pandemic has made face-to-face rehabilitation inaccessible. Virtual reality (VR) is increasingly regarded as a potentially effective option for offering health care interventions. This systematic review and meta-analysis investigate VR-based rehabilitation's effectiveness on outcomes following TKA.
From inception to May 22, 2021, PubMed/Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, Scopus, PsycINFO, Physiotherapy Evidence Database, China National Knowledge Infrastructure, and Wanfang were comprehensively searched to identify randomized controlled trials (RCTs) evaluating the effect of VR-based rehabilitation on patients following TKA according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions.
Eight studies were included in the systematic review, and seven studies were included in the meta-analysis. VR-based rehabilitation significantly improved visual analog scale (VAS) scores within 1 month (standardized mean difference [SMD]: -0.44; 95% confidence interval [CI]: -0.79 to -0.08, P = 0.02), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) within 1 month (SMD: -0.71; 95% CI: -1.03 to -0.40, P < 0.01), and the Hospital for Special Surgery Knee Score (HSS) within 1 month and between 2 months and 3 months (MD: 7.62; 95% CI: 5.77 to 9.47, P < 0.01; MD: 10.15; 95% CI: 8.03 to 12.27, P < 0.01; respectively) following TKA compared to conventional rehabilitation. No significant difference was found in terms of the Timed Up and Go (TUG) test.
VR-based rehabilitation improved pain and function but not postural control following TKA compared to conventional rehabilitation. More high-quality RCTs are needed to prove the advantage of VR-based rehabilitation. As the COVID-19 pandemic continues, it is necessary to promote this rehabilitation model.
物理治疗被认为是全膝关节置换术（TKA）后获得最佳结果的重要环节。新冠疫情使面对面的康复治疗变得难以实现。虚拟现实（VR）正逐渐被视为提供医疗干预的一种潜在有效选择。本系统评价和荟萃分析旨在研究基于 VR 的康复治疗对 TKA 后结局的影响。
从成立到 2021 年 5 月 22 日，通过全面检索 PubMed/Medline、Embase、Web of Science、Cochrane 中央对照试验注册库、Scopus、PsycINFO、物理治疗证据数据库、中国知网和万方数据库，以确定符合系统评价和荟萃分析报告的首选项目和 Cochrane 干预措施系统评价手册的随机对照试验（RCT），评估基于 VR 的康复治疗对 TKA 后患者的影响。
本系统评价纳入 8 项研究，荟萃分析纳入 7 项研究。基于 VR 的康复治疗在 1 个月内显著改善了视觉模拟量表（VAS）评分（标准化均数差 [SMD]：-0.44；95%置信区间 [CI]：-0.79 至 -0.08，P=0.02）、1 个月内的西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）（SMD：-0.71；95% CI：-1.03 至 -0.40，P<0.01）和 1 个月内及 2 个月至 3 个月内的特种外科医院膝关节评分（HSS）（MD：7.62；95% CI：5.77 至 9.47，P<0.01；MD：10.15；95% CI：8.03 至 12.27，P<0.01；分别）。与常规康复治疗相比，TUG 测试无显著差异。
与常规康复治疗相比，基于 VR 的康复治疗可改善 TKA 后疼痛和功能，但不能改善姿势控制。需要更多高质量的 RCT 来证明基于 VR 的康复治疗的优势。随着新冠疫情的持续，有必要推广这种康复模式。
