Rehabilitation Interventions Using Immersive Virtual Reality for People With Parkinson’s Disease: A Systematic Review and Meta-Analysis

Abstract

Background: Research into motor rehabilitation using Immersive Virtual Reality [Immersive Virtual Reality] for people with Parkinson’s Disease s rapidly growing in popularity. The aims of this review were to investigate the effect of VR interventions on lower limb and upper limb function in people with Parkinson's disease and determine whether the type of virtual reality intervention used influences intervention effect. Method: Seven databases [PubMed, EMBASE, Scopus, CINAHL, SPORTDiscus, TRIP database, google scholar] were searched using keywords relating to Parkinson's disease, immersive virtual reality and lower limb. Results: Sixteen articles were included: two randomised controlled trials and fourteen quasi-experimental designs. Augmented reality or immersive virtual reality technologies were used in interventions. Three studies looked at the upper limb, and thirteen the lower limb. For the upper limb, the box and block test was used in two studies but only one produced relevant data for meta-analysis. For the lower limb, six studies had relevant data [gait analysis] for meta-analysis: Using Augmented Reality, cadence, standardised mean difference = -0.08, 95% CI [‐0.54 to 0.28], I2 = 52%; Length standardised mean difference= -0.00, 95% CI [‐0.21 to 0.20], I2= 0%; Speed standardised mean difference= -0.08, 95% CI [‐0.32 to 0.16], I2= 0%. Using Immersive Virtual Reality, cadence standardised mean difference = -0.16, 95% CI [ ‐1.89 to 2.21], I2 = 71%; Length standardised mean difference= -0.28, 95% CI [‐1.73 to 1.13], I2=44%; Speed standardised mean difference= -0.06, 95% CI [‐1.44 to 1.34], I2=71%. Conclusion: There is therefore no clear evidence that either Immersive Virtual Reality or Augmented Reality is effective in improving motor function in the lower limb or upper limb. There is no clear consensus on which virtual reality-based approach out of Augmented Reality or Immersive Virtual Reality is the most effective. Moreover, risk of bias is high as many of the studies used non-randomised methods. KEYWORDS: Parkinson’s disease, Rehabilitation, Virtual reality, Augmented reality, gait.