基于虚拟现实的疗法对中风后抑郁症的影响：一项随机对照试验的系统评价和荟萃分析。

Impact of virtual reality-based therapy on post-stroke depression: A systematic review and meta-analysis of randomized controlled trials.

作者信息

Blázquez-González Patricia, Mirón-González Rubén, Lendínez-Mesa Alejandro, Luengo-González Raquel, Mancebo-Salas Noelia, Camacho-Arroyo María Teresa, Martínez-Hortelano José Alberto

机构信息

Department of Nursing, Red Cross Nursing School, Madrid, Spain.

Biomechanics and Bioengineering Applied to Health, Doctoral School, University of Alcalá, Madrid, Spain.

出版信息

Worldviews Evid Based Nurs. 2024 Apr;21(2):194-201. doi: 10.1111/wvn.12699. Epub 2023 Dec 27.

DOI:10.1111/wvn.12699

PMID:38149683

Abstract

BACKGROUND

Post-stroke depression is the most common neuropsychiatric consequence and reduces rehabilitation effectiveness. However, the efficacy of virtual reality (VR) on mental health treatment for patients after a stroke is uncertain.

AIMS

The aim of this study was to evaluate the efficacy of VR as a co-adjuvant form of treatment to reduce depression in stroke patients admitted to neurorehabilitation units.

METHODS

We systematically searched medical databases including PubMed, CINAHL, PsycINFO, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to November 16, 2023. Clinical trials comparing the use of VR as an adjuvant form of treatment in stroke patients' rehabilitation with the usual treatment were included. Pooled standardized mean differences were calculated using a random-effects model. Subgroup analyses were performed according to type of stroke, VR characteristics, and the scale used to measure depression. Meta-regression analysis was performed for intervention duration and to determine the mean age of the participants.

RESULTS

Eight studies and 388 stroke patients were included. The VR interventions were associated with a lower risk of depression in patients (ES = -0.69; 95% CI [-1.05, -0.33]; I = 57.6%; p ≤ .02). The estimates were not affected by the type of stroke, the type of VR used, the blinding process, the type of scale used to detect depression, the duration of the intervention (weeks and minutes), and the total number of sessions. Meta-regression shows that younger samples (p = .00; 95% CI [0.01, 0.08) and longer interventions (p = < .05; 95% CI [-0.00, -0.00) lead to a greater reduction in depression.

LINKING EVIDENCE TO ACTION

This review provides an important basis for treating depression in patients after a stroke. Professionals working in stroke neurorehabilitation units should consider VR as a form of co-adjuvant treatment for depression in patients.

SYSTEMATIC REVIEW REGISTRATION

CRD42022303968.

摘要

背景

中风后抑郁是最常见的神经精神后果，会降低康复效果。然而，虚拟现实（VR）对中风患者心理健康治疗的疗效尚不确定。

目的

本研究旨在评估VR作为一种辅助治疗形式对入住神经康复科的中风患者减轻抑郁的疗效。

方法

我们系统检索了医学数据库，包括PubMed、CINAHL、PsycINFO、Embase、Cochrane图书馆、科学网和ClinicalTrials.gov，检索时间从建库至2023年11月16日。纳入比较将VR作为辅助治疗形式用于中风患者康复与常规治疗的临床试验。使用随机效应模型计算合并标准化均数差。根据中风类型、VR特征和用于测量抑郁的量表进行亚组分析。对干预持续时间和参与者的平均年龄进行Meta回归分析。

结果

纳入8项研究，共388例中风患者。VR干预与患者抑郁风险降低相关（效应量= -0.69；95%置信区间[-1.05, -0.33]；I² = 57.6%；p≤0.02）。估计值不受中风类型、所用VR类型、盲法过程、用于检测抑郁的量表类型、干预持续时间（周和分钟）以及总疗程数的影响。Meta回归显示，年龄较小的样本（p = 0.00；95%置信区间[0.01, 0.08]）和较长的干预时间（p = <0.05；95%置信区间[-0.00, -0.00]）导致抑郁程度降低更大。