Fang Enhui, Guan Hui, Du Binhong, Ma Xuejun, Ma Lihong
School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
Department of Rehabilitation, Jinan Children's Hospital, Jinan, China.
Front Neurol. 2025 Jul 30;16:1582110. doi: 10.3389/fneur.2025.1582110. eCollection 2025.
OBJECTIVE: Cerebral palsy (CP), a pediatric neuromotor disorder, profoundly impacts functional independence and participation. Virtual reality (VR) has developed as a potential neurorehabilitation tool, yet its therapeutic efficacy remains inconsistently validated. This overview aims to synthesize evidence from systematic reviews (SRs) and meta-analyses (MAs) to evaluate VR's effectiveness in CP rehabilitation. METHODS: Systematic searches across ten databases-Embase, Web of Science, Cochrane Library, PubMed, CINAHL, JBI, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), China Bio-Medical Literature Service System (Sino-Med), and Wanfang Database-identified SRs/MAs on VR for CP from inception to November 10, 2024. The duplicate rate of primary studies was assessed by calculating the corrected covered area (CCA) through the establishment of a literature overlap matrix. Methodological rigor, reporting quality, bias risk, and evidence quality were appraised using the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA2020), the Risk of Bias in Systematic Reviews (ROBIS), and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tools, respectively. RESULTS: Sixteen SRs/MAs (5 low quality, 11 very low quality, according to AMSTAR-2) were included. The CCA was calculated as 0.135, indicating a high degree of overlap. PRISMA 2020 compliance revealed incomplete reporting in 37% of items. ROBIS indicated low bias risk in 13 studies. GRADE assessments classified 58 outcomes: 9 moderate (15.5%), 21 low (36.2%), and 28 very low (48.3%) quality. VR demonstrated clinical potential for improving motor function and activities of daily living (ADL), particularly in younger children with higher intervention dosages. However, heterogeneity in outcome measures, CP subtypes, and VR protocols limited generalizability. CONCLUSION: VR shows potential in improving motor dysfunction and ADL in CP. However, the included SRs/MAs typically exhibited low methodological and evidence quality. Therefore, caution must be taken when interpreting these findings. Moreover, high-quality randomized controlled trials and standardized VR protocols are urgently needed to establish evidence-based guidelines for CP rehabilitation. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024614631, CRD42024614631.
目的:脑性瘫痪(CP)是一种小儿神经运动障碍,对功能独立性和参与度有深远影响。虚拟现实(VR)已发展成为一种潜在的神经康复工具,但其治疗效果仍未得到一致验证。本综述旨在综合系统评价(SR)和荟萃分析(MA)的证据,以评估VR在CP康复中的有效性。 方法:在十个数据库(Embase、科学网、考克兰图书馆、PubMed、护理学与健康领域数据库、循证卫生保健国际协作网、中国知网、维普中文科技期刊数据库、中国生物医学文献服务系统、万方数据库)中进行系统检索,以确定从起始到2024年11月10日关于VR用于CP的SR/MA。通过建立文献重叠矩阵计算校正覆盖面积(CCA)来评估原始研究的重复率。分别使用多重系统评价评估2(AMSTAR-2)、系统评价和荟萃分析优先报告项目2020(PRISMA2020)、系统评价中的偏倚风险(ROBIS)以及推荐分级评估、制定和评价(GRADE)工具来评估方法的严谨性、报告质量、偏倚风险和证据质量。 结果:纳入了16项SR/MA(根据AMSTAR-2,5项质量低,11项质量极低)。计算得出CCA为0.135,表明重叠程度较高。PRISMA 2020合规性显示37%的项目报告不完整。ROBIS表明13项研究的偏倚风险较低。GRADE评估对58项结果进行了分类:9项为中等质量(15.5%),21项为低质量(36.2%),28项为极低质量(48.3%)。VR显示出改善运动功能和日常生活活动(ADL)的临床潜力,尤其是在干预剂量较高的年幼儿童中。然而,结果测量、CP亚型和VR方案的异质性限制了普遍性。 结论:VR在改善CP的运动功能障碍和ADL方面显示出潜力。然而,纳入的SR/MA通常方法质量和证据质量较低。因此,在解释这些结果时必须谨慎。此外,迫切需要高质量的随机对照试验和标准化的VR方案,以建立CP康复的循证指南。 系统评价注册:https://www.crd.york.ac.uk/PROSPERO/view/CRD42024614631,CRD42024614631。
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