What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta analysis of upper-limb and cognitive outcomes

They say nothing about 100% recovery  but do use the tyranny of low expectations to suggest efficacy( small to medium effects). NOT GOOD ENOUGH!

 What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and metaanalysis of upper-limb and cognitive outcomes

 

• Anna Aminov,
• Jeffrey M. Rogers,
• Sandy Middleton,
• Karen Caeyenberghs &
• Peter H. Wilson 

Journal of NeuroEngineering and Rehabilitation volume 15, Article number: 29 (2018) Cite this article

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Abstract

Background

Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper-limb function and cognitive abilities following a stroke. However, an updated synthesis of the literature is needed to capture growth in recent research and address gaps in our understanding of factors that may optimize training parameters and treatment effects.

Methods

Published randomized controlled trials comparing VR to conventional therapy were retrieved from seven electronic databases. Treatment effects (Hedge’s g) were estimated using a random effects model, with motor and functional outcomes between different protocols compared at the Body Structure/Function, Activity, and Participation levels of the International Classification of Functioning.

Results

Thirty-three studies were identified, including 971 participants (492 VR participants). VR produced small to medium overall effects (g = 0.46; 95% CI: 0.33–0.59, p < 0.01), above and beyond conventional therapies. Small to medium effects were observed on Body Structure/Function (g = 0.41; 95% CI: 0.28–0.55; p < 0.01) and Activity outcomes (g = 0.47; 95% CI: 0.34–0.60, p < 0.01), while Participation outcomes failed to reach significance (g = 0.38; 95% CI: -0.29-1.04, p = 0.27). Superior benefits for Body Structure/Function (g = 0.56) and Activity outcomes (g = 0.62) were observed when examining outcomes only from purpose-designed VR systems. Preliminary results (k = 4) suggested small to medium effects for cognitive outcomes (g = 0.41; 95% CI: 0.28–0.55; p < 0.01). Moderator analysis found no advantage for higher doses of VR, massed practice training schedules, or greater time since injury.

Conclusion

VR can effect significant gains on Body Structure/Function and Activity level outcomes, including improvements in cognitive function, for individuals who have sustained a stroke. The evidence supports the use of VR as an adjunct for stroke rehabilitation, with effectiveness evident for a variety of platforms, training parameters, and stages of recovery.

Background

Stroke is one of the leading global causes of disability [1, 2], with over 17 million individuals worldwide sustaining a stroke each year [2]. Although stroke mortality is decreasing with improvements in medical technology [3], the neurological trauma resulting from stroke can be devastating, and the majority of stroke survivors have substantial motor [4, 5], cognitive [6,7,8,9] and functional rehabilitation needs [3, 10, 11], and much reduced quality of life [3, 12, 13]. Targeted rehabilitation can help address some of these post-stroke deficits, however, historically, many individuals, in particular patients with cognitive impairment, have difficulty engaging in standard therapies [14,15,16] at a level that will produce meaningful and lasting improvements [16,17,18,19]. Enriched and interactive rehabilitation programs are clearly needed to minimize functional disability [13, 20], increase participation in age-appropriate roles and activities [21], lead to greater motivation and treatment compliance [17, 22], and reduce the long-term expense of care in stroke survivors [20, 23, 24].