Virtual Reality-based Therapy Research Articles

Non-Immersive Virtual Reality-Based Therapy Applied in Cardiac Rehabilitation: A Systematic Review with Meta-Analysis.

The aim of this systematic review with meta-analysis was to assess the effectiveness of non-immersive virtual reality (niVR) active videogames in patients who underwent cardiac rehabilitation (CR). A systematic review with meta-analysis, according to the PRISMA guidelines and previously registered in PROSPERO (CRD42023485240), was performed through a literature search in PubMed (Medline), SCOPUS, WOS, and PEDro since inception to 21 November 2023. We included randomized controlled trials (RCTs) that assessed the effectiveness of an niVR intervention, in comparison with conventional CR and usual care, on aerobic capacity and cardiovascular endurance (physical function), anxiety, depression, and quality of life (QoL). The risk of bias in individual studies was assessed using the Cochrane risk of bias tool. Effect size was estimated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model. Nine RCT that met the inclusion criteria were included in the meta-analysis. The meta-analysis showed a moderate-to-large effect favoring niVR active videogames included in CR in increasing aerobic capacity and cardiovascular endurance (SMD = 0.74; 95% CI 0.11 to 1.37; p = 0.021) and reducing anxiety (SMD = -0.66; 95% CI -1.13 to -0.2; p = 0.006). Only 4.8% of patients reported adverse events while performing niVR active videogames. Inclusion of niVR active videogames in CR programs is more effective than conventional CR in improving aerobic capacity and cardiovascular endurance and in reducing anxiety.

Impact of virtual reality-based therapy on post-stroke depression: A systematic review and meta-analysis of randomized controlled trials.

Post-stroke depression is the most common neuropsychiatric consequence and reduces rehabilitation effectiveness. However, the efficacy of virtual reality (VR) on mental health treatment for patients after a stroke is uncertain. The aim of this study was to evaluate the efficacy of VR as a co-adjuvant form of treatment to reduce depression in stroke patients admitted to neurorehabilitation units. We systematically searched medical databases including PubMed, CINAHL, PsycINFO, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to November 16, 2023. Clinical trials comparing the use of VR as an adjuvant form of treatment in stroke patients' rehabilitation with the usual treatment were included. Pooled standardized mean differences were calculated using a random-effects model. Subgroup analyses were performed according to type of stroke, VR characteristics, and the scale used to measure depression. Meta-regression analysis was performed for intervention duration and to determine the mean age of the participants. Eight studies and 388 stroke patients were included. The VR interventions were associated with a lower risk of depression in patients (ES = -0.69; 95% CI [-1.05, -0.33]; I2 = 57.6%; p ≤ .02). The estimates were not affected by the type of stroke, the type of VR used, the blinding process, the type of scale used to detect depression, the duration of the intervention (weeks and minutes), and the total number of sessions. Meta-regression shows that younger samples (p = .00; 95% CI [0.01, 0.08) and longer interventions (p = < .05; 95% CI [-0.00, -0.00) lead to a greater reduction in depression. This review provides an important basis for treating depression in patients after a stroke. Professionals working in stroke neurorehabilitation units should consider VR as a form of co-adjuvant treatment for depression in patients. CRD42022303968.

Complications associated with the use of virtual reality therapy during the treatment of postoperative pain

