Effects of Virtual Reality Therapy on the Balance and Health-Related Quality of Life of Patients With Stroke: A Systematic Review
Introduction: Stroke is one of the leading causes of death worldwide. Despite the glowing advancement of Virtual Reality Therapy (VRT), clear evidence about its effectiveness in stroke is still scarce. Hence it is essential to review the current information to provide up-to-date insight. Therefore the aim of this review is to evaluate the effects of VRT on the balance and Health-related Quality of Life (HRQoL) in patients with stroke.
Data Sources: A literature search was done in Google Scholar, PEDro, Cochrane Library, Medline, Web of Science, and PubMed databases.
Eligibility Criteria: We performed a systematic review of randomized controlled trials published from June 2014 to January 2020, evaluating the effects of VRT on the balance and/or HRQoL in stroke. Fourteen eligible trials were analyzed, of which, 7 studies focused on balance and 7 on HRQoL.
Quality Appraisal: Methodological quality and risk of bias were assessed using the Cochrane tool.
Results: Most of the trials supported the effectiveness of VRT in improving balance and HRQoL. However, few trials reported similar improvements in HRQoL using VRT via Nintendo WiiTM games and conventional physiotherapy.
Conclusions: High to moderate evidence supports the effectiveness of VRT use in improving balance and HRQoL in stroke survivors.
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990-2010: Findings from the global burden of disease study 2010. The Lancet. 2014; 383(9913):245-55. [DOI:10.1016/S0140-6736(13)61953-4]
Kim JH, Jang SH, Kim CS, Jung JH, You JH. Use of virtual reality to enhance balance and ambulation in chronic stroke: A double-blind, randomized controlled study. American Journal of Physical Medicine & Rehabilitation. 2009; 88(9):693-701. [DOI:10.1097/PHM.0b013e3181b33350] [PMID]
Merians AS, Jack D, Boian R, Tremaine M, Burdea GC, Adamovich SV, et al. Virtual reality-augmented rehabilitation for patients following stroke. Physical Therapy. 2002; 82(9):898-915. [DOI:10.1093/ptj/82.9.898] [PMID]
You SH, Jang SH, Kim YH, Hallett M, Ahn SH, Kwon YH, et al. Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: An experimenter-blind randomized study. Stroke. 2005; 36(6):1166-71. [DOI:10.1161/01.STR.0000162715.43417.91] [PMID]
Lam YS, Man DW, Tam SF, Weiss PL. Virtual reality training for stroke rehabilitation. NeuroRehabilitation. 2006; 21(3):245-53. [DOI:10.3233/NRE-2006-21308] [PMID]
Schultheis MT, Rizzo AA. The application of virtual reality technology in rehabilitation. Rehabilitation Psychology. 2001; 46(3):296-311. [DOI:10.1037/0090-55126.96.36.1996]
Levin MF, Weiss PL, Keshner EA. Emergence of virtual reality as a tool for upper limb rehabilitation: Incorporation of motor control and motor learning principles. Physical therapy. 2015; 95(3):415-25. [DOI:10.2522/ptj.20130579] [PMID] [PMCID]
Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database of Systematic Reviews. 2017; 2017(11):CD008349. [DOI:10.1002/14651858.CD008349.pub4] [PMID] [PMCID]
Lewis GN, Rosie JA. Virtual reality games for movement rehabilitation in neurological conditions: How do we meet the needs and expectations of the users? Disability and Rehabilitation. 2012; 34(22):1880-6. [DOI:10.3109/09638288.2012.670036] [PMID]
Kang HK, Chung YJ. Effects of treadmill training with real optic flow scene on balance and balance self-efficacy in individuals following stroke: A pilot randomized controlled trial. Physical Therapy Rehabilitation Science. 2012; 1(1):33-9. http://kmbase.medric.or.kr/KMID/1012020120010010033
Minet LR, Peterson E, von Koch L, Ytterberg C. Occurrence and predictors of falls in people with stroke: Six-year prospective study. Stroke. 2015; 46(9):2688-90. [DOI:10.1161/STROKEAHA.115.010496] [PMID]
Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: A systematic review. The Lancet Neurology. 2009; 8(8):741-54. [DOI:10.1016/S1474-4422(09)70150-4]
Kollen B, van de Port I, Lindeman E, Twisk J, Kwakkel G. Predicting improvement in gait after stroke: A longitudinal prospective study. Stroke. 2005; 36(12):2676-80. [DOI:10.1161/01.STR.0000190839.29234.50] [PMID]
Bolton DA, Brown KE, McIlroy WE, Staines WR. Transient inhibition of the dorsolateral prefrontal cortex disrupts somatosensory modulation during standing balance as measured by electroencephalography. Neuroreport. 2012; 23(6):369-72. [DOI:10.1097/WNR.0b013e328352027c] [PMID]
Lai SM, Studenski S, Duncan PW, Perera S. Persisting consequences of stroke measured by the Stroke Impact Scale. Stroke. 2002; 33(7):1840-4. [DOI:10.1161/01.STR.0000019289.15440.F2] [PMID]
López Espuela F, Portilla Cuenca JC, Leno Díaz C, Párraga Sánchez JM, Gamez-Leyva G, Casado Naranjo I. [Sex differences in long-term quality of life after stroke: Influence of mood and functional status (English-Spanish)]. Neurología (English Edition). 2019 June. [DOI:10.1016/j.nrleng.2017.10.002] [PMID]
de Rooij IJM, van de Port IGL, Meijer JWG. Effect of virtual reality training on balance and gait ability in patients with stroke: Systematic review and meta-analysis. Physical Therapy. 2016; 96(12):1905-18. [DOI:10.2522/ptj.20160054] [PMID]
Iruthayarajah J, McIntyre A, Cotoi A, Macaluso S, Teasell R. The use of virtual reality for balance among individuals with chronic stroke: A systematic review and meta-analysis. Topics in Stroke Rehabilitation. 2017; 24(1):68-79. [DOI:10.1080/10749357.2016.1192361] [PMID]
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine. 2009; 151(4):264-9. [DOI:10.7326/0003-4819-151-4-200908180-00135] [PMID]
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011; 343:d5928. [DOI:10.1136/bmj.d5928] [PMID] [PMCID]
Lisa S, Anne TH, Heidi S, Martin B, Christine Y, Hillel F. Sitting balance exercise performed using Virtual Reality training on a stroke rehabilitation inpatient service: A randomized controlled study. PM & R. 2020 January. [DOI:10.1002/pmrj.12331]
Sheehy L, Taillon-Hobson A, Sveistrup H, Bilodeau M, Yang C, Welch V, et al. Home-based virtual reality training after discharge from hospital-based stroke rehabilitation: A parallel randomized feasibility trial. Trials. 2019; 20:333. [DOI:10.1186/s13063-019-3438-9] [PMID] [PMCID]
Henrique PPB, Colussi EL, De Marchi ACB. Effects of exergame on patients’ balance and upper limb motor function after stroke: A randomized controlled trial. Journal of Stroke and Cerebrovascular Diseases. 2019; 28(8):2351-7. [DOI:10.1016/j.jstrokecerebrovasdis.2019.05.031] [PMID]
Lee MM, Shin DC, Song CH. Canoe game-based virtual reality training to improve trunk postural stability, balance, and upper limb motor function in subacute stroke patients: A randomized controlled pilot study. Journal of Physical Therapy Science. 2016; 28(7):2019-24. [DOI:10.1589/jpts.28.2019] [PMID] [PMCID]
In T, Lee K, Song C. Virtual Reality reflection therapy improves balance and gait in patients with chronic stroke: Randomized controlled trials. Medical Science Monitor. 2016; 22:4046-53. [DOI:10.12659/MSM.898157] [PMID] [PMCID]
Lloréns R, Gil-Gómez JA, Alcañiz M, Colomer C, Noé E. Improvement in balance using a virtual reality-based stepping exercise: A randomized controlled trial involving individuals with chronic stroke. Clinical Rehabilitation. 2015; 29(3):261-8. [DOI:10.1177/0269215514543333] [PMID]
McEwen D, Taillon-Hobson A, Bilodeau M, Sveistrup H, Finestone H. Virtual Reality exercise improves mobility after stroke: An inpatient randomized controlled trial. Stroke. 2014; 45(6):1853-5. [DOI:10.1161/STROKEAHA.114.005362] [PMID]
