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Soleimani M, Ghazisaeedi M, Heydari S. The efficacy of virtual reality for upper limb rehabilitation in stroke patients: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2024; 24:135. [PMID: 38790042 PMCID: PMC11127427 DOI: 10.1186/s12911-024-02534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Stroke frequently gives rise to incapacitating motor impairments in the upper limb. Virtual reality (VR) rehabilitation has exhibited potential for augmenting upper extremity recovery; nonetheless, the optimal techniques for such interventions remain a topic of uncertainty. The present systematic review and meta-analysis were undertaken to comprehensively compare VR-based rehabilitation with conventional occupational therapy across a spectrum of immersion levels and outcome domains. METHODS A systematic search was conducted in PubMed, IEEE, Scopus, Web of Science, and PsycNET databases to identify randomized controlled trials about upper limb rehabilitation in stroke patients utilizing VR interventions. The search encompassed studies published in the English language up to March 2023. The identified studies were stratified into different categories based on the degree of immersion employed: non-immersive, semi-immersive, and fully-immersive settings. Subsequent meta-analyses were executed to assess the impact of VR interventions on various outcome measures. RESULTS Of the 11,834 studies screened, 55 studies with 2142 patients met the predefined inclusion criteria. VR conferred benefits over conventional therapy for upper limb motor function, functional independence, Quality of life, Spasticity, and dexterity. Fully immersive VR showed the greatest gains in gross motor function, while non-immersive approaches enhanced fine dexterity. Interventions exceeding six weeks elicited superior results, and initiating VR within six months post-stroke optimized outcomes. CONCLUSIONS This systematic review and meta-analysis demonstrates that adjunctive VR-based rehabilitation enhances upper limb motor recovery across multiple functional domains compared to conventional occupational therapy alone after stroke. Optimal paradigms likely integrate VR's immersive capacity with conventional techniques. TRIAL REGISTRATION This systematic review and meta-analysis retrospectively registered in the OSF registry under the identifier [ https://doi.org/10.17605/OSF.IO/YK2RJ ].
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Affiliation(s)
- Mohsen Soleimani
- Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeedi
- Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroush Heydari
- Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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Blázquez-González P, Mirón-González R, Lendínez-Mesa A, Luengo-González R, Mancebo-Salas N, Camacho-Arroyo MT, Muriel-García A, García-Sastre MM. Efficacy of the use of video games on mood, anxiety and depression in stroke patients: preliminary findings of a randomised controlled trial. J Neurol 2024; 271:1224-1234. [PMID: 38197947 PMCID: PMC10896939 DOI: 10.1007/s00415-023-12043-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND In the different published studies, there is no consensus on the efficacy of virtual reality as an adjuvant treatment of mood states. AIM The aim of this study is to evaluate the impact of no immersive virtual reality with the Nintendo Switch device in rehabilitation treatment on mood, anxiety and depression in stroke patients admitted to neurorehabilitation units. METHODS Fifty-eight patients admitted to neurorehabilitation units underwent a 1:3 multicentre randomised clinical trial. The intervention group consisted of 17 patients and the control group of 41 patients. The intervention group performed 6 virtual reality sessions together with the conventional treatment, and the control group performed only the conventional rehabilitation sessions. Primary and secondary clinical outcomes were measured before and six weeks after the intervention. RESULTS Comparing the intervention group and control group, the anxiety levels of the intervention group decreased compared to the results observed in the control group (p = 0.01), as did the dependence of the intervention group (0.015). On the other hand, the results obtained after the intervention by the control group for anxiety (0.479) and depression (0.292) were not statistically significant. CONCLUSION Rehabilitation VR used as an adjuvant treatment to conventional treatment has a beneficial impact on the neurological status and state of anxiety of stroke patients admitted to neurorehabilitation units. TRIAL REGISTRATION Registered in the https://clinicaltrials.gov/ repository (NTC NCT05143385). Protocol registration date 7 October 2021, retrospectively registered.
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Affiliation(s)
- Patricia Blázquez-González
- Department of Nursing, Red Cross University, Madrid, Spain
- Biomechanics and Bioengineering Applied to Health, Doctoral School, University of Alcalá, Madrid, Spain
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
| | - Rubén Mirón-González
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain
| | - Alejandro Lendínez-Mesa
- Departamento de EnfermeríaServicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raquel Luengo-González
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain.
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain.
- Group for Research in Nursing Care, Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain.
