Highlights
- •
- Combined RFVE with CR treatment provided clinically meaningful improvements
- •
- Effectiveness of RFVE is comparable for ischemic and hemorrhagic post-stroke patients
- •
- Effectiveness of virtual therapy remains sensitive to time since stroke onset
- •
- Effectiveness of virtual therapy do not dependent on age and sex
Abstract
Objective
To
evaluate the effectiveness of reinforced feedback in virtual
environment (RFVE) treatment combined with conventional rehabilitation
(CR) in comparison with CR alone, and to study whether changes are
related to stroke aetiology (i.e. ischemic or hemorrhagic).
Design
Randomized controlled trial.
Setting
Inpatients in a hospital facility for intensive rehabilitation.
Participants
136 patients within one year from onset of a single stroke.
Interventions
The
experimental treatment was based on the combination of RFVE with CR,
while control treatment was based on the same amount of CR. Both
treatments lasted 2 hours daily, 5 days a week, for 4 weeks.
Main Outcome Measures
Fugl-Meyer
upper extremity (F-M UE) scale (primary outcome), Functional
Independence Measure (FIM), National Institutes of Health Stroke Scale
(NIHSS), and Edmonton Symptom Assessment Scale (ESAS) (secondary
outcomes). Kinematic parameters of requested movements: duration (Time),
mean linear velocity (Speed), number of submovements (Peak) (secondary
outcomes).
Results
136
patients (ischemic=78, hemorrhagic=58) were randomized in two groups
(RFVE=68, CR=68) and stratified by stroke aetiology (ischemic,
hemorrhagic). Both groups improved after treatment, but the experimental
group had better results than the control group (Mann-Whitney U test)
at: F-M UE (p<0.001), FIM (p<0.001), NIHSS (p≤0.014), ESAS
(p≤0.022), Time (p<0.001), Speed (p<0.001), Peak (p<0.001).
Stroke aetiology did not have significant effects on patient outcomes.
Conclusion
The
RFVE therapy combined with CR treatment promotes better outcomes for
upper limb than the same amount of CR, regardless of stroke aetiology
(Clinical Trial Registration – NCT01955291).
Keywords
- Stroke;
- Virtual Reality;
- Rehabilitation;
- Treatment Effectiveness
List of abbreviations
- RFVE, Reinforced Feedback in Virtual Environment;
- CR, Conventional Rehabilitation;
- QoL, Quality of Life;
- VR, Virtual Reality;
- KR, Knowledge of Results;
- KP, Knowledge of Performance;
- CNS, Central Nervous System;
- VRRS, Virtual Reality Rehabilitation System;
- F-M UE, Fugl-Meyer upper extremity scale;
- FIM, Functional Independence Measure scale;
- NIHSS, National Institutes of Health Stroke scale;
- ESAS, Edmonton Symptom Assessment scale;
- MMSE, Mini-Mental State Examination;
- SD, Standard Deviation;
- ADL, Activities of Daily Living
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© 2018 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
https://www.sciencedirect.com/science/article/pii/S0003999318300996
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