Virtual reality for stroke rehabilitation

• Published in: Cochrane database of systematic reviews 2015-02, Vol.2015 (2), p.CD008349-CD008349
• Main Authors: Laver, Kate E, George, Stacey, Thomas, Susie, Deutsch, Judith E, Crotty, Maria
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Humans; Medicine General & Introductory Medical Sciences; Psychomotor Performance; Randomized Controlled Trials as Topic; Stroke - psychology; Stroke Rehabilitation; Therapy, Computer-Assisted - methods; User-Computer Interface; Video Games
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD008349.pub3

Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles have been rapidly adopted in clinical settings. This is an update of a Cochrane Review published in 2011. To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance activity, global motor function, cognitive function, activity limitation, participation restriction and quality of life, voxels or regions of interest identified via imaging, and adverse events. Additionally, we aimed to comment on the feasibility of virtual reality for use with stroke patients by reporting on patient eligibility criteria and recruitment. We searched the Cochrane Stroke Group Trials Register (October 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 11), MEDLINE (1950 to November 2013), EMBASE (1980 to November 2013) and seven additional databases. We also searched trials registries and reference lists. Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance function and activity, and global motor function. Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted investigators to obtain missing information. We included 37 trials that involved 1019 participants. Study sample sizes were generally small and interventions varied. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains 'low' or 'very low' quality when rated using the GRADE system. Control groups received no intervention or therapy based on a standard care approach. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of partic