| | - Noelia Mancebo-Salas
- General Directorate of Social Services With the Ministry of Family, Youth and Social Policy of the, Community of Madrid, Madrid, Spain
| | | | - Alfonso Muriel-García
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Montserrat García-Sastre
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain
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Yan C, Zheng Y, Zhang X, Gong C, Wen S, Zhu Y, Jiang Y, Li X, Fu G, Pan H, Teng M, Xia L, Li J, Qian K, Lu X. Development and validation of a nomogram model for predicting unfavorable functional outcomes in ischemic stroke patients after acute phase. Front Aging Neurosci 2023; 15:1161016. [PMID: 37520125 PMCID: PMC10375043 DOI: 10.3389/fnagi.2023.1161016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Prediction of post-stroke functional outcome is important for personalized rehabilitation treatment, we aimed to develop an effective nomogram for predicting long-term unfavorable functional outcomes in ischemic stroke patients after acute phase. Methods We retrospectively analyzed clinical data, rehabilitation data, and longitudinal follow-up data from ischemic stroke patients who underwent early rehabilitation at multiple centers in China. An unfavorable functional outcome was defined as a modified Rankin Scale (mRS) score of 3-6 at 90 days after onset. Patients were randomly allocated to either a training or test cohort in a ratio of 4:1. Univariate and multivariate logistic regression analyses were used to identify the predictors for the development of a predictive nomogram. The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive ability in both the training and test cohorts. Results A total of 856 patients (training cohort: n = 684; test cohort: n = 172) were included in this study. Among them, 518 patients experienced unfavorable outcomes 90 days after ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment classification (p = 0.024), antihypertensive agents use [odds ratio (OR) = 1.86; p = 0.041], 15-day Barthel Index score (OR = 0.930; p < 0.001) and 15-day mRS score (OR = 13.494; p < 0.001) were selected as predictors for the unfavorable outcome nomogram. The nomogram model showed good predictive performance in both the training (AUC = 0.950) and test cohorts (AUC = 0.942). Conclusion The constructed nomogram model could be a practical tool for predicting unfavorable functional outcomes in ischemic stroke patients underwent early rehabilitation after acute phase.
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Affiliation(s)
- Chengjie Yan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xintong Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Gong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shibin Wen
- Department of Neurology, Jiuquan City People’s Hospital, Jiuquan, China
| | - Yonggang Zhu
- Department of Rehabilitation Medicine, The First People’s Hospital of Lianyungang, Lianyungang, China
| | - Yujuan Jiang
- Department of Rehabilitation Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Xipeng Li
- Department of Neurology, Xingtai People’s Hospital, Xingtai, China
| | - Gaoyong Fu
- Department of Rehabilitation Medicine, The First People’s Hospital of Yibin, Yibin, China
| | - Huaping Pan
- Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Meiling Teng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingfeng Xia
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kun Qian
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Tennant M, Anderson N, Youssef GJ, McMillan L, Thorson R, Wheeler G, McCarthy MC. Effects of immersive virtual reality exposure in preparing pediatric oncology patients for radiation therapy. Tech Innov Patient Support Radiat Oncol 2021; 19:18-25. [PMID: 34286115 PMCID: PMC8274338 DOI: 10.1016/j.tipsro.2021.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Procedural anxiety in children undergoing radiation therapy (RT) is common and is associated with poor procedural compliance and an increased used of general anaesthesia (GA). There is emerging evidence that Virtual Reality (VR) technology may reduce medical procedural distress through realistic and educative exposure to actual procedures via virtual simulation. OBJECTIVE To examine the feasibility, acceptability and efficacy of an Immersive VR exposure intervention aimed at reducing anxiety and enhancing preparedness for pediatric patients undergoing radiation therapy, and their parents. METHOD A convenience sample of patients (6-18 years) scheduled for RT, and their parent caregivers, were recruited consecutively over a 14-month period. Patients were exposed to a virtual simulation of both CT Simulation (Phase 1) and RT (Phase 2), prior to these procedures occurring. Pre-and-post VR intervention measures (anxiety, health literacy) were administered across multiple time points. GA requirement following VR intervention was also recorded. RESULTS Thirty children and adolescents were recruited (88% participation rate). High VR acceptability and satisfaction was reported by patients, parents and radiation therapists. There were minimal adverse effects associated with VR. The VR intervention was found to improve children's understanding of the RT procedures (health literacy) and lower pre-procedural child and parental anxiety. Only one child in the study required GA (3.33%). CONCLUSIONS This study provides novel and preliminary support for utilizing VR to prepare children and families for RT. Subsequent implementation of VR into routine paediatric RT has the potential to improve clinical and operational outcomes.
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Affiliation(s)
- Michelle Tennant
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia
- Children’s Cancer Centre, The Royal Children’s Hospital, Parkville, Victoria 3052, Australia
| | - Nigel Anderson
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3010, Australia
| | - George J. Youssef
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia
| | - Laura McMillan
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia
| | - Renae Thorson
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Greg Wheeler
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3010, Australia
| | - Maria C. McCarthy
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia
- Children’s Cancer Centre, The Royal Children’s Hospital, Parkville, Victoria 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria 3052, Australia
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Fazeli HR, Peng Q. Estimation of spatial-temporal hand motion parameters in rehabilitation using a low-cost noncontact measurement system. Med Eng Phys 2021; 90:43-53. [PMID: 33781479 DOI: 10.1016/j.medengphy.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 01/15/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
Data collection and analysis are commonly used in a rehabilitation process to measure performances of the treatment. There is a lack of studies on the rehabilitation process monitored by a user-friendly interface. A low-cost system is developed in this research to assist users and therapists to measure hand motions and analyse important data of hand joints. The system consists of modules of data capturing, data analysis, and user interface. A Leap Motion sensor is used to capture joint positions of hand motions. Signal processing and wavelet de-noising methods are developed to improve accuracy of the data analysis. The user interface is designed using the Unity software to show graphical information of joint positions and motion parameters. The system has features of noncontact measurements, interactive environment, analysing and recording temporal data of motion parameters of hands. The system is validated by a gold standard motion capturing system. Case studies show effectiveness of the proposed system.
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Affiliation(s)
- Hamid Reza Fazeli
- Department of Mechanical Engineering, University of Manitoba, Winnipeg R3T 5V6, Canada
| | - Qingjin Peng
- Department of Mechanical Engineering, University of Manitoba, Winnipeg R3T 5V6, Canada.
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