Deans' stroke musings: Virtual reality for upper limb rehabilitation in sub-acute and chronic stroke: a randomized controlled trial

This is useless until it is written up in stroke protocol format and published in a publicly available database. Your doctor will never find this and the only option is for survivors to find it and bring it to their therapists attention for recovery use.

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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We would like to acknowledge Aneta Kiper, MSc, PT for her support and assistance throughout the study.

Conflict of Interest

The Authors declare that there is no conflict of interest

: Corresponding author Pawel Kiper Fondazione Ospedale San Camillo IRCCS via Alberoni 70, 30126 Venezia, Italy Tel. 00390412207214, Fax. 00390412207129

Deans' stroke musings

Thursday, February 22, 2018

Virtual reality for upper limb rehabilitation in sub-acute and chronic stroke: a randomized controlled trial