前交叉韧带损伤后基于虚拟现实的治疗可有效减轻疼痛并改善膝关节功能、运动模式和动态平衡：一项系统评价和荟萃分析。
Virtual reality-based therapy after anterior cruciate ligament injury effectively reduces pain and improves knee function, movement patterns, and dynamic balance: A systematic review and meta-analysis.
作者信息
Cortés-Pérez Irene, Desdentado-Guillem Jose María, Camacho-Delgado María Soledad, Del Rocío Ibancos-Losada María, Obrero-Gaitán Esteban, Lomas-Vega Rafael
机构信息
Department of Health Sciences, University of Jaén, Jaén, Spain.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2025 May;33(5):1736-1753. doi: 10.1002/ksa.12477. Epub 2024 Sep 20.
PURPOSE
Virtual reality-based therapy (VRBT) may be an effective physical therapy complement employed in the rehabilitation of patients with anterior cruciate ligament (ACL) injury. This study aims to assess the effectiveness of VRBT in improving pain, knee function, strength, proprioception, flexion range of motion (ROM), and dynamic balance after ACL injury.
METHODS
We conducted this systematic review with meta-analysis following PRISMA criteria. Since inception to June 2024, we searched in PubMed Medline, WOS, SCOPUS, CINAHL and PEDro without publication date and language restrictions. Randomised controlled trials (RCTs), comprising only patients with ACL injury, that assess the effectiveness of VRBT compared to classical interventions on the outcomes of interest were included. PEDro scale was employed to analyze the methodological quality of the RCTs included. Cohen's standardised mean difference (SMD) and its 95% confidence interval (95% CI) was used to calculate the pooled effect in meta-analyses.
RESULTS
Nine RCTs, providing data from 330 participants (26.96 ± 3.11 years, 85% males) were included. The RCTs included showed good methodological quality (PEDro scale = 6.88 points), being, performance and detection biases, the most common biases reported. Meta-analyses showed that VRBT was more effective than classical interventions in reducing pain (SMD = -1.15; 95% CI -1.85 to -0.45; p = 0.001; I = 0%), and increasing knee function (SMD = 1.71; 95% CI 0.93 to 2.5; p < 0.001; I = 0%), strength (SMD = 0.82; 95% CI 0.4-1.23; p < 0.001; I = 0%) and flexion ROM (SMD = 0.7; 95% CI 0.37-1.01; p < 0.001; I = 0%). Additionally, VRBT improved postero-medial (SMD = 0.46; 95% CI 0.01-0.9; p = 0.045; I = 15.1%) and postero-lateral CoP excursion (SMD = 0.75; 95% CI 0.3-1.21; p = 0.001; I = 0%), being effective in improving dynamic balance.
CONCLUSION
VRBT is an effective physical therapy complement to be included in the ACL's rehabilitation programmes due to reduces pain and increases knee function, strength, ROM and dynamic balance after ACL injury.
LEVEL OF EVIDENCE
Level II.
目的
基于虚拟现实的治疗（VRBT）可能是前交叉韧带（ACL）损伤患者康复中一种有效的物理治疗补充手段。本研究旨在评估VRBT对改善ACL损伤后疼痛、膝关节功能、力量、本体感觉、屈曲活动范围（ROM）和动态平衡的有效性。
方法
我们按照PRISMA标准进行了这项系统评价和荟萃分析。从数据库建立至2024年6月，我们在PubMed Medline、WOS、SCOPUS、CINAHL和PEDro中进行检索，无出版日期和语言限制。纳入仅包含ACL损伤患者的随机对照试验（RCT），这些试验评估了VRBT与传统干预措施相比对感兴趣结局的有效性。采用PEDro量表分析纳入的RCT的方法学质量。在荟萃分析中，使用Cohen标准化均数差（SMD）及其95%置信区间（95%CI）计算合并效应。
结果
纳入了9项RCT，提供了330名参与者（26.96±3.11岁，85%为男性）的数据。纳入的RCT显示出良好的方法学质量（PEDro量表=6.88分），其中表现性和检测性偏倚是报告中最常见的偏倚。荟萃分析表明，VRBT在减轻疼痛（SMD=-1.15；95%CI -1.85至-0.45；p=0.001；I²=0%）、改善膝关节功能（SMD=1.71；95%CI 0.93至2.5；p<0.001；I²=0%）、力量（SMD=0.82；95%CI 0.4 - 1.23；p<0.001；I²=0%）和屈曲ROM（SMD=0.7；95%CI 0.37 - 1.01；p<0.001；I²=0%）方面比传统干预措施更有效。此外，VRBT改善了后内侧（SMD=0.46；95%CI 0.01 - 0.9；p=0.045；I²=15.1%）和后外侧的压力中心偏移（SMD=0.75；95%CI 0.3 - 1.21；p=0.001；I²=0%），对改善动态平衡有效。
结论
由于VRBT可减轻ACL损伤后的疼痛并增加膝关节功能、力量、ROM和动态平衡，因此它是ACL康复计划中一种有效的物理治疗补充手段。
证据水平
二级。
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