Stroke research should provide EXACT PROTOCOLS! Not lazy 'recommendations'!
Effectiveness of virtual reality-based rehabilitation on the upper extremity motor function of stroke patients: A protocol for systematic review and meta-analysis
- Jiali Zhang,
- Jie Yang,
- Qiuzhu Xu,
- Yan Xiao,
- Liang Zuo,
- Enli Cai
- Published: November 7, 2024
- https://doi.org/10.1371/journal.pone.0313296
Abstract
Introduction
Upper extremity deficits (UED) is a common and impactful complication among stroke survivors. Virtual reality (VR)-based rehabilitation holds potential for enhancing rehabilitation intensity and engagement by stimulating tasks. While several clinical studies have examined the effectiveness and safety of VR-based rehabilitation, there is a need for further research to improve consistency in outcomes.
Materials and methods
The study will incorporate randomized controlled trials (RCTs) concerning the effects of VR-based rehabilitation on upper extremity (UE) function in stroke survivors. A comprehensive search of databases including PubMed, Embase, Cochrane Library, Web of Science, Scopus, Cinahl, China National Knowledge Infrastructure (CNKI), Wan-fang, and Chinese Biology Medicine Database will be performed from inception to the start of the study. Primary outcomes will focus on upper limb motor function assessments such as the Fugl-Meyer Upper Extremity (FMUE), Box and Block Test (BBT), Wolf Motor Function Test (WMFT), and Action Research Arm Test (ARAT). Secondary outcomes related to activities of daily living will include the Barthel Index (BI) and Functional Independence Measure (FIM). Research selection, data extraction, and quality assessment will be independently conducted by two researchers. The recently revised Cochrane risk of bias tool will be employed to evaluate study quality. Meta-regression and subgroup analyses will be utilized to identify effective therapy delivery modes and patterns. The assessment, development, and evaluation of recommendations approach will be applied to achieve a robust conclusion.
Discussion
This study provides a rigorous synthesis to evaluate optimal parameters—specifically intensity and duration—for VR-based rehabilitation interventions aimed at enhancing UE function in stroke survivors. Our secondary objective is to assess the impact of these parameters on rehabilitation outcomes. We anticipate an accurate, transparent, and standardized review process that will yield evidence-based recommendations for integrating VR technology into treating upper extremity dysfunction in stroke patients, offering clinicians effective strategies to enhance upper limb function.
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Citation: Zhang J, Yang J, Xu Q, Xiao Y, Zuo L, Cai E (2024) Effectiveness of virtual reality-based rehabilitation on the upper extremity motor function of stroke patients: A protocol for systematic review and meta-analysis. PLoS ONE 19(11): e0313296. https://doi.org/10.1371/journal.pone.0313296
Editor: Domiziano Tarantino, University of Naples Federico II: Universita degli Studi di Napoli Federico II, ITALY
Received: April 24, 2024; Accepted: October 18, 2024; Published: November 7, 2024
Copyright: © 2024 Zhang et al. This is an open access article distributed under the terms of the Crea, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.
Funding: The study is supported by a grant from "Research on the Integrated Nursing Intervention Model of Traditional Chinese and Western Medicine for Early Recovery Patients with Ischemic Stroke Based on KTA" (Project No. 202101AZ070001-221) in Yunnan Province, China. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Stroke is a leading cause of disability worldwide, affecting almost 14 million people annually [1, 2]. While stroke mortality rates show a declining trend, the number of individuals experiencing the consequences of stroke is increasing due to population growth and ageing [3]. This upward trend has led to substantial, enduring disabilities in adults [4].
Approximately 75% of stroke survivors will demonstrate enduring deficits in motor control of their arm and hand, leading to enormous personal and societal consequences [5]. This increase in the number of stroke survivors highlights the growing need for rehabilitation services [6]. A common and severe disabling complication of stroke is UED [7]. These deficits persist partly due to the failure of current nonrepresentational approaches to substantially reduce upper-limb impairment [8]. Common manifestations of UED include loss of strength, reduced flexibility, abnormal cooperative interaction incursion, and muscle tension disorders [9]. These impairments can cause disabilities in common activities such as reaching, picking up objects, and holding onto objects [10].
Moreover, the restoration of UE function is a complex process with poor prognoses [11], which significantly affects patients’ independence in daily activities and greatly reduces their quality of life. This places a considerable burden on both families and society. Consequently, it is crucial to enhance the functional capacity of the UE and promote greater levels of independence in individuals after a stroke. Contemporary clinical strategies for UE rehabilitation rely on fostering neuroplasticity post-brain impairments [12]. Intensive and extensive task-specific training emphasizing numerous repetitions, has emerged as crucial in motor therapy following a stroke [13].
According to the guideline, postural training and task-oriented upper limb training have the potential to positively influence on upper limb motor control [14]. Currently, the field of neurorehabilitation encompasses several technologies that hold promise for addressing various neurological dysfunctions [15]. Among these, VR stands out as an innovative intervention in rehabilitation nursing, offering an enriched environment conducive to task-specific training and delivering multimodal feedback to promote functional recovery [16]. VR interventions for motor impairments showed positive rehabilitative effects in stroke survivors [17]. The three fundamental concepts of VR are immersion, imagination, and interaction [18]. Patients can immerse themselves in simulated scenarios, interact with their environment by engaging imagery, and receive real-time feedback, fostering immersive experiences conducive to motor rehabilitation. In parallel with usual rehabilitation therapy programs, VR not only supplements existing strategies but also motivates patients to engage in more purposeful practices, thereby intensifying the effectiveness of targeted movements.
However, there is still no consensus in the field of UE rehabilitation regarding the specific types, duration, and intensity of VR training required to assess its clinical effectiveness [19]. Moreover, a previous meta-analysis indicated a significant increase in the utilization of VR-based training for UE rehabilitation, resulting in varied outcomes. To effectively assess the impact of VR training in improving upper limb dysfunction post-stroke, it is essential to establish a comprehensive and standardized protocol for systematic reviews and meta-analyses. Our primary objective is to develop this standardized protocol to assess the effectiveness of VR-based rehabilitation in enhancing upper limb motor function among adult stroke survivors. Additionally, we aim to investigate the intensity and duration of VR interventions to optimize outcomes related to upper limb functionality. The positive findings from this study may prompt further research into the optimal dosing of VR training, ultimately advancing clinical practice for stroke rehabilitation and contributing to future clinical practice guidelines.
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