Zhang Jiali, Jiang Xin, Xu Qiuzhu, Cai Enli, Ding Hao
Department of Anesthesia, The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming Hospital of Traditional Chinese Medicine, 650500 Kunming, Yunnan, China.
Department of Clinical Pharmacy, Baoying People's Hospital, 225800 Yangzhou, Jiangsu, China.
J Integr Neurosci. 2024 Dec 27;23(12):225. doi: 10.31083/j.jin2312225.
Recently, there has been a surge in virtual reality (VR)-based training for upper limb (UL) rehabilitation, which has yielded mixed results. Therefore, we aimed to explore the effects of conventional therapy combined with VR-based training on UL dysfunction during post-stroke rehabilitation.
Studies published in English before May 2023 were retrieved from PubMed, Embase, and the Cochrane Library. We also included randomized controlled trials that compared the use of conventional therapy and VR-based training with conventional therapy alone in post-stroke rehabilitation. The meta-analysis was performed using Review Manager Software (version 5.3; The Nordic Cochrane Centre, The Cochrane Collaboration; Copenhagen, Denmark) and Stata/MP 17.0 (StataCorp, LLC, College Station, TX, USA). Univariate and multivariate meta-regression analyses were performed to investigate the effects of stroke duration, VR characteristics, and type of conventional therapy on VR-based training.
In total, 27 randomized controlled trials were included, which enrolled 1354 patients. Our results showed that conventional therapy plus VR-based training is better than conventional therapy alone in UL motor impairment recovery measured using Fugl-Meyer Upper Extremity (standardized mean difference [SMD] = 0.32, 95% confidence interval [CI]: 0.07-0.57, Z = 2.52, = 0.01). Meta-regression showed that stroke duration had independent effects on Fugl-Meyer Upper Extremity scores of VR-based training in rehabilitation ( = 0.041). Furthermore, in subgroup analysis based on stroke duration, stroke duration >6 months was statistically significant (SMD = 0.20, 95% CI: 0.01-0.39, Z = 2.06, = 0.04). No relevant publication bias ( = 0.1303), and no significant difference in activity limitation assessed using the Box-Block Test (mean difference [MD] = 2.79, 95% CI: -0.63-6.20, Z = 1.60, = 0.11) was observed. Regarding the functional independence measured using the Functional Independence Measure scale, studies presented no significant difference between the experimental and control groups (MD = 1.15, 95% CI: -1.84-4.14, Z = 0.76, = 0.45).
Conventional therapy plus VR-based training is superior to conventional therapy alone in promoting the recovery of UL motor function after stroke. Therefore, VR-based training may be a potential option for improving UL motor function. The study was registered on PROSPERO (https://www.crd.york.ac.uk/prospero/), registration number: CRD42023472709.
最近，基于虚拟现实（VR）的上肢（UL）康复训练激增，但其结果好坏参半。因此，我们旨在探讨传统疗法联合基于VR的训练对脑卒中后康复期间UL功能障碍的影响。
从PubMed、Embase和Cochrane图书馆检索2023年5月之前发表的英文研究。我们还纳入了比较在脑卒中后康复中使用传统疗法与单独使用传统疗法联合基于VR的训练的随机对照试验。使用Review Manager软件（版本5.3；北欧Cochrane中心，Cochrane协作网；丹麦哥本哈根）和Stata/MP 17.0（美国德克萨斯州大学站StataCorp有限责任公司）进行荟萃分析。进行单变量和多变量荟萃回归分析，以研究卒中持续时间、VR特征和传统疗法类型对基于VR的训练的影响。
总共纳入了27项随机对照试验，共1354例患者。我们的结果表明，在使用Fugl-Meyer上肢量表测量的UL运动功能恢复方面，传统疗法加基于VR的训练优于单独的传统疗法（标准化均数差[SMD]=0.32，95%置信区间[CI]：0.07-0.57，Z=2.52，P=0.01）。荟萃回归显示，卒中持续时间对康复中基于VR的训练的Fugl-Meyer上肢评分有独立影响（P=0.041）。此外，在基于卒中持续时间的亚组分析中，卒中持续时间>6个月具有统计学意义（SMD=0.20，95%CI：0.01-0.39，Z=2.06，P=0.04）。未发现相关的发表偏倚（P=0.1303），并且使用Box-Block测试评估的活动受限方面未观察到显著差异（均数差[MD]=2.79，95%CI：-0.63-6.20，Z=1.60，P=0.11）。关于使用功能独立性测量量表测量的功能独立性，研究显示实验组和对照组之间无显著差异（MD=1.15，95%CI：-1.84-4.14，Z=0.76，P=0.45）。
传统疗法加基于VR的训练在促进脑卒中后UL运动功能恢复方面优于单独的传统疗法。因此，基于VR的训练可能是改善UL运动功能的一个潜在选择。该研究已在PROSPERO（https://www.crd.york.ac.uk/prospero/）上注册，注册号：CRD42023472709。
