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Cited by 237Stroke Rehabilitation and RecoveryVirtual Reality Applications and ImpactsTranscranial Magnetic Stimulation Studies

The DOI matches its Crossref record; 133 of the 133 references it cites were found in a registry or an index.

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

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Aminov, Anna, Rogers, Jeffrey M., Middleton, Sandy, Caeyenberghs, Karen, Wilson, Peter H.·2018·Journal of NeuroEngineering and Rehabilitation
DOI 10.1186/s12984-018-0370-2PMC PMC5870176
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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.

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Fig. 1 Population, Intervention, Comparison, Outcome (PICO) Question and the main variables included in the systematic literature review and meta-analysis
Fig. 1 Population, Intervention, Comparison, Outcome (PICO) Question and the main variables included in the systematic literature review and meta-analysisCC BY · PubMed Central
Fig. 2 Four-phase Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram, showing the process for identifying and screening of the articles for inclusion and exclusion in the systematic literature review and meta-analysis
Fig. 2 Four-phase Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram, showing the process for identifying and screening of the articles for inclusion and exclusion in the systematic literature review and meta-analysisCC BY · PubMed Central
Fig. 3 Forest plot showing the main effect-sizes of Virtual Rehabilitation after stroke on the motor, functional, and cognitive outcomes combined; the three levels of the International Classification of Functioning (Body Function outcomes included Fugl-Meyer Assessment-Upper Extremity and Modified Ashworth Scale; Activity outcomes included Box and Blocks Test; Participation outcomes included Motor Activity Log and Quality of Movement); and cognitive outcomes using the random-effects model. Notes: CG: Computerized Gaming; CI: Confidence Intervals; CT: Conventional Treatment; ICF: International Classifacation of Functioning; VE: Virtual Environment; VR: Virtual Rehabilitation
Fig. 3 Forest plot showing the main effect-sizes of Virtual Rehabilitation after stroke on the motor, functional, and cognitive outcomes combined; the three levels of the International Classification of Functioning (Body Function outcomes included Fugl-Meyer Assessment-Upper Extremity and Modified Ashworth Scale; Activity outcomes included Box and Blocks Test; Participation outcomes included Motor Activity Log and Quality of Movement); and cognitive outcomes using the random-effects model. Notes: CG: Computerized Gaming; CI: Confidence Intervals; CT: Conventional Treatment; ICF: International Classifacation of Functioning; VE: Virtual Environment; VR: Virtual RehabilitationCC BY · PubMed Central
Fig. 4 Forest plot showing the main moderator analyses of Virtual Rehabilitation outcomes after stroke using the random-effects model. Note: AR: Additional Rehabilitation; CI: Confidence Intervals; CT: Conventional Treatment; TAU; Treatment As Usual; VR: Virtual Rehabilitation
Fig. 4 Forest plot showing the main moderator analyses of Virtual Rehabilitation outcomes after stroke using the random-effects model. Note: AR: Additional Rehabilitation; CI: Confidence Intervals; CT: Conventional Treatment; TAU; Treatment As Usual; VR: Virtual RehabilitationCC BY · PubMed Central
Fig. 5 Forest plot showing the main effect-sizes of Virtual Environment therapy after stroke on the three levels of the International Classification of Functioning using the random-effects model. Body Function outcomes included Fugl-Meyer Assessment-Upper Extremity and Modified Ashworth Scale; Activity outcomes included Box and Blocks Test; Participation outcomes included Motor Activity Log and Quality of Movement. Note: CI; Confidence Intervals; CT: Conventional Treatment; ICF: International Classifacation of Functioning; VE: Virtual Environment
Fig. 5 Forest plot showing the main effect-sizes of Virtual Environment therapy after stroke on the three levels of the International Classification of Functioning using the random-effects model. Body Function outcomes included Fugl-Meyer Assessment-Upper Extremity and Modified Ashworth Scale; Activity outcomes included Box and Blocks Test; Participation outcomes included Motor Activity Log and Quality of Movement. Note: CI; Confidence Intervals; CT: Conventional Treatment; ICF: International Classifacation of Functioning; VE: Virtual EnvironmentCC BY · PubMed Central
Fig. 6 Forest plot showing the follow-up effects of Virtual Rehabilitation after stroke on the motor, functional, and cognitive outcomes combined using the random-effects model Note: CI; Confidence Intervals; ICF: International Classifacation of Functioning
Fig. 6 Forest plot showing the follow-up effects of Virtual Rehabilitation after stroke on the motor, functional, and cognitive outcomes combined using the random-effects model Note: CI; Confidence Intervals; ICF: International Classifacation of FunctioningCC BY · PubMed Central

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  1. Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H. Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence Oxford center for Evidence-Based Medicine 2011.

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Metadata

Authors
Aminov, A., Rogers, J. M., Middleton, S., Caeyenberghs, K., & Wilson, P. H.
Affiliations
  • Australian Catholic University (AU)
  • South Eastern Sydney Local Health District (AU)
Corresponding author
Wilson, Peter H.
ORCID
Venue
Journal of NeuroEngineering and Rehabilitation
Publisher
Springer Science and Business Media LLC
Published
2018-03-27
Volume
15
Issue
1
Pages
29-29
ISSN
1743-0003 (ISSN-L)
DOI
10.1186/s12984-018-0370-2
PMC
PMC5870176
OpenAlex
W2798072203
Cited by
236
References
132
Citations by year
2026: 15 · 2025: 30 · 2024: 51 · 2023: 25 · 2022: 35 · 2021: 28 · 2020: 29 · 2019: 15 · 2018: 8
FWCI
2.51
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of NeuroEngineering and Rehabilitation (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Bank (Australian Catholic University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • Prince of Wales Hospital Foundation (Grant No. 4R/14)
  • The Research Training Program
Topics
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords
virtual reality rehabilitation, stroke rehabilitation, upper limb function, cognitive function, conventional therapy comparison, International Classification of Functioning, Disability and Health, body structure and function, participation outcomes, training dose, massed practice, time since injury, adjunctive therapy
MeSH terms
Stroke Rehabilitation, Virtual Reality, Cognition, Humans, Randomized Controlled Trials as Topic, Stroke, Upper Extremity

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