Lu Yaqin, Ge Yonggui, Chen Wanqiang, Xing Wenting, Wei Lushan, Zhang Caixia, Yang Yusheng
Department of Rehabilitation, The First Hospital of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China.
Syst Rev. 2022 Mar 19;11(1):50. doi: 10.1186/s13643-022-01924-5.
An increasing number of systematic reviews (SRs) and meta-analyses (MAs) of clinical trials have begun to investigate the effects of virtual reality (VR) in patients with Parkinson disease (PD). The aim of this overview was to systematically summarize the current best evidence for the effectiveness of VR therapy for the rehabilitation of people with PD.
We searched SR-MAs based on randomized controlled trials (RCTs) for relevant literature in PubMed, Embase, and Cochrane library databases for systematic reviews from inception to December 5, 2020, and updated to January 26, 2022. The methodological quality of included SR-MAs was evaluated with the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and the certainty of evidence for outcomes with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We created an evidence map using a bubble plot format to represent the evidence base in 5 dimensions: effect size of VR therapy versus active intervention (AT), clinical outcome area, number of trials, statistical significance, and certainty of evidence.
From a total of 585 reports, 12 reviews were identified, of which only one was rated moderate quality, three were rated low quality, and eight were rated critically low quality by AMSTAR 2. Compared with AT, VR therapy induced increased benefits on stride/step length, balance, and neuropsychiatric symptoms. Compared with passive intervention (PT), VR therapy had greater effects on gait speed, stride/step length, balance, activities of daily living, and postural control in people with PD. Certainty of evidence varied from very low to moderate.
We found the methodological quality of the reviews was poor, and certainty of the most evidence within them was low to very low. We were therefore unable to conclude with any confidence that, in people with PD, VR therapy is harmful or beneficial for gait, balance, motor function, quality of life, activities of daily living, cognitive function, neuropsychiatric symptoms, and postural control. In the future, rigorous-designed, high-quality RCTs with larger sample sizes are needed to further verify the effectiveness of VR therapy in the treatment of PD.
越来越多关于临床试验的系统评价（SRs）和荟萃分析（MAs）开始研究虚拟现实（VR）对帕金森病（PD）患者的影响。本综述的目的是系统总结VR疗法对PD患者康复有效性的当前最佳证据。
我们在PubMed、Embase和Cochrane图书馆数据库中检索基于随机对照试验（RCTs）的SR-MAs，以获取从数据库建立到2020年12月5日的相关文献，并更新至2022年1月26日。采用系统评价方法学质量评估2（AMSTAR-2）评估纳入的SR-MAs的方法学质量，采用推荐分级、评估、制定与评价（GRADE）对结果的证据确定性进行评估。我们使用气泡图格式创建了一个证据图，以在五个维度上展示证据基础：VR疗法与主动干预（AT）的效应大小、临床结局领域、试验数量、统计学意义和证据确定性。
从总共585篇报告中，识别出12篇综述，其中只有一篇被评为中等质量，三篇被评为低质量，八篇被AMSTAR 2评为极低质量。与AT相比，VR疗法在步幅/步长、平衡和神经精神症状方面带来了更大益处。与被动干预（PT）相比，VR疗法对PD患者的步态速度、步幅/步长、平衡、日常生活活动和姿势控制有更大影响。证据确定性从极低到中等不等。
我们发现这些综述的方法学质量较差，其中大多数证据的确定性为低到极低。因此，我们无法确定对于PD患者，VR疗法对步态、平衡、运动功能、生活质量、日常生活活动、认知功能、神经精神症状和姿势控制是有害还是有益。未来，需要设计严谨、样本量更大的高质量RCT来进一步验证VR疗法在治疗PD中的有效性。
