Effects of home-based virtual reality upper extremity rehabilitation in persons with chronic stroke: a randomized controlled trial.
Hiroyuki Ase, Kaoru Honaga, Mami Tani and 6 others
PMID 39901178WHAT IT FOUND
In 14 people with chronic stroke, adding home VR task practice to weekly occupational therapy improved arm movement and hand use more than conventional home exercises with the same weekly therapy.
The study was small and baseline scores differed.
Key findings
01The primary FMA-UE total score showed a significant between-group difference in change before-post (P=0.027) and before-post 4w (P=0.024).
02The VR group's FMA-UE total score change was 8.9 ± 1.9 before-post and 10.1 ± 7.7 before-post 4w. The change exceeded the reported minimal clinically important difference of 5.25.
03The VR group showed significant between-group differences in MAL-14 AoU before-post (P=0.014) and before-post 4w (P=0.007). The MAL-14 AoU evaluates frequency of paretic hand use.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study enrolled 14 participants instead of the planned 30 because recruitment was interrupted by the COVID-19 pandemic. The control group started with lower arm function and hand use scores, with average FMA-UE 7.3 lower and average MAL-14 AoU 0.40 lower than the VR group. Participants could not be blinded to whether they used the VR device. Follow-up was only 4 weeks after the intervention, so longer-term effects were not tested. The device requires some active movement, and the paper says it is practical for relatively mild paralysis. The control group's exercise time was self-reported, while the VR group's time was also recorded by the device. The text and Table 2 report different standard deviations for the VR group's FMA-UE before-post change, 8.9 ± 6.9 in the text and 8.9 ± 1.9 in Table 2.
The easy way to misread this
Do not conclude that the VR glove alone caused the improvement. The VR group received home VR practice plus weekly outpatient occupational therapy, and the control group received conventional home exercises plus weekly outpatient occupational therapy. The study cannot separate the contribution of the device from the therapist guidance. The sample was small, and the control group began with lower arm function scores.