Effects of virtual reality rehabilitation after spinal cord injury: a systematic review and meta-analysis.

Only 16 studies were reviewed, and only 9 were pooled. The paper states 248 subjects took part across the included studies, and most included studies were non-randomized. Only 5 randomized controlled trials were available, and most pooled outcomes combined only two studies. VR systems, durations, frequencies, commercial status, and outcome measures varied across studies. The authors did not analyze results by injury severity. The impact of training intensity or total hours remains unclear because of the limited number of studies. Safety was poorly reported: only one study reported no adverse events, and the remaining studies did not report adverse-event numbers or types. Dropout was higher in the VR group than in conventional rehabilitation, but only five patients withdrew. The significant Walking Index for Spinal Cord Injury and Berg Balance Scale results changed when one study was removed. Some funnel plots showed publication bias, including motor function score and Spinal Cord Independence Measure within-subject analyses. Many VR studies added VR to conventional rehabilitation. The separate contribution of VR cannot be isolated.

The supplied funding and conflict statement names the Research Project of Mianyang City Health Commission and Scientific research Project of Sichuan Provincial Health Commission. It does not report additional author conflicts.

Do not conclude that VR is proven to improve spinal cord injury walking, lower-limb motor scores or independence. The significant walking index and balance results came from small before-after studies, many motor and daily-living outcomes were not significant, and key results changed when one study was removed. VR was often added to conventional therapy, so its independent effect is unclear.