Use of Virtual Reality in Burn Rehabilitation: A Systematic Review and Meta-analysis

ObjectivesWe systematically reviewed published clinical trials to evaluate the effectiveness of virtual reality (VR) technology on functional improvement, pain relief, and reduction of mental distress among burn patients undergoing rehabilitation.Data SourcesSystematic searches were conducted in 4 databases, including PubMed, the Cochrane Library, Embase, and Web of Science, from inception to August 2021.Study SelectionRandomized controlled trials (RCTs) evaluating any type of VR for the rehabilitation in burn patients with dysfunction were included.Data ExtractionTwo reviewers evaluated the eligibility, and another 2 reviewers used the Cochrane risk of bias assessment tool to assess the risk of bias. The extracted data included the main results of rehabilitation evaluation (quality of life [QOL], work performance, range of motion [ROM] of joints, hand grip and pinch strength, pain, fun, anxiety), the application performance of VR (realness and presence), adverse effects (fatigue and nausea), and characteristics of the included studies. Heterogeneity was evaluated using the chi-square tests and I² statistics. Random- or fixed-effects models were conducted to pool the effect sizes expressed as standardized mean differences (SMDs).Data SynthesisSixteen RCTs with 535 burn patients were included. VR-based interventions were superior to usual rehabilitation in QOL and work performance of burn patients and produced positive effect on the average gain of ROM (SMD=0.72) as well. VR was not associated with improved hand grip and pinch strength (SMD=0.50, 1.22, respectively) but was associated with reduced intensity, affective, and cognitive components of pain (SMD=−1.26, −0.71, −1.01, respectively) compared with control conditions. Ratings of fun in rehabilitation therapy were higher (SMD=2.38), and anxiety scores were lower (SMD=−0.73) than in control conditions.ConclusionsVR-based burn rehabilitation significantly improves the QOL and work performance of burn patients, increases the ROM gain in the joints, reduces the intensity and unpleasantness of pain and the time spent thinking about pain, increases the fun in the rehabilitation therapy, reduces the anxiety caused by the treatment, and has no obvious adverse effects. However, it did not significantly improve hand grip or pinch strength.     

The Use of Virtual Reality in Back Pain Rehabilitation: A Systematic Review and Meta-Analysis

This systematic review aimed to synthesize the existing evidence of extended reality (XR) on pain and motor function outcomes in patients with back pain. Following the Cochrane guidelines, relevant articles of any language were selected by 2 independent reviewers from CINAHL, Cochrane, Embase, Medline and Web of Knowledge databases. Of 2,050 unique citations, 24 articles were included in our review. These studies included a total of 900 back pain patients. Despite broader XR search, all interventions were virtual reality (VR) based and involved physical exercises (n = 17, 71%), hippotherapy (n = 4, 17%), motor imagery (n = 1, 4%), distraction (n = 1, 4%), and cognitive-behavior therapy (n = 1, 4%). Sixteen controlled studies were included in a meta-analysis which suggested that VR provides a significant improvement in terms of back pain intensity over control interventions (Mean Difference: -0.67; 95% CI: -1.12 to -0.23; I² = 85%). Almost all included studies presented high risk of bias, highlighting the need to improve methodology in the examination of VR interventions. While the specific set of studies showed high heterogeneity across several methodological factors, a tentative conclusion could be drawn that VR was effective improving back pain intensity and tends to have a positive effect on improving other pain outcomes and motion function.PerspectiveExtended reality technologies have appeared as interesting nonpharmacological options for the treatment of back pain, with the potential to minimise the need for opioid medications. Our systematic review summarised existing applications of extended reality for back pain and proposed a few recommendations to direct further studies in the field.     