Relevance. The therapy based on virtual reality is used as a method of non-pharmacological treatment of postoperative pain. Possible complications are poorly understood, making it difficult to use in everyday clinical practice.The objective was the evaluation of the development of complications when using therapy based on virtual reality in the treatment of postoperative pain syndrome.Materials and methods. A prospective clinical study was performed. 90 patients who had to perform surgical interventions were included. After randomization, three groups were formed: group I (n = 30) – therapy with a 15-minute session as an addition to standard therapy for postoperative pain, group II (n = 30) – therapy with a 25-minute session, and group III (n = 30) receiving only drug treatment of postoperative pain syndrome. Virtual reality-based therapy (VR-therapy) was performed 3, 7, 12 hours after surgery using the Oculus Quest 2 device. Postoperative nausea, vomiting and dizziness were considered complications of VR-therapy. The development of complications was assessed using the FMS (Fast Motion Sickness Scale) self-assessment of motion sickness and the Postoperative Nausea and Vomiting Scale (PONV). The quality of the patient’s recovery after anesthesia was assessed using the QoR-15 scale.Results. There were no differences in the incidence of visually induced motion sickness between groups with different session durations. The incidence of postoperative nausea and vomiting and the need for antiemetic drugs did not differ between the main and control groups. A positive correlation was found between the occurrence of visually induced motion sickness (VIMS) and the use of opioid drugs in the postoperative period. In patients with a VR-therapy session duration of 25 minutes, the indicators of the quality of recovery after anesthesia were higher than in other groups.Conclusions. The use of VR-therapy with a session of 15 and 25 minutes does not lead to an increase in the incidence of postoperative nausea and vomiting. The duration of therapy did not affect the development of VIMS. The indicators of the quality of recovery after anesthesia in the group with a duration of VR-therapy of 25 minutes were higher than in other groups.

Exploration of the role of emotional expression of treatment-resistant schizophrenia patients having followed virtual reality therapy: a content analysis

BackgroundEmotional responses are an important component of psychotherapeutic processes. Avatar therapy (AT) is a virtual reality-based therapy currently being developed and studied for patients suffering from treatment resistant schizophrenia. Considering the importance of identifying emotions in therapeutical processes and their impact on the therapeutic outcome, an exploration of such emotions is needed.MethodsThe aim of this study is to identify the underlying emotions at the core of the patient-Avatar interaction during AT by content analysis of immersive sessions transcripts and audio recordings. A content analysis of AT transcripts and audio recordings using iterative categorization was conducted for 16 patients suffering from TRS who underwent AT between 2017 and 2022 (128 transcripts and 128 audio recordings). An iterative categorization technique was conducted to identify the different emotions expressed by the patient and the Avatar during the immersive sessions.ResultsThe following emotions were identified in this study: Anger, Contempt/ Disgust, Fear, Sadness, Shame/ Embarrassment, Interest, Surprise, Joy and Neutral. Patients expressed mostly neutral, joy and anger emotions whereas the Avatar expressed predominantly interest, disgust/contempt, and neutral emotions.ConclusionsThis study portrays a first qualitative insight on the emotions that are expressed in AT and serves as a steppingstone for further investigation in the role of emotions in the therapeutic outcomes of AT.

Status and Clinical Experiences from the Challenge Trial – A Randomized Controlled Trial Investigating Virtual Reality-based Therapy for Auditory Hallucinations

Status and Clinical Experiences from the Challenge Trial – A Randomized Controlled Trial Investigating Virtual Reality-based Therapy for Auditory Hallucinations

Virtual reality based-therapy: targeting balance impairments to improve gait in stroke

Virtual reality based-therapy: targeting balance impairments to improve gait in stroke

The CHALLENGE trial: the effects of a virtual reality-assisted exposure therapy for persistent auditory hallucinations versus supportive counselling in people with psychosis: study protocol for a randomised clinical trial

BackgroundMany patients suffering from schizophrenia spectrum disorders continue having distressing auditory hallucinations in spite of treatment with antipsychotic medication. The aim of this trial is to examine the effect of a targeted virtual reality therapy for persistent auditory hallucinations in individuals with psychosis. The trial explores whether this type of therapy can decrease the severity, frequency and distress of auditory hallucinations and, additionally, whether it can reduce clinical symptoms and enhance daily functioning in individuals with psychosis.MethodsThe study is a randomised, assessor-blinded parallel-group superiority clinical trial, allocating a total of 266 patients to either the experimental intervention or supportive counselling. The participants will be randomised to either (1) seven sessions of virtual reality therapy or (2) seven sessions of supportive counselling to be delivered within the first 12 weeks after inclusion in the study. All participants will be assessed at baseline and 12 and 24 weeks post-baseline. Independent assessors blinded to the treatment allocation will evaluate the outcome. The primary outcome is the level of auditory hallucinations measured with the Psychotic Symptoms Rating Scales (PSYRATS-AH) total score at the cessation of treatment at 12 weeks. Secondary outcomes are frequency of auditory hallucinations, the distress caused by auditory hallucinations, perceived voice power, patient acceptance of voices, patients’ ability to respond to voices in an assertive way and social and daily function.DiscussionPromising evidence of the efficacy of this immersive virtual reality-based therapy for auditory hallucinations exist, but evidence needs to be established in a large, methodological rigorous trial. If the therapy proves to be beneficial in reducing the severity of refractory auditory hallucinations, a large group of patients with schizophrenia and related disorders could be the target group of this short-term psychotherapeutic intervention.

