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

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.

Keywords: functional performance; neurological rehabilitation; physical therapy; quality of life; spinal cord injuries; virtual reality.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of the different phases of the systematic review and meta-analysis.
Figure 2
Figure 2
Risk of bias of the studies included in the systematic review.
Figure 3
Figure 3
Overall risk of bias. Each category is presented by percentages.
Figure 4
Figure 4
Forest plot for functional performance measured by FIM scale. A green block indicates the weight assigned to the study and the horizontal line depicts the confidence interval. A black rhombus shows the overall result.
Figure 5
Figure 5
Forest plot for functional performance measured by SCIM scale. A green block indicates the weight assigned to the study and the horizontal line depicts the confidence interval. A black rhombus shows the overall result.
Figure 6
Figure 6
Forest plot for functional performance measured by SCIM self-care subtest. A green block indicates the weight assigned to the study and the horizontal line depicts the confidence interval. A black rhombus shows the overall result.
Figure 7
Figure 7
Forest plot for functional performance measured by Barthel index. A green block indicates the weight assigned to the study and the horizontal line depicts the confidence interval. A black rhombus shows the overall result.

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