虚拟现实技术对脑卒中患者上下肢运动功能康复效果的系统评价

目的系统评价虚拟现实技术对脑卒中患者上下肢运动功能康复的效果。方法计算机检索PubMed、Cochrane Cen-tral Register of Controlled Trials、中国知网、维普、万方数据库中关于虚拟现实技术改善脑卒中患者运动功能障碍的随机对照试验。搜索时限从建库至2013年1月。按照Cochrane系统评价员手册推荐方法逐一评价纳入研究的质量,提取有效数据,对符合质量要求的文献数据采用RevMan 5.0软件对最终纳入文献数据进行统计学分析。结果最终纳入20篇文献,其中上肢运动功能相关13篇,下肢运动功能相关7篇。Meta分析结果显示,虚拟现实技术疗法对Fugl-Meyer评定法(FMA)上肢部分(WMD=4.27,95%CI:2.47~6.06,Z=4.67,P<0.00001)及盒子和阻碍物测试(BBT)(WMD=9.29,95%CI:5.24~13.34,Z=4.50,P<0.00001)与常规康复治疗比较,其差异均有统计学意义。而Berg平衡量表(BBS)(WMD=1.63,95%CI:-0.83~4.09,Z=1.30,P=0.20)和步行速度(WMD=0.01,95%CI:-0.14~0.17,Z=0.18,P=0.86)与常规康复治疗比较,其差异无统计学意义。纳入文献质量的Jadad评分,低质量16篇,高质量4篇。结论虚拟现实技术能明显改善脑卒中后患者上肢运动功能,但对于脑卒中患者下肢运动功能的恢复无明显疗效。     

虚拟现实技术在脑卒中患者康复中的应用及研究进展

本文综述了虚拟现实技术在脑卒中患者的评估和康复方面的应用和研究进展。并且提出了现有研究的一些局限性。随着VR技术的硬件和软件不断更新发展,一个能够综合评定和全方位康复的一体化VR系统有望应运而生,更好地满足脑卒中患者在医院、社区和家庭中的康复需求。     

虚拟现实技术对脑卒中偏瘫患者平衡功能的疗效

目的比较基于虚拟现实技术(VR)的平衡训练和传统平衡训练对脑卒中偏瘫患者静态和动态平衡功能的效果。方法20 例脑卒中偏瘫患者,随机分为实验组(n=10)和对照组(n=10)。两组患者均进行常规神经内科药物治疗和康复训练。实验组接受“城市驾车”“驾船”“小径遭遇”等3 种VR游戏训练,对照组接受传统平衡训练。分别于训练前、训练4 周后采用Berg 平衡量表(BBS)、“起立-行走”计时测试(TUGT)评定,采用平衡测试仪对患者的姿势稳定性和稳定极限进行测量。结果训练后,两组BBS和TUGT评分均较训练前显著改善(P<0.001),实验组显著优于对照组(P<0.001)。训练后两组患者部分姿势稳定性和稳定极限参数均较训练前改善(P<0.05),实验组优于对照组(P<0.05)。结论基于VR的平衡训练较传统的平衡训练能更有效地提高脑卒中偏瘫患者的动静态平衡功能。     

Effects of Virtual Reality Rehabilitation Training on Cognitive Function and Activities of Daily Living of Patients With Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis

ObjectiveTo determine the effects of virtual reality (VR) rehabilitation training on the cognitive function and activities of daily living (ADL) of patients with poststroke cognitive impairment (PSCI).Data SourcesFour Chinese databases and 6 English databases were systematically searched for studies published until August 31, 2021, by using Medical Subject Headings of the National Library of Medicine terms such as virtual reality, cognition disorders, cognitive dysfunction, and stroke and free terms such as virtual environment, VR, cognition impairment, cerebrovascular accident, and PSCI.Study SelectionRandomized controlled trials treating PSCI with VR training were included. The control groups received conventional treatments such as conventional rehabilitation training and drug therapy; the experimental groups received VR rehabilitation training. The outcome measures were cognitive function and ADL.Data ExtractionTwo researchers independently extracted key information from eligible studies. The methodological quality of the studies was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions v5.1.0. Meta-analysis was performed using RevMan v5.4. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.Data SynthesisTwenty-one studies (1149 participants) were included. Meta-analyses found that compared with the control group, VR rehabilitation training increased Mini-Mental State Examination, Montreal Cognitive Assessment, Loewenstein Occupational Therapy Cognitive Assessment, Rivermead Behavioral Memory Test Second Edition, Barthel Index, Modified Barthel Index, and FIM scores; event-related potential 300 (P300) amplitude; and the N-acetylaspartate/creatinine (Cr) ratio on proton magnetic resonance spectroscopy (¹H-MRS) and reduced P300 latency; Trail Making Test scores; and the choline-containing compounds/Cr ratio on ¹H-MRS (all P<.05). These results indicated that VR training improved cognitive function and ADL in PSCI.ConclusionsVR rehabilitation training promotes the rehabilitation of cognitive function and recovery of ADL in patients with PSCI and may be a good complementary approach to conventional cognitive interventions.     

