Effectiveness of Virtual Reality on Functional Performance after Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Amaranta De Miguel-Rubio,Alejandro Salazar,David Lucena-Anton,M Dolores Rubio,Rocio Camacho

doi:10.3390/jcm9072065

Abstract

A spinal cord injury (SCI) usually results in a significant limitation in the functional outcomes, implying a challenge to the performance of activities of daily living. The main aim of this study is to analyze the effectiveness of virtual reality to improve functional performance in patients with SCI. The search was performed between October and December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Web of Science, and Embase. The methodological quality of the studies was evaluated through the PEDro scale, and the risk of bias was evaluated with the Cochrane collaboration’s tool. Seven articles were included in this systematic review, and five of them in the meta-analysis. Statistical analysis showed favorable results for functional performance in control group performing conventional therapy, measured by the functional independence measure (standardized mean difference (SMD)= −0.70; 95% confidence interval: −1.25 to −0.15). Results were inconclusive for other outcomes. Most studies have not shown beneficial effects on functional performance compared with conventional physical therapy. The results obtained showed that virtual reality may not be more effective than conventional physical therapy in improving functional performance in patients with SCI.

Highlights

A spinal cord injury (SCI) affects the conduction of sensorimotor signals, causing temporary or permanent alterations [1] on mobility or autonomic function below the level of the injury, so that the more cranial the injury, the more severe it is
virtual reality (VR) represents a multidisciplinary tool in clinical medicine, which is used in many applications including pain management, assessment of neurocognitive impairment, training of medical techniques and physical rehabilitation [5]
The following descriptor terms combined with Boolean operators were employed: (“spinal cord injury” OR “spinal cord injuries” OR “paraplegia” OR “quadriplegia” OR “tetraplegia”) AND (“virtual reality” OR “virtual reality exposure therapy” OR “virtual systems” OR “augmented reality” OR “videogame” OR “video games” OR “exergames” OR “exergaming” OR “play-based therapy” OR “commercial games”)

Summary

Introduction

A spinal cord injury (SCI) affects the conduction of sensorimotor signals, causing temporary or permanent alterations [1] on mobility or autonomic function below the level of the injury, so that the more cranial the injury, the more severe it is. This leads to a significant limitation in the functional outcomes and patient’s activities of daily living (ADLs), and a loss of quality of life [2,3]. In addition to conventional physical therapy (CPT), new rehabilitation tools such as virtual reality (VR) have emerged in recent years. In recent years there has been a growing interest in the use of VR, video games or even video games that include physical therapy (exergaming) [7]

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