Park M, Ko MH, Oh SW, Lee JY, Ham Y, Yi H, et al. Effects of Virtual Reality-based planar motion exercises on upper extremity function, range of motion, and health-related quality of life: A multicenter, single-blinded, randomized, controlled pilot study. Journal of Neuroengineering and Rehabilitation. 2019; 16:122. [DOI:10.1186/s12984-019-0595-8] [PMID] [PMCID]
de Rooij IJM, van de Port IG, Visser-Meily JMA, Meijer JWG. Virtual Reality gait training versus non-virtual reality gait training for improving participation in subacute stroke survivors: Study protocol of the ViRTAS randomized controlled trial. Trials. 2019; 20:89. [DOI:10.1186/s13063-018-3165-7] [PMID] [PMCID]
Adie K, Schofield C, Berrow M, Wingham J, Humfryes J, Pritchard C, et al. Does the use of Nintendo Wii SportsTM improve arm function? Trial of WiiTM in Stroke: A randomized controlled trial and economics analysis. Clinical Rehabilitation. 2017; 31(2):173-85. [DOI:10.1177/0269215516637893] [PMID]
Lee M, Son J, Kim J, Pyun SB, Eun SD, Yoon B. Comparison of individualized virtual reality-and group-based rehabilitation in older adults with chronic stroke in community settings: A pilot randomized controlled trial. European Journal of Integrative Medicine. 2016; 8(5):738-46. [DOI:10.1016/j.eujim.2016.08.166]
Shin JH, Kim MY, Lee JY, Jeon YJ, Kim S, Lee S, et al. Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: A single-blinded, randomized controlled trial. Journal of Neuroengineering and Rehabilitation. 2016; 13:17. [DOI:10.1186/s12984-016-0125-x] [PMID] [PMCID]
Zheng CJ, Liao WJ, Xia WG. Effect of combined low-frequency repetitive transcranial magnetic stimulation and virtual reality training on upper limb function in subacute stroke: A double-blind randomized controlled trail. Journal of Huazhong University of Science and Technology [Medical Sciences]. 2015; 35(2):248-54. [DOI:10.1007/s11596-015-1419-0] [PMID]
da Silva Ribeiro NM, Ferraz DD, Pedreira É, Pinheiro Í, da Silva Pinto AC, Neto MG, et al. Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients. Topics in Stroke Rehabilitation. 2015; 22(4):299-305. [DOI:10.1179/1074935714Z.0000000017] [PMID]
Brumels KA, Blasius T, Cortright T, Oumedian D, Solberg B. Comparison of efficacy between traditional and video game based balance programs. Clinical Kinesiology. 2008; 62(4):26-31. https://search.proquest.com/openview/5a8e5af88bde91c8d9098d9f259cc36e/1?pq-origsite=gscholar&cbl=29722
Pietrzak E, Pullman S, McGuire A. Using virtual reality and videogames for traumatic brain injury rehabilitation: A structured literature review. GAMES FOR HEALTH: Research, Development, and Clinical Applications. 2014; 3(4):202-14. [DOI:10.1089/g4h.2014.0013] [PMID]
Morone G, Tramontano M, Iosa M, Shofany J, Iemma A, Musicco M, et al. The efficacy of balance training with video game-based therapy in subacute stroke patients: A randomized controlled trial. BioMed Research International. 2014; 2014:580861. [DOI:10.1155/2014/580861] [PMID] [PMCID]
Imam B, Jarus T. Virtual reality rehabilitation from social cognitive and motor learning theoretical perspectives in stroke population. Rehabilitation Research and Practice. 2014; 2014:594540. [DOI:10.1155/2014/594540] [PMID] [PMCID]
Lord SE, Rochester L, Weatherall M, McPherson KM, McNaughton HK. The effect of environment and task on gait parameters after stroke: A randomized comparison of measurement conditions. Archives of Physical Medicine and Rehabilitation. 2006; 87(7):967-73. [DOI:10.1016/j.apmr.2006.03.003] [PMID]
Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, et al. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PloS One. 2014; 9(2):e87987. [DOI:10.1371/journal.pone.0087987] [PMID] [PMCID]
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.