Virtual Reality for Upper Limb Rehabilitation in Subacute and Chronic Stroke: A Randomized Controlled Trial

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 etiology (ie, ischemic, hemorrhagic).

虚拟现实技术在脑卒中患者平衡功能康复的应用

本文简要回顾了虚拟现实技术的特点、起源与发展及在康复中的应用,重点介绍其在脑卒中患者平衡功能康复方面的应用及其疗效,同时简要介绍目前国内外常用的平衡功能的评定方法。     

A Systematic Review of Virtual Reality Therapeutics for Acute Pain Management

ObjectivesThe purpose of this systematic review is to examine the delivery and clinical efficacy of virtual reality (VR) therapeutics for acute pain management in adults and identify practical considerations of VR deployment, as well as current gaps in the literature.DesignA systematic review.Data sourcesA search of PubMed, CINAHL, PsychINFO, Embase, Compendex, and Inspec was completed using Medical Subject Headings (MeSH) and keyword search terms related to acute pain and VR.Review/Analysis methodsA systematic review of all pertinent articles published between January 1, 2000, and August 1, 2020, was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.ResultsTwenty-three articles met final inclusion criteria and were included in this review. Studies utilized VR in a variety of settings for wound care, procedure-induced pain, physical or occupational therapy, dental treatment or generalized acute pain. A likely mechanism by which VR promoted analgesia in these studies is distraction. Of the reviewed studies, 19 (83%) reported decreases in pain intensity while using VR compared with no VR use or with a non-VR group.ConclusionsThis systematic review found VR to be an effective tool for acute pain management. Findings from this review also underscore the importance of addressing the patient's sense of presence and levels of immersion, interaction, and interest when deploying VR. Future VR studies should consider incorporation of anxiety, presence, and VR side effect measures in addition to acute pain metrics.     

虚拟现实技术在脑卒中患者平衡功能康复中的应用进展

对脑卒中患者平衡功能康复中的常见虚拟现实技术及其应用进行综述,为脑卒中患者平衡功能康复的临床实践提供借鉴。     

Barriers,Facilitators and Interventions to Support Virtual Reality Implementation in Rehabilitation: A Scoping Review

Virtual reality and active video games (VR/AVGs) are promising rehabilitation tools because of their potential to facilitate abundant, motivating, and feedback-rich practice. However, clinical adoption remains low despite a growing evidence base and the recent development of clinically accessible and rehabilitation-specific VR/AVG systems. Given clinicians’ eagerness for resources to support VR/AVG use, a critical need exists for knowledge translation (KT) interventions to facilitate VR/AVG integration into clinical practice. KT interventions have the potential to support adoption by targeting known barriers to, and facilitators of, change. This scoping review of the VR/AVG literature uses the Theoretical Domains Framework (TDF) to (1) structure an overview of known barriers and facilitators to clinical uptake of VR/AVGs for rehabilitation; (2) identify KT strategies to target these factors to facilitate adoption; and (3) report the results of these strategies. Barriers/facilitators and evaluated or proposed KT interventions spanned all but 1 and 2 TDF domains, respectively. Most frequently cited barriers/facilitators were found in the TDF domains of Knowledge, Skills, Beliefs About Capabilities, Beliefs About Consequences, Intentions, Goals, Environmental Context and Resources, and Social Influences. Few studies empirically evaluated KT interventions to support adoption; measured change in VR/AVG use did not accompany improvements in self-reported skills, attitudes, and knowledge. Recommendations to target frequently identified barriers include technology development to meet end-user needs more effectively, competency development for end-users, and facilitated VR/AVG implementation in clinical settings. Subsequent research can address knowledge gaps in both clinical and VR/AVG implementation research, including on KT intervention effectiveness and unexamined TDF domain barriers.