Digital and Interactive Health Interventions Minimize the Physical and Psychological Impact of Breast Cancer, Increasing Women's Quality of Life: A Systematic Review and Meta-Analysis.

Simple SummaryThe development of digital and virtual devices for therapeutic purposes has been widely studied in recent years. There is a growing scientific interest in analyzing the effects of digital and interactive health interventions (DIHIs) in the management of different neurological and musculoskeletal pathologies, as well as breast cancer (BC). DIHIs include the use of a wide variety of virtual reality devices, as well as smartphone apps and games, to reduce the impact of BC signs and symptoms on women. In the present review, we assessed the effect of DIHIs, in comparison to conventional interventions or usual care, on improving the motor control and function of the upper extremities affected by lymphedema after BC surgery, including pain, anxiety, depression, and different dimensions of quality of life. In addition, we investigated which type of DIHI was more useful for women with BC: virtual reality devices or smartphone apps.Digital and interactive health interventions (DIHIs), such as virtual-reality-based therapy (VRBT) and smartphone-app-based therapy (SABT), may be useful for reducing the impact of the signs and symptoms of breast cancer (BC) in women. The aim of this meta-analysis was to explore the effect of DIHIs on improving pain, anxiety, depression, quality of life (QoL), and upper extremity (UE) disability-related lymphedema in women with BC. Methods: We searched PubMed Medline, Web of Science, Scopus, CINAHL, Physiotherapy Evidence Database, and SciELO for the period ending February 2022. We included studies that assessed the effect of DIHIs on UE motor disability, pain, anxiety, depression, and QoL in women with BC. The effect size was calculated using Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI). Results: Twenty studies providing data from 1613 women with BC were included. With respect to UE disability, DIHIs increased flexion (SMD, 1.92; 95%CI: −1.16, 2.68), abduction (SMD, 1.66; 95%CI: 0.91, 2.42), external rotation shoulder range of motion (SMD, 1.1; 95%CI: 0.36, 1.85), UE function (SMD, −0.72; 95%CI: −1.31, −0.13), and handgrip strength (SMD, 0.4; 95%CI: 0.21, 0.59). DIHIs reduced pain (SMD, −0.8; 95%CI: −1.31, −0.26), anxiety (SMD, −1.02; 95%CI: −1.71, −0.34), and depression (SMD, −1.57; 95%CI: −3.1, −0.08). Finally, DIHIs increased overall health (SMD, 0.6; 95%CI: 0.31, 0.89). Conclusions: Right at the end of therapy, DIHIs are effective at improving UE function, pain, anxiety, depression, and QoL in women with BC. VRBT has a greater effect than SABT for the assessed outcomes.

Various Types of Virtual Reality-Based Therapy for Eating Disorders: A Systematic Review.

(1) Background: Interactive VR (virtual reality) environments (i.e., using three-dimensional graphics presented with a head-mounted display) have recently become a popular professional tool for the treatment of patients with eating disorders (EDs). However, there are no published review reports that have analyzed the original papers between 2015 and 2021, which additionally focused only on HMD (head-mounted display) 3DVR (three-dimensional virtual reality) exposure and included only three therapeutic categories for ED patients. (2) Methods: The EbscoHost and Scopus databases were searched to identify relevant papers on VR research employing VR in the assessment and treatment of eating disorders. (3) Results: In addition to the known therapeutic divisions for ED, there are new forms of therapy based on 360 cameras, eye-tracking, and remote therapy. (4) Conclusions: The potential of VR in combination with different therapies may offer an alternative for future research. More rigorous testing, especially in terms of larger sample sizes, the inclusion of control groups or multisessions, and follow-up measures, is still needed. The current state of research highlights the importance of the nature and content of VR interventions for ED patients. Future research should look to incorporate more home-based and remote forms of VR tools.

