Fully Immersive Virtual Reality-Based Cognitive Remediation for Adults with Psychosocial Disabilities: A Systematic Scoping Review of Methods Intervention Gaps and Meta-Analysis of Published Effectiveness Studies

Alessandra Perra, Chiara Laura Riccardo, Valerio De Lorenzo, Erika De Marco, Lorenzo Di Natale, Peter Konstantin Kurotschka, Antonio Preti, Mauro Giovanni Carta, Alessandra Perra, Chiara Laura Riccardo, Valerio De Lorenzo, Erika De Marco, Lorenzo Di Natale, Peter Konstantin Kurotschka, Antonio Preti, Mauro Giovanni Carta

Abstract

Background: Cognitive Remediation (CR) programs are effective for the treatment of mental diseases; in recent years, Virtual Reality (VR) rehabilitation tools are increasingly used. This study aimed to systematically review and meta-analyze the published randomized controlled trials that used fully immersive VR tools for CR programs in psychiatric rehabilitation. We also wanted to map currently published CR/VR interventions, their methods components, and their evidence base, including the framework of the development intervention of CR in fully immersive VR.

Methods: Level 1 of evidence. This study followed the PRISMA extension for Scoping Reviews and Systematic Review. Three electronic databases (Pubmed, Cochrane Library, Embase) were systematically searched, and studies were included if they met the eligibility criteria: only randomized clinical trials, only studies with fully immersive VR, and only CR for the adult population with mental disorders.

Results: We found 4905 (database) plus 7 (manual/citation searching articles) eligible studies. According to inclusion criteria, 11 studies were finally reviewed. Of these, nine included patients with mild cognitive impairment, one with schizophrenia, and one with mild dementia. Most studies used an ecological scenario, with improvement across all cognitive domains. Although eight studies showed significant efficacy of CR/VR, the interventions' development was poorly described, and few details were given on the interventions' components.

Conclusions: Although CR/VR seems to be effective in clinical and feasibility outcomes, the interventions and their components are not clearly described. This limits the understanding of the effectiveness and undermines their real-world implementation and the establishment of a gold standard for fully immersive VR/CR.

Keywords: cognitive remediation; mental health; psychiatric rehabilitation; recovery; virtual reality.

Conflict of interest statement

The authors declare that there are no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flow-diagram.
Figure 2
Figure 2
Risk of bias summary plot according to the National Institutes of Health Quality Assessment of Controlled Intervention Studies. Quality assessment of the included studies on cognitive remediation through fully immersive virtual reality in adults with psychosocial disabilities.
Figure 3
Figure 3
Executive Function. Liao et al., 2019 [79]; Liao et al., 2020 [81]; Park et al., 2020 [84]; Thapa et al., 2020 [80]; Kang et al., 2021 [77]; Maeng et al., 2021 [78].
Figure 4
Figure 4
Attention. Hwang et al., 2017 [82]; Liao et al., 2019 [79]; Park et al., 2020 [84]; Thapa et al., 2020 [80]; Kang et al., 2021 [77]; Maeng et al., 2021 [78].
Figure 5
Figure 5
Memory. Hwang et al., 2017 [82]; Liao et al., 2020 [81]; Park et al., 2020 [84]; Kang et al., 2021 [77]; Maeng et al., 2021 [78].
Figure 6
Figure 6
Language. Liao et al., 2020 [81]; Park et al., 2020 [84]; Kang et al., 2021 [77]; Maeng et al., 2021 [78].
Figure 7
Figure 7
Global Cognition. Liao et al., 2020 [81]; Park et al., 2020 [84]; Thapa et al., 2020 [80]; Kang et al., 2021 [77]; Kwan et al., 2021 [83].

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Source: PubMed

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