What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes.
Anna Aminov, Jeffrey M Rogers, Sandy Middleton and 2 others
PMID 29587853WHAT IT FOUND
Virtual rehabilitation added small to medium gains in arm movement and daily tasks over usual therapy.
Both custom systems and game consoles helped, but participation outcomes did not improve.
Key findings
01Virtual rehabilitation showed a small to medium benefit over conventional therapy when all outcomes were combined.
02Both purpose-designed virtual environments and commercial gaming systems were better than conventional therapy, and purpose-designed systems were significantly better than commercial gaming.
03Cognitive outcomes showed a small significant benefit, but only four studies reported them and the finding was described as tenuous.
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
Cognitive results rested on only four studies, and the fail-safe N was 2, so the finding is fragile. Participation outcomes were non-significant and based on five studies, with large heterogeneity. Many trials were small, with an average of 15 participants per group, and some had fewer than 10 participants in the VR group. Participants were usually not blinded, and four included studies were rated fair quality because allocation concealment, blinding, or intention-to-treat analysis was missing. Egger's test suggested smaller studies may have reported larger effects, and the review protocol was not registered. Dose, timing, control group type, and outcome measures varied widely, so a specific VR protocol is not clear.
Declared interests
The supplied text names Prince of Wales Hospital Foundation and The Research Training Program (RTP) as funders; it does not state author conflicts.
The easy way to misread this
Do not read the significant cognitive result as proof that virtual rehabilitation improves cognition after stroke. Only four studies reported cognitive outcomes, and the fail-safe N was 2, so the authors described this finding as tenuous.