Virtual reality-based therapy associated with blood flow restriction in older adults: A proposal for integration of techniques.

Virtual reality-based therapy associated with blood flow restriction in older adults: A proposal for integration of techniques.

Bilateral Movement-based Computer Games Improve Sensorimotor Functions in Subacute Stroke Survivors.

BackgroundPrevious studies have reported that movement-based computer gaming is more effective than conventional intervention in enhancing upper limb rehabilitation.ObjectiveTo evaluate whether the use of bilateral movement-based computer games could augment the effects of conventional intervention in improving the upper limb motor function, grip strength and health-related quality of life of subacute stroke survivors.MethodsA total of 93 subjects with subacute stroke were randomized into 2 groups receiving one of two 3.5-h interventions for 2 days per week over 8 weeks: (i) “bilateral movement-based computer games + conventional rehabilitation”; and (ii) “video-directed exercise + conventional rehabilitation” (control group).ResultsA total of 83 subjects completed the interventions and follow-up assessments. Compared with video-directed exercise + conventional rehabilitation, bilateral movement-based computer games + conventional rehabilitation produced greater improvements in upper limb motor impairment from mid-treatment to follow-up 1 month post-intervention, greater improvements in upper limb function from post-intervention to 1 month follow-up, and earlier improvements in grip strength (paretic) from mid-intervention to follow-up 1 month post-intervention. Subjects who received bilateral movement-based computer games + conventional rehabilitation also continued to improve in motor function from post-intervention to 1 month post-intervention.ConclusionBilateral movement-based computer games may serve as an adjuvant therapy to conventional rehabilitation programmes for improving upper limb recovery among stroke survivors.LAY ABSTRACTUpper limb sensorimotor impairment is a common and serious post-stroke sequel, affecting up to two-thirds of stroke survivors. Simultaneous bilateral training is a rehabilitative method that requires the use of both paretic and non-paretic sides completing identical tasks at the same time. Previous findings suggested that bilateral upper limb training was superior to unilateral upper limb training in improving upper limb motor impairment. Given that virtual reality-based therapy can be advantageous for engaging and encouraging participation in repetitive rehabilitative training tasks, this study aimed to investigate whether bilateral movement-based computer gaming (BMCG) using custom-made handlebars could better improve the upper limb motor function, grip strength and health-related quality of life of subacute stroke survivors than a conventional rehabilitation programme. After 16 sessions of bilateral BMCG, it was found that subacute stroke survivors had greater improvements in upper limb motor control, functional use of paretic upper limb and health-related quality of life than after a conventional rehabilitation programme. Thus, the combined use of computer gaming and bilateral movement-based training could be an adjunct therapy to conventional physiotherapy and occupational therapy in cognitively intact subacute stroke survivors.

Use of Virtual Reality-Based Therapy in Patients with Urinary Incontinence: A Systematic Review with Meta-Analysis.

It is estimated that over 400 million people worldwide experience some form of urinary incontinence (UI). Pelvic floor muscle training (PFMT) is commonly used in cases of urine loss. Game therapy (GT) has been suggested as a new conservative modality for UI treatments. GT represents a form of virtual reality (VR) that allows users to interact with elements of a simulated scenario. The purpose of this review was to assess the potential of using VR-based PFMT in the treatment of UI with a particular focus on the impact of this form of therapy on the patients’ muscle function, symptoms of UI and quality of life (QoL). The following electronic databases were searched: PubMed, Embase, Cochrane Library, Scopus and Web of Science. Systematic review methods were based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Electronic medical databases were searched from inception to 28 January 2021. From a total of 38 articles, 26 were analyzed after removing duplicates, then 22 records were excluded according to inclusion criteria and 4 were assessed as full texts. Finally, 2 randomized controlled trials (RCT) with 79 patients were included. For the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the meta-analysis showed a significant difference in favor of the control condition (MD = 2.22; 95% CI 0.42, 4.01; I2 = 0%). Despite the popularity of the use of VR in rehabilitation, we found a scarcity of literature evaluating the application of VR in the field of UI therapy. Only one study matched all of the criteria established. The effects of VR training improved PFM function and QoL; however, these changes were comparable to those of traditional PFMT. It is not possible to reach final conclusions from one study; thus, further development of VR interventions in the field of UI treatments are needed.

