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What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes
Open accessAbstract
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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“VR-assisted therapies offer numerous benefits, both for the clinician and the patient, highlighted by most authors cited in this paper, such as: availability, the potential of being used in a more ecological way, and the possibility of molding the virtual environment according to the specific pathology and needs of the patient (Aminov et al., 2018; Botella et al., 2015; Clu”
From Virtual reality and psychedelics for the treatment of psychiatric disease: A systematic literature review (2020) · cites this paper as Aminov et al., 2018
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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.
- Venue
- Journal of NeuroEngineering and Rehabilitation
- Published
- 2018-03-27
- Volume
- 15
- Issue
- 1
- Pages
- 29-29
- ISSN
- 1743-0003 (ISSN-L)
- 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
- gold
- doi.org
- 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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