Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, Córdoba, Spain.
Centro Docente Privado Albor, Córdoba, Spain.
J Med Internet Res. 2023 Jun 30;25:e47391. doi: 10.2196/47391.
Obstetric brachial palsy (OBP) is a pathology caused by complications during childbirth because of cervical spine elongation, affecting the motor and sensory innervation of the upper limbs. The most common lesion occurs on the C5 and C6 nerve branches, known as Erb-Duchenne palsy. The least common lesion is when all nerve roots are affected (C5-T1), which has the worst prognosis. Virtual reality (VR) is commonly used in neurological rehabilitation for the evaluation and treatment of physical deficits.
This systematic review aims to assess the efficacy of VR in the rehabilitation of upper limb function in patients with OBP.
A search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines in several scientific databases-PubMed, Web of Science, PEDro, Cochrane, MEDLINE, Scopus, and CINAHL-without language or date restrictions and including articles published up to April 2023. The inclusion criteria were established according to the population, intervention, comparison, outcome, and study (PICOS) design framework: children aged <18 years diagnosed with OBP, VR therapy used in addition to conventional therapy or isolated, VR therapy compared with conventional therapy, outcomes related to OBP rehabilitation therapy, and randomized controlled trials (RCTs). The PEDro scale was used to assess the methodological quality of the RCTs, and the Cochrane Collaboration tool was used to assess the risk of bias. The Review Manager statistical software (version 5.4; The Cochrane Collaboration) was used to conduct the meta-analysis. The results were synthesized through information extraction and presented in tables and forest plots.
In total, 5 RCTs were included in this systematic review, with 3 (60%) providing information for the meta-analysis. A total of 138 participants were analyzed. All the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed no favorable results for all outcomes except for the hand-to-mouth subtest of the Mallet scoring system (functional activity; standardized mean difference -0.97, 95% CI -1.67 to -0.27; P=.007).
The evidence for the use of VR therapy for upper limb rehabilitation outcomes in patients with OBP was insufficient to support its efficacy and strongly recommend its use. Nevertheless, scientific literature supports the use of VR technologies for rehabilitation as it provides several advantages, such as enhancing the patient's motivation, providing direct feedback, and focusing the patient's attention during the intervention. Thus, the use of VR for upper limb rehabilitation in patients with OBP is still in its first stages. Small sample sizes; limited long-term analysis; lack of testing of different doses; and absence of International Classification of Functioning, Disability, and Health-related outcomes were present in the included RCTs, so further research is needed to fully understand the potential of VR technologies as a therapeutic approach for patients with OBP.
PROSPERO CRD42022314264; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=314264.
产科臂丛神经麻痹（OBP）是一种由分娩期间颈椎伸长引起的并发症导致的病理学，影响上肢的运动和感觉神经支配。最常见的病变发生在 C5 和 C6 神经分支，称为 Erb-Duchenne 麻痹。最不常见的病变是所有神经根都受到影响（C5-T1），预后最差。虚拟现实（VR）常用于神经康复，用于评估和治疗身体缺陷。
本系统评价旨在评估 VR 在 OBP 患者上肢功能康复中的疗效。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）2020 年指南，在几个科学数据库（PubMed、Web of Science、PEDro、Cochrane、MEDLINE、Scopus 和 CINAHL）中进行了搜索，没有语言或日期限制，并包括截至 2023 年 4 月发表的文章。纳入标准根据人群、干预、比较、结局和研究（PICOS）设计框架制定：年龄<18 岁的 OBP 诊断儿童、除常规治疗外使用 VR 治疗或单独使用 VR 治疗、VR 治疗与常规治疗比较、与 OBP 康复治疗相关的结局、随机对照试验（RCT）。使用 PEDro 量表评估 RCT 的方法学质量，使用 Cochrane 协作工具评估偏倚风险。使用 Review Manager 统计软件（版本 5.4；Cochrane 协作）进行荟萃分析。通过信息提取对结果进行综合，并以表格和森林图呈现。
共纳入 5 项 RCT，其中 3 项（60%）提供了用于荟萃分析的信息。共分析了 138 名参与者。所有研究均使用半沉浸式或非沉浸式 VR 系统。统计分析显示，除了 Mallet 评分系统的手到口亚测试（功能活动；标准化均数差-0.97，95%CI-1.67 至-0.27；P=0.007）外，所有结局均无有利结果。
VR 治疗 OBP 患者上肢康复结局的证据不足以支持其疗效，并强烈建议不要使用。然而，科学文献支持将 VR 技术用于康复，因为它提供了一些优势，例如增强患者的动机、提供直接反馈以及在干预过程中集中患者的注意力。因此，VR 用于 OBP 患者的上肢康复仍处于初级阶段。纳入的 RCT 存在样本量小、缺乏长期分析、未测试不同剂量、缺乏国际功能、残疾和健康相关结局等问题，因此需要进一步研究以充分了解 VR 技术作为 OBP 患者治疗方法的潜力。
PROSPERO CRD42022314264；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=314264。