Perceptions and preferences of patients with cardiac conditions to the inclusion of virtual reality-based therapy with conventional cardiovascular rehabilitation: A qualitative study

BackgroundVirtual reality-based therapy (VRBT) has been recently used in rehabilitation programs, as it can improve patient's adherence to treatment. However, patients’ acceptance of VRBT has been scarcely investigated. ObjectiveTo qualitatively analyze the perceptions and preferences of patients about the inclusion of VRBT to a conventional cardiovascular rehabilitation program (CRP). MethodsFifteen patients from a randomized clinical trial participated in focus groups for qualitative assessment. ResultsPatients demonstrated good acceptance and satisfaction of VRBT. Physical and psychosocial benefits were highlighted, and patients reported the perception of higher exercise intensity in VRBT then when doing conventional training. In addition, the frequency of VRBT (once a week), associated with conventional treatment was reported as satisfactory. Cognitive aspects that influenced participation to the new approach were also raised by study participants. ConclusionPatients with cardiac conditions demonstrated satisfaction with the inclusion of VRBT in a conventional CRP, demonstrating that VRBT has the potential to be a new approach for this patient population, allowing training diversification. Benefits perceived by patients include physical, mental, and social aspects. Trial RegisteredNCT04336306 (https://clinicaltrials.gov/ct2/show/NCT04336306)

The Use of Virtual and Computational Technologies in the Psychomotor and Cognitive Development of Children with Down Syndrome: A Systematic Literature Review.

Individuals with Down syndrome (DS) have numerous comorbidities due to trisomy 21. However, virtual reality-based therapy (VRT) has been used nowadays as a learning and visual motor tool in order to facilitate the development and learning process of this group. The aim of this article was to carry out an integrative review of the literature on the use of virtual and computational technologies in the stimulation of children with DS. A search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) through single key words or their combinations using AND or OR operators: “Down syndrome” AND (“development” OR “cognition” OR “visomotor” OR “digital game” OR “virtual reality”). Eventually, 18 articles were included in our review. The games used in the research were able to stimulate, through the visual field, global motor skills, balance, body scheme and spatial organization, in addition to the learning of mathematical concepts, in order to directly influence the autonomous life activities, language skills, social skills and educational aspects of people with DS. Electronic games contribute to the teaching-learning relationship and stimulate neuropsychomotor and cognitive functions and development in children with DS.

Use of virtual reality-based therapy in the field of chronic stroke rehabilitation to improve hand function: asystematic review

A stroke is neurological damage that results in the need for medical and physical therapy management. From this perspective, virtual reality (VR) is a promising rehabilitation technology that reproduces real-life scenarios through computer-generated environments. VR can be a complementary strategy to conventional rehabilitation approaches by potentially improving hand motor function and activities of daily living (ADLs). This study aimed to evaluate the effectiveness of VR-based therapy in improving hand function for people suffering from chronic stroke. For this systematic review, we searched PubMed, Cochrane, Physiotherapy Evidence Database(PEDro) and registers on International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov including all eligible articles. In the end, 8 articles were included. Three reviewers independently searched for randomized controlled trials (RCT) of VR intervention in patients with chronic stroke, including only studies where hand function rehabilitation was specifically targeted. In conclusion, VR used in rehabilitation for patients with chronic stroke improves several outcomes of hand function and may be considered as an addition to rehabilitation in routine use. Seven out of eight included studies had a high-quality score on PEDro scale. Future studies should focus on how the advantages of VR therapy for hand function can be sustained over a longer period.

