Department of Rehabilitation Therapy, Shanghai Ruijin Rehabilitation Hospital, Shanghai 200023, China.
Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
J Clin Neurosci. 2022 Sep;103:85-91. doi: 10.1016/j.jocn.2022.07.005. Epub 2022 Jul 15.
Virtual reality (VR) and computer-assisted cognitive rehabilitation (CACR) are two emerging rehabilitation therapies for stroke patients. The aim of this study was to compare the rehabilitation efficacy of these two treatments for patients with post-stroke cognitive impairment (PSCI).
A network search of Embase, Web of Science, PubMed, Cochrane Library, VIP, WanFang Data, and CNKI databases was performed from their inception to February 2022 for screening randomized controlled trials related to VR and CACR in the treatment of PSCI. The quality of the included studies was assessed using the Cochrane risk bias assessment tool. The primary outcomes of the included studies contained at least one of the following clinical outcome measures: Mini-mental state examination (MMSE) or Montreal Cognitive Assessment (MoCA). After screening the literature, assessing the quality and extracting the data, a network meta-analysis was performed with STATA software.
A total of 21 randomized controlled trials were included, including 1,047 patients. The results of network meta-analysis showed that under MMSE index, VR group (p = 0.067) and CACR group (p = 0.054) tended to be superior to CT group, but it was not significant. Both the VR (p = 0.024) and CACR (p < 0.001) groups had significantly better outcomes compared to the conventional therapy group in terms of MoCA. The ranking results under both indicators showed that CACR had the best treatment effect, followed by VR.
In general, VR and CACR have superior efficacy compared with conventional therapy, in which CACR may be the best treatment option.
虚拟现实（VR）和计算机辅助认知康复（CACR）是两种新兴的脑卒中患者康复治疗方法。本研究旨在比较这两种治疗方法对脑卒中后认知障碍（PSCI）患者的康复效果。
系统检索 Embase、Web of Science、PubMed、Cochrane 图书馆、VIP、万方数据和中国知网数据库，检索时限从建库至 2022 年 2 月，收集关于 VR 和 CACR 治疗 PSCI 的随机对照试验。采用 Cochrane 偏倚风险评估工具评价纳入研究的质量。纳入研究的主要结局至少包含以下一种临床结局评估指标：简易精神状态检查量表（MMSE）或蒙特利尔认知评估量表（MoCA）。筛选文献、评价质量和提取数据后，采用 STATA 软件进行网络荟萃分析。
共纳入 21 项随机对照试验，包含 1047 例患者。网络荟萃分析结果显示，在 MMSE 评分指标下，VR 组（p=0.067）和 CACR 组（p=0.054）可能优于 CT 组，但差异无统计学意义。在 MoCA 评分指标下，VR 组（p=0.024）和 CACR 组（p<0.001）的疗效均显著优于常规治疗组。两种指标的排序结果均显示，CACR 的治疗效果最佳，其次是 VR。
总体而言，VR 和 CACR 与常规治疗相比具有更好的疗效，其中 CACR 可能是最佳的治疗选择。
