Integrating virtual reality and exergaming in cognitive rehabilitation of patients with Parkinson disease: a systematic review of randomized controlled trials.
Nicola Marotta, Dario Calafiore, Claudio Curci and 5 others
PMID 36169933WHAT IT FOUND
Across 10 small trials of VR or exergaming for cognition in Parkinson's, results were mixed.
Some showed the technology outperformed conventional rehab; others showed both groups improving equally. Most trials treated cognition as a secondary measure, and the tests were too varied to combine.
Key findings
01Results were inconsistent across trials. In two VR studies, both the technology group and the treadmill-only control group improved equally on Trail Making B and executive function, with no between-group difference. In another VR study, there was no difference between groups on the FIM cognitive subscale. In contrast, two other VR studies found the technology group scored higher on global cognitive, attention, and visuospatial measures.
02In most of the included trials, cognitive assessment was a secondary outcome rather than the primary endpoint, meaning the studies were not designed or powered to detect a cognitive effect.
03Four of the ten included trials were rated as having a high overall risk of bias, and the cognitive outcome measures were too inconsistent across studies to allow a quantitative pooling of results.
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
Four of the ten included trials were rated as having a high overall risk of bias. In most of the included studies, cognitive assessment was a secondary outcome, so the trials were not powered or designed to detect a cognitive effect. The cognitive outcome measures were too inconsistent across studies to allow a quantitative pooling, so no overall effect estimate could be calculated. The interventions varied widely (semi-immersive VR, robotic-assisted gait training, Wii, Kinect, online games), making it impossible to attribute any effect to a specific type of technology. Individual trial sample sizes were small, ranging from 12 to 20 participants. Only one trial directly compared two commercial exergaming devices, so it is not possible to say which platform is better.
The easy way to misread this
Do not read the positive cognitive scores in two VR trials as proof that virtual reality improves thinking in Parkinson's. In the other VR trials, both groups improved equally or there was no difference, cognition was a secondary measure in most studies, and four of the ten trials had a high risk of bias.
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