The Effectiveness of Occupation-based Virtual Reality Intervention on Upper Extremity Functional Improvement in Post-stroke Individuals: A Systematic Review

Purpose: Virtual reality (VR)-based therapy is an emerging practice in the clinical setting and still requires research documenting its efficacy. This review analyzed the effectiveness of VR-based therapy on upper extremity (UE) motor recovery in individuals with chronic stroke by analyzing multiple randomized controlled trials. Methods: Search limits for this review consisted of articles published between January 2010 and January 2020 and available in English. Search keywords were based on language in individual databases (e.g. stroke or cerebrovascular accident, upper extremity, occupational therapy). Articles were limited to include only randomized control trials consisting of adult patients (18+) with UE impairment due to chronic stroke (onset at least 3 months prior) and occupation-based virtual reality intervention. Results: 242 articles were screened; eight met the inclusion criteria. Forms of VR within the reviewed articles included traditional gaming systems, mobile-based game devices, and VR combined with real instrument training. These studies showed improved outcomes following VR training such as improvement of UE function, activity participation, and health-related quality of life. Conclusion: The results of this review suggest that VR-based therapy has efficacy equal to or greater than conventional therapy for improving function in the upper extremity of adult patients with chronic stroke. As supported by research, practitioners may incorporate virtual reality-based therapy into conventional clinical sessions to assist in improving UE function and interactions within different environments and to help enhance overall participation in daily tasks and occupational performance in their clients.

Virmentalness: Prototype of Therapy for Dysthymia Patients Using Virtual Reality

AbstractDepressive disorders can happen to anyone and will affect the pattern of life. However, there are still people who underestimate depression itself. Generally, depression problems or mental disorders are carried out with psychotherapy, a method for treating problems to find out the experienced problem and using anti-depressants. This study aims to produce a therapeutic aid for depression sufferers in this dysthymia by using Virtual Reality technology, which can be used by patients and medical experts, namely psychologists and psychotherapists, to use Virtual Reality-based therapy methods. The research method used is the prototyping method. The way to collect data is by interview and scientific literature. Researchers used Unity3D Software to create Virtual Reality applications. Virmentalness application is expected to help people with dysthymia symptoms in doing therapy to reduce symptoms. The application displays a 3D viewing environment of a room, a 360-degree atmosphere, and content video and audio for therapy methods. Keywords— Depressive disorders, Dysthymia, Virtual Reality, Therapy, Android

Virtual Reality-Based Therapy Reduces the Disabling Impact of Fibromyalgia Syndrome in Women: Systematic Review with Meta-Analysis of Randomized Controlled Trials.

Background: Virtual reality-based therapy (VRBT) is a novel therapeutic approach to be used in women with fibromyalgia syndrome (FMS). The aim of our study is to assess the effect of VRBT to reduce the impact of FMS in outcomes such as pain, dynamic balance, aerobic capacity, fatigue, quality of life (QoL), anxiety and depression. Methods: Systematic review with meta-analysis was conducted from a bibliographic search in PubMed, Scopus, PEDro, Web of Science and CINAHL until April 2021 in accordance with PRISMA guidelines. We included randomized controlled trials (RCTs) that compare VRBT versus others to assess the mentioned outcomes in women with FMS. Effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (95% CI). Results: Eleven RCTs involving 535 women with FMS were included. Using the PEDro scale, the mean methodological quality of the included studies was moderate (6.63 ± 0.51). Our findings showed an effect of VRBT on the impact of FMS (SMD −0.62, 95% CI −0.93 to −0.31); pain (SMD −0.45, 95% CI −0.69 to −0.21); dynamic balance (SMD −0.76, 95% CI −1.12 to −0.39); aerobic capacity (SMD 0.32, 95% CI 0.004 to 0.63); fatigue (SMD −0.58, 95% CI −1.02 to −0.14); QoL (SMD 0.55, 95% CI 0.3 to 0.81); anxiety (SMD −0.47, 95% CI −0.91 to −0.03) and depression (SMD −0.46, 95% CI −0.76 to −0.16). Conclusions: VRBT is an effective therapy that reduces the impact of FMS, pain, fatigue, anxiety and depression and increases dynamic balance, aerobic capacity and quality of life in women with FMS. In addition, VRBT in combination with CTBTE showed a large effect in reducing the impact of FMS and fatigue and increasing QoL in these women.

Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis.

