Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis.
Martina Maier, Belén Rubio Ballester, Armin Duff and 2 others
PMID 30700224WHAT IT FOUND
Rehabilitation-specific and commercial VR did not differ clearly.
Rehabilitation-specific VR showed better upper-limb movement and daily hand use than usual therapy, while commercial VR did not.
Key findings
01The subgroup comparison between rehabilitation-specific and commercial VR did not show a significant difference for body function (P = .70) or activity (P = .36).
02Rehabilitation-specific VR studies showed a significant benefit for body function (SMD = 0.23; 95% CI = 0.10 to 0.36; P = .0007) and activity (SMD = 0.31; 95% CI = 0.15 to 0.47; P = .0001) compared with conventional therapy.
03Commercial VR studies showed no significant effect for body function (SMD = 0.16; 95% CI = -0.14 to 0.47; P = .30) or activity (SMD = 0.15; 95% CI = -0.15 to 0.45; P = .33) compared with conventional therapy.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The analysis compares each VR type with conventional therapy separately; it does not directly test rehabilitation-specific VR against commercial VR. Many trials could not blind patients or therapists, which can influence effort and performance. Some trials did not clearly report allocation concealment or missing-data handling. The commercial VR subgroup had relatively few studies, so a null result may reflect limited power. The content analysis relied on what papers explicitly reported, so unreported principles may have been missed. Protocols and outcome scales varied widely, so the effect of VR alone cannot be separated from conventional therapy or other treatment components. Clinically important differences were not available for all scales and stroke stages. The authors noted that some rehabilitation-specific systems were commercial and could not rule out conflict-of-interest influence.
Declared interests
One author was founder and interim CEO of a company that aims to bring neurorehabilitation technology to society. The other authors declared no conflicts. The study was supported by research grants named SANAR, cDAC, and socSMCs.
The easy way to misread this
Do not conclude that all VR systems improve poststroke upper-limb recovery. Commercial VR showed no clear benefit, and rehabilitation-specific VR was not clearly better than commercial VR.