OrthoEvidence, Burlington, ON, Canada.
Division of Orthopaedics, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
Knee Surg Sports Traumatol Arthrosc. 2022 Aug;30(8):2548-2555. doi: 10.1007/s00167-022-06910-x. Epub 2022 Feb 19.
The use of virtual reality (VR) based rehabilitation has increased substantially within orthopedic surgery, particularly in the field of total knee arthroplasty (TKA). The objective of this systematic review and meta-analysis was to compare patient-reported outcomes and cost analyses from randomized controlled trials (RCT) utilizing VR-based rehabilitation in patients following TKA.
MEDLINE, EMBASE, and Cochrane databases were searched for RCTs involving VR-based rehabilitation following TKA. Quantitative synthesis was conducted for pain scores and functional outcomes. Narrative outcomes were reported for results not amenable to quantitative synthesis.
A total of 9 RCTs with 835 patients were included with follow-up ranging from 10 days to 6 months postoperatively. No differences in pain scores were demonstrated between VR-based and traditional rehabilitation at 2 weeks and 3 months postoperatively. VR-based rehabilitation demonstrated improved functional outcomes at 12 weeks (n = 353) postoperatively [mean difference (MD) - 3.32, 95% confidence interval (CI) - 5.20 to - 1.45, moderate certainty evidence] and 6 months (n = 66) postoperatively [MD - 4.75, 95% CI - 6.69 to - 2.81, low certainty evidence], compared to traditional rehabilitation. One trial demonstrated significant cost savings with the use of VR-based rehabilitation.
VR-based rehabilitation for patients undergoing TKA represents an evolving field that may have advantages over traditional therapy for some patients. The current review is limited by the low quality of evidence in the literature. This is a rapidly evolving field with more trials needed to determine the impact of VR-based rehabilitation on patients undergoing TKA.
Level I; meta-analysis of randomized controlled trials.
虚拟现实（VR）为基础的康复治疗在骨科手术中得到了广泛应用，特别是在全膝关节置换术（TKA）领域。本系统综述和荟萃分析的目的是比较接受 TKA 后使用基于 VR 的康复治疗的随机对照试验（RCT）患者的报告的结果和成本分析。
在 MEDLINE、EMBASE 和 Cochrane 数据库中检索了关于 TKA 后基于 VR 的康复治疗的 RCT。对疼痛评分和功能结果进行了定量综合。对于无法进行定量综合的结果，报告了叙述性结果。
共纳入 9 项 RCT，共 835 例患者，术后随访时间为 10 天至 6 个月。在术后 2 周和 3 个月时，基于 VR 的康复与传统康复之间的疼痛评分没有差异。在术后 12 周（n=353）和 6 个月（n=66）时，基于 VR 的康复显示出更好的功能结果[平均差异（MD）-3.32，95%置信区间（CI）-5.20 至-1.45，中等确定性证据]，与传统康复相比。一项试验表明，使用基于 VR 的康复治疗可显著节省成本。
接受 TKA 的患者的 VR 为基础的康复治疗是一个不断发展的领域，对于某些患者来说，可能比传统疗法有优势。本综述受到文献中证据质量低的限制。这是一个快速发展的领域，需要更多的试验来确定基于 VR 的康复对接受 TKA 的患者的影响。
I 级；随机对照试验的荟萃分析。