Patients with multiple sclerosis (PwMS) have a high level of fatigue and a reduced quality of life (QoL) due to the impact of multiple sclerosis (MS). Virtual reality-based therapy (VRBT) is being used to reduce disability in PwMS. The aim of this study was to assess the effect of VRBT on fatigue, the impact of MS, and QoL in PwMS. Methods: A systematic review with meta-analysis was conducted through a bibliographic search on PubMed, Scopus, Web of Science, and PEDro up to April 2021. We included randomized controlled trials (RCTs) with PwMS that received VRBT in comparison to conventional therapy (CT) including physiotherapy, balance and strength exercises, and stretching or physical activity, among others; or in comparison to simple observation; in order to assess fatigue, MS-impact, and QoL. The effect size was calculated using Cohen’s standardized mean difference with a 95% confidence interval (95% CI). Results: Twelve RCTs that provided data from 606 PwMS (42.83 ± 6.86 years old and 70% women) were included. The methodological quality mean, according to the PEDro Scale, was 5.83 ± 0.83 points. Our global findings showed that VRBT is effective at reducing fatigue (SMD −0.33; 95% CI −0.61, −0.06), lowering the impact of MS (SMD −0.3; 95% CI −0.55, −0.04), and increasing overall QoL (0.5; 95% CI 0.23, 0.76). Subgroup analysis showed the following: (1) VRBT is better than CT at reducing fatigue (SMD −0.4; 95% CI −0.7, −0.11), as well as in improving the mental dimension of QoL (SMD 0.51; 95% CI 0.02, 1); (2) VRBT is better than simple observation at reducing the impact of MS (SMD −0.61; 95% CI −0.97, −0.23) and increasing overall QoL (SMD 0.79; 95% CI 0.3, 1.28); and (3) when combined with CT, VRBT is more effective than CT in improving the global (SMD 0.6, 95% CI 0.13, 1.07), physical (SMD 0.87; 95% CI 0.3, 1.43), and mental dimensions (SMD 0.6; 95% CI 0.08, 1.11) of QoL. Conclusion: VRBT is effective at reducing fatigue and MS impact and improving QoL in PwMS.

The Effect of Virtual Reality-Based Therapy on Improving Upper Limb Functions in Individuals With Stroke: A Randomized Control Trial.

Background: Stroke is a common cause of motor disability. The recovery of upper limb after stroke is poor, with few stroke survivors regaining some functional use of the affected upper limb. This is further complicated by the fact that the prolonged rehabilitation is accompanied by multiple challenges in using and identifying meaningful and motivated treatment tasks that may be adapted and graded to facilitate the rehabilitation program. Virtual reality-based therapy is one of the most innovative approaches in rehabilitation technology and virtual reality systems can provide enhanced feedback to promote motor learning in individuals with neurological or musculoskeletal diseases.Purpose: This study investigated the effect of virtual reality-based therapy on improving upper limb functions in individuals with chronic stroke.Methods: Forty Saudi individuals with chronic stroke (6–24 months following stroke incidence) and degree of spasticity ranged between 1, 1 + and 2 according to Modified Ashworth Scale were included in this study. Participants were randomly assigned into two groups, experimental and control, with the experimental group undertaking a conventional 1-h functional training program, followed by another hour of virtual reality-based therapy using Armeo Spring equipment and the control group received 2 h of a conventional functional training program. The treatment program was conducted three times per week for three successive months. The change in the scores of Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), WMFT-Time (time required to complete the test) and Hand Grip Strength (HGS) were recorded at baseline and after completion of the treatment. Parametric (paired and unpaired t-tests) non-parametric (Wilcoxon and Mann–Whitney tests) statistical tests were used to identify the differences within and between groups (experimental group and control group) and evaluation times (pre- and immediately post-treatment).Results: Both groups showed significant differences (all, P < 0.05) in all measured variables after 3 months of the treatment. Individuals with stoke in the experimental group had a better improvement in ARAT (P < 0.01), WMFT (P < 0.01) and WMFT-Time (P < 0.01) scores after completion of the treatment compared to the control group. No significant difference in HGS scores was detected between groups after completion of the treatment (P = 0.252).Conclusion: The use of combined treatment of virtual reality-based therapy and conventional functional training program is more effective for improving upper limb functions in individuals with chronic stroke than the use of the conventional program alone.