不同模式的虚拟现实对上肢恢复的影响：关于优化中风康复的系统评价和网状Meta分析

Effects of virtual reality with different modalities on upper limb recovery: a systematic review and network meta-analysis on optimizing stroke rehabilitation.

作者信息

Zhang Jiali, Liu Mingxiu, Yue Junlin, Yang Jinmei, Xiao Yan, Yang Jie, Cai Enli

机构信息

The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China.

Bishan Hospital of Chongqing Medical University, Chongqing, China.

出版信息

Front Neurol. 2025 Apr 1;16:1544135. doi: 10.3389/fneur.2025.1544135. eCollection 2025.

DOI:10.3389/fneur.2025.1544135

PMID:40236896

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11996652/

Abstract

BACKGROUND

As a major cause of disability worldwide, stroke affects about 80% of survivors with upper limb (UL) motor dysfunction, significantly impairing their quality of life. Virtual reality (VR) has been recognized as an innovative rehabilitation tool; however, the effectiveness of VR systems with different immersion modalities is still uncertain. This systematic review and network meta-analysis (NMA) aims to evaluate the comparative effectiveness of intervention measures, including non-immersive gaming consoles, immersive VR (IVR), non-immersive VR (NIVR), and conventional therapy (CT) on upper limb motor function in stroke rehabilitation.

MATERIALS AND METHODS

A systematic search of PubMed, Embase, Cochrane Library, and Scopus identified randomized controlled trials (RCTs) published up to 12 June 2024. UL motor recovery was assessed using the Fugl-Meyer Upper Extremity (FMUE) scale. The NMA was performed using the Bayesian approach with the BUGSnet package in R software to calculate the relative effectiveness of each intervention.

RESULTS

34 RCTs involving 1,704 participants were included. Among non-immersive gaming systems, Microsoft Kinect demonstrated the greatest effective in enhancing UL motor function, followed by Nintendo Wii, then NIVR and IVR head-mounted devices. CT showed the least effective. Specifically, Microsoft Kinect significantly improved FMUE scores (mean difference [MD] = 7.27, 95% confidence interval [CI]: 0.59 to 13.77,  < 0.05), followed by Nintendo Wii (MD = 4.53, 95% CI: 0.87 to 8.14,  < 0.05), and NIVR (MD = 3.57, 95% CI: 1.18 to 6.01,  < 0.05). In contrast, IVR head-mounted devices showed no statistically significant differences in outcomes, with MD of 4.16 (95% CI: -0.02 to 8.38).

CONCLUSION

Non-immersive gaming console of Microsoft Kinect is the most effective intervention for improving UL motor function in stroke survivors. In contrast, IVR head-mounted devices did not offer significant advantages over CT. These findings suggest that non-immersive gaming consoles of Microsoft Kinect could be a more cost-effective and accessible alternative for stroke rehabilitation.

摘要

背景

作为全球致残的主要原因，中风影响了约80%的上肢（UL）运动功能障碍幸存者，严重损害了他们的生活质量。虚拟现实（VR）已被公认为一种创新的康复工具；然而，不同沉浸模式的VR系统的有效性仍不确定。本系统评价和网络荟萃分析（NMA）旨在评估干预措施的比较效果，包括非沉浸式游戏机、沉浸式VR（IVR）、非沉浸式VR（NIVR）和传统疗法（CT）对中风康复中上肢运动功能的影响。

材料与方法

对PubMed、Embase、Cochrane图书馆和Scopus进行系统检索，以确定截至2024年6月12日发表的随机对照试验（RCT）。使用Fugl-Meyer上肢（FMUE）量表评估UL运动恢复情况。使用R软件中的BUGSnet包采用贝叶斯方法进行NMA，以计算每种干预措施的相对有效性。

结果

纳入了34项涉及1704名参与者的RCT。在非沉浸式游戏系统中，微软Kinect在增强UL运动功能方面显示出最大的效果，其次是任天堂Wii，然后是NIVR和IVR头戴设备。CT显示效果最差。具体而言，微软Kinect显著提高了FMUE评分（平均差[MD]=7.27，95%置信区间[CI]：0.59至13.77，P<0.05），其次是任天堂Wii（MD=4.53，95%CI：0.87至8.14，P<0.05）和NIVR（MD=3.57，95%CI：1.18至6.01，P<0.05）。相比之下，IVR头戴设备在结果上没有统计学显著差异，MD为4.16（95%CI：-0.02至8.38）。