Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China.
Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology School of Medicine; Department of Wound Repair, Southern University of Science and Technology Hospital, Shenzhen, China.
Arch Phys Med Rehabil. 2023 Mar;104(3):502-513. doi: 10.1016/j.apmr.2022.08.005. Epub 2022 Aug 27.
OBJECTIVES: We systematically reviewed published clinical trials to evaluate the effectiveness of virtual reality (VR) technology on functional improvement, pain relief, and reduction of mental distress among burn patients undergoing rehabilitation. DATA SOURCES: Systematic searches were conducted in 4 databases, including PubMed, the Cochrane Library, Embase, and Web of Science, from inception to August 2021. STUDY SELECTION: Randomized controlled trials (RCTs) evaluating any type of VR for the rehabilitation in burn patients with dysfunction were included. DATA EXTRACTION: Two reviewers evaluated the eligibility, and another 2 reviewers used the Cochrane risk of bias assessment tool to assess the risk of bias. The extracted data included the main results of rehabilitation evaluation (quality of life [QOL], work performance, range of motion [ROM] of joints, hand grip and pinch strength, pain, fun, anxiety), the application performance of VR (realness and presence), adverse effects (fatigue and nausea), and characteristics of the included studies. Heterogeneity was evaluated using the chi-square tests and I statistics. Random- or fixed-effects models were conducted to pool the effect sizes expressed as standardized mean differences (SMDs). DATA SYNTHESIS: Sixteen RCTs with 535 burn patients were included. VR-based interventions were superior to usual rehabilitation in QOL and work performance of burn patients and produced positive effect on the average gain of ROM (SMD=0.72) as well. VR was not associated with improved hand grip and pinch strength (SMD=0.50, 1.22, respectively) but was associated with reduced intensity, affective, and cognitive components of pain (SMD=-1.26, -0.71, -1.01, respectively) compared with control conditions. Ratings of fun in rehabilitation therapy were higher (SMD=2.38), and anxiety scores were lower (SMD=-0.73) than in control conditions. CONCLUSIONS: VR-based burn rehabilitation significantly improves the QOL and work performance of burn patients, increases the ROM gain in the joints, reduces the intensity and unpleasantness of pain and the time spent thinking about pain, increases the fun in the rehabilitation therapy, reduces the anxiety caused by the treatment, and has no obvious adverse effects. However, it did not significantly improve hand grip or pinch strength.
目的：我们系统地回顾了已发表的临床试验，以评估虚拟现实 (VR) 技术在改善烧伤患者康复功能、缓解疼痛和减轻精神困扰方面的有效性。
资料来源：系统检索了 4 个数据库，包括 PubMed、Cochrane 图书馆、Embase 和 Web of Science，时间从建库到 2021 年 8 月。
研究选择：纳入了评估任何类型 VR 技术用于治疗功能障碍烧伤患者康复的随机对照试验 (RCT)。
资料提取：两名评审员评估纳入标准，另外两名评审员使用 Cochrane 偏倚风险评估工具评估偏倚风险。提取的数据包括康复评估的主要结果（生活质量[QOL]、工作表现、关节活动度[ROM]、手握力和捏力、疼痛、乐趣、焦虑）、VR 的应用性能（真实感和存在感）、不良反应（疲劳和恶心）以及纳入研究的特征。使用卡方检验和 I 统计量评估异质性。采用随机或固定效应模型汇总表示为标准化均数差 (SMD) 的效应量。
资料综合：纳入了 16 项 RCT，共 535 名烧伤患者。与常规康复相比，基于 VR 的干预措施在烧伤患者的生活质量和工作表现方面更优，并且对 ROM 的平均增益也有积极影响（SMD=0.72）。VR 与握力和捏力的改善无关（SMD=0.50、1.22），但与对照条件相比，与疼痛的强度、情感和认知成分的降低有关（SMD=-1.26、-0.71、-1.01）。康复治疗中的乐趣评分更高（SMD=2.38），焦虑评分更低（SMD=-0.73）。
结论：基于 VR 的烧伤康复显著改善烧伤患者的生活质量和工作表现，增加关节 ROM 增益，减轻疼痛的强度和不愉快感以及患者思考疼痛的时间，增加康复治疗的乐趣，减轻治疗引起的焦虑，且无明显不良反应。然而，它并没有显著改善手握力或捏力。
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