Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Researchers recently investigated the effectiveness of virtual reality (VR) in helping children with cerebral palsy (CP) to improve motor function. A systematic review of randomized controlled trials (RCTs) using a meta-analytic method to examine the effectiveness of VR in children with CP was thus needed.

Purpose: The purpose of this study was to update the current evidence about VR by systematically examining the research literature.

Data Sources: A systematic literature search of PubMed, CINAHL, Cochrane Central Register of Controlled Trials, ERIC, PsycINFO, and Web of Science up to December 2016 was conducted.

Study Selection: Studies with an RCT design, children with CP, comparisons of VR with other interventions, and movement-related outcomes were included.

Data Extraction: A template was created to systematically code the demographic, methodological, and miscellaneous variables of each RCT. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the study quality. Effect size was computed and combined using meta-analysis software. Moderator analyses were also used to explain the heterogeneity of the effect sizes in all RCTs.

Data Synthesis: . The literature search yielded 19 RCT studies with fair to good methodological quality. Overall, VR provided a large effect size (d = 0.861) when compared with other interventions. A large effect of VR on arm function (d = 0.835) and postural control (d = 1.003) and a medium effect on ambulation (d = 0.755) were also found. Only the VR type affected the overall VR effect: an engineer-built system was more effective than a commercial system.

Limitations: The RCTs included in this study were of fair to good quality, had a high level of heterogeneity and small sample sizes, and used various intervention protocols.

Conclusions: Then compared with other interventions, VR seems to be an effective intervention for improving motor function in children with CP.

Figures

Figure 1.

Flow diagram of numbers of studies identified, excluded, and finally included in this meta-analysis. CP = cerebral palsy, RCT = randomized controlled trial, VR = virtual reality.

Figure 2.

Forest plot of effect size in all studies. Std diff = standard difference, VR = - virtual reality.

Figure 3.

Forest plots of effect sizes in different outcome measures. (a) Forest plot for studies including outcome variables that measured arm function. (b) Forest plot for studies including outcome variables that measured ambulation function. (c) Forest plot for studies including outcome variables that measured postural control. Std diff = standard difference, VR = - virtual reality.

Figure 3.

Forest plots of effect sizes in different outcome measures. (a) Forest plot for studies including outcome variables that measured arm function. (b) Forest plot for studies including outcome variables that measured ambulation function. (c) Forest plot for studies including outcome variables that measured postural control. Std diff = standard difference, VR = - virtual reality.