康复护理干预对防止脑卒中患者跌倒的作用

目的：探讨康复护理干预对防止脑卒中患者跌倒的作用。方法：脑卒中患者70例随机分为观察组和对照组各35例,均给予神经内科常规药物治疗,观察组患者在治疗前、治疗中均配合评估、心理康复、运动训练,药物、助行器和家庭康复指导等康复护理干预。结果：治疗3个月后随访,2组患者跌倒次数及计时起立行走测试（TUG）评分与治疗前比较明显降低,Berg平衡量表（BBS）及跌倒效能量表（MFES）评分明显提高（P〈0.01或0.05）,且观察组与对照组比较,观察组表现更显著（P〈0.01或0.05）。结论：康复护理干预对降低脑卒中患者的跌倒有积极作用。     

虚拟现实技术在脑卒中运动康复中的应用现状

脑卒中患者的运动康复是虚拟现实技术应用的一个新领域。研究者们研制和利用不同的虚拟现实训练系统,对可能的影响因素进行观察后发现,光流速度、输出设备差异和提供反馈的类型均影响虚拟治疗的效果。对不同病程脑卒中患者疗效的研究证实,虚拟现实技术不仅能够改善脑梗死偏瘫患者的上肢和下肢运动功能,而且能够提高患者的日常生活能力;与机器人、减重平板训练等联合使用的初步结果安全有效。并在影像学研究方面找到支持使用虚拟现实技术的部分证据。这些研究对于虚拟现实技术的应用前景具有重要的临床意义。     

Virtual Reality Technology for Pain and Anxiety Management among Patients with Cancer: A Systematic Review

BackgroundPain and anxiety have negative effects on the treatment of patients with cancer. Virtual reality technology is a form of distraction which is still unclear in its methodological quality in reducing pain and anxiety.AimsTo summarize and evaluate the methodological quality of primary studies on the virtual reality (VR) technology for the management of pain and anxiety among patients with cancer, and to analyze the effectiveness of VR in the reviewed studies.DesignThis review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.SettingMultiple databases from their inception through November 2018.MethodsA comprehensive search was performed to identify studies that evaluated the effectiveness of VR in managing pain and anxiety among patients with cancer. The methodological quality of included studies was appraised using the modified Downs and Black checklist.ResultsThirteen studies published between 1999 and 2018 were eligible for inclusion. These included studies were classified as being of good or fair quality. The consensus across the included studies was that compared with standard care, VR plus standard care were more effective in reducing pain and anxiety especially in children and adolescent patients who were undergoing painful procedures, and in adult and elderly patients who were undergoing anti-cancer treatments and during their hospitalization.ConclusionAlthough more high- methodological quality studies are needed to determine whether VR technology is effective in controlling symptoms in patients with cancer, the results of this review suggested that VR intervention may be beneficial for the management of pain and anxiety in patients with cancer. Therefore, clinicians may consider VR technology as an adjunctive intervention for pain and anxiety management.     

酒精干预对大（小）鼠缺血性卒中结局影响的系统评价

目的系统评价酒精干预对大（小）鼠缺血性卒中结局的影响。方法计算机检索PubMed、EMbase、BIOSIS、CNKI、WanFangData和VIP数据库中关于酒精干预用于缺血性卒中动物模型的研究,检索时间截至2012年6月。按纳入与排除标准筛选文献、提取资料和进行方法学质量评价后,采用RevMan5．1软件进行Meta分析。结果共纳入8个研究。Meta分析结果显示：与对照组相比,酒精干预组对缺血性卒中的影响无统计学意义[MD=-6．98％,95％CI（-20．38％,6．43％）,P=0．31],但低剂量急性酒精干预（≤2g／kgy可改善缺血性卒中预后[MD=-22．83％,95％CI（-38．77％,-6．89％）,P=0．005],而高浓度慢性酒精干预会加重缺血性卒中脑缺血损伤[MD=24．06％,95％CI（10．54％。37．58％）,P=0．000510结论低剂量酒精干预对大（小）鼠具有潜在的神经保护作用,高剂量酒精干预则可能加重其脑损伤程度。但应注意,受纳入研究发表偏倚等因素的影响,酒精干预对大（小）鼠卒中结局的影响程度可能被高估。