基于虚拟现实的镜像疗法系统对中风后上肢康复的影响：随机对照试验的系统评价和荟萃分析
Effects of a virtual reality-based mirror therapy system on upper extremity rehabilitation after stroke: a systematic review and meta-analysis of randomized controlled trials.
作者信息
Okamura Ryohei, Nakashima Akira, Moriuchi Takefumi, Fujiwara Kengo, Ohno Kanta, Higashi Toshio, Tomori Kounosuke
机构信息
Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
Major of Occupational Therapy, Department of Rehabilitation, School of Health Science, Tokyo University of Technology, Tokyo, Japan.
出版信息
Front Neurol. 2024 Jan 8;14:1298291. doi: 10.3389/fneur.2023.1298291. eCollection 2023.
INTRODUCTION
Virtual reality-based mirror therapy (VRMT) has recently attracted attention as a novel and promising approach for treating upper extremity dysfunction in patients with stroke. However, the clinical efficacy of VRMT has not been investigated.
METHODS
This study aimed to conduct a meta-analysis to evaluate the effects of VRMT on upper extremity dysfunction in patients with stroke. We screened articles published between January 2010 and July 2022 in PubMed, Scopus, MEDLINE, and Cochrane Central Register of Controlled Trials. Our inclusion criteria focused on randomized controlled trials (RCTs) comparing VRMT groups with control groups (e.g., conventional mirror therapy, occupational therapy, physical therapy, or sham therapy). The outcome measures included the Fugl-Meyer assessment upper extremity test (FMA-UE), the box and block test (BBT), and the manual function test (MFT). Risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool 2.0. We calculated the standardized mean differences (SMD) and 95% confidence intervals (95% CI). The experimental protocol was registered in the PROSPERO database (CRD42022345756).
RESULTS
This study included five RCTs with 148 stroke patients. The meta-analysis showed statistical differences in the results of FMA-UE [SMD = 0.81, 95% CI (0.52, 1.10), < 0.001], BBT [SMD = 0.48, 95% CI (0.16, 0.80), = 0.003], and MFT [SMD = 0.72, 95% CI (0.05, 1.40), = 0.04] between the VRMT and the control groups.
DISCUSSION
VRMT may play a beneficial role in improving upper extremity dysfunction after stroke, especially when combined with conventional rehabilitation. However, there were differences in the type of VRMT, stage of disease, and severity of upper extremity dysfunction. Multiple reports of high-quality RCTs are needed to clarify the effects of VRMT.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42022345756.
引言
基于虚拟现实的镜像疗法（VRMT）作为一种治疗中风患者上肢功能障碍的新颖且有前景的方法，最近受到了关注。然而，VRMT的临床疗效尚未得到研究。
方法
本研究旨在进行一项荟萃分析，以评估VRMT对中风患者上肢功能障碍的影响。我们筛选了2010年1月至2022年7月期间在PubMed、Scopus、MEDLINE和Cochrane对照试验中央注册库上发表的文章。我们的纳入标准集中在比较VRMT组与对照组（如传统镜像疗法、职业疗法、物理疗法或假治疗）的随机对照试验（RCT）。结局指标包括Fugl-Meyer评估上肢测试（FMA-UE）、箱块测试（BBT）和手动功能测试（MFT）。使用Cochrane协作偏倚风险工具2.0评估偏倚风险。我们计算了标准化均数差（SMD）和95%置信区间（95%CI）。实验方案已在PROSPERO数据库（CRD42022345756）中注册。
结果
本研究纳入了5项RCT，共148例中风患者。荟萃分析显示，VRMT组与对照组在FMA-UE[SMD = 0.81，95%CI（0.52，1.10），<0.001]、BBT[SMD = 0.48，95%CI（0.16，0.80），= 0.003]和MFT[SMD = 0.72，95%CI（0.05，1.40），= 0.04]结果上存在统计学差异。
讨论
VRMT可能在改善中风后上肢功能障碍方面发挥有益作用，尤其是与传统康复相结合时。然而，VRMT的类型、疾病阶段和上肢功能障碍的严重程度存在差异。需要多项高质量RCT报告来阐明VRMT的效果。
系统评价注册
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