Effectiveness of virtual reality technology on functional mobility of older adults: systematic review and meta-analysis

BACKGROUND

The accessibility, versatility and motivation provided by virtual reality technology (VRT) have fostered its rapid expansion as a rehabilitation technique to improve functional mobility. The aim of this study was to investigate the effectiveness of rehabilitation programmes using VRT, specific virtual reality technology (VRT-S) and non-specific virtual reality technology (VRT-NS), to improve functional mobility in individuals aged >60 years versus conventional treatment (CT) or no intervention.

METHODS

Nine databases (Cochrane Library, Scopus, PEDro, Medline, CSIC, Web of Science, OT Seeker, NGCH and CINAHL) were searched to identify randomised trials up to December 2019. Results of clinical trials that used VRT-S and VRT-NS in rehabilitation were combined, using a random effects model with inverse variance weighting of the studies. GRADE was used to assess the quality of evidence. The protocol was registered in PROSPERO: CRD42019131630. Overall, there was moderate quality of evidence for the functional mobility results, which means that the estimate of effect is likely to change.

RESULTS

Sixteen of the 18 studies selected (n = 568) provided data for the subgroup meta-analysis. VRT-NS was more effective in improving functional mobility than no intervention [standardised mean difference (SMD) = -1.02; 95% confidence interval (CI) -1,91 to -0,14). VRT-NS was also more effective than CT in improving resistance in ambulation (SMD = -1.20; 95% CI -1.93 to 0.46). No significant differences were found between VRT-S and CT or no intervention. Programmes in which >18 sessions were applied were more beneficial (SMD = -0.89; 95% CI -1.71 to -0.08; <0.001) than programmes with ≤18 sessions (SMD = 0.04; 95% CI -0.51 to 0.59) versus no intervention.

CONCLUSIONS

Our results suggest that VRT is an effective intervention for improving functional mobility in older persons compared with CT. VRT-NS proved to be more effective than VRT-S. However, these results are still not conclusive due to the low methodological quality of the studies. Thus, new studies and analyses are required.

Can exergames contribute to improving walking capacity in older adults? A systematic review and meta-analysis

BACKGROUND

The accessibility, low cost and motivation generated by exergames has fostered its rapid expansion as a rehabilitation technique.

OBJECTIVE

To estimate the effectiveness of rehabilitation programs using IVGT in improving walking capacity of people aged 60 years and over.

MATERIALS AND METHODS

The electronic data research following the PRISMA Statement (Scopus, Cochrane, Web of Science, OT Seeker, National Guideline Clearinghouse, Trip Database, CSIC Spanish National Research Council) was completed in September 2018. The results of randomized clinical trials using exergames for rehabilitation of walking capacity were combined. The calculations have followed the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The Grading of Recommendations Assessment, Development and Evaluation system was used to evaluate the quality of the evidence.

RESULTS

We obtained data from 14 trials, including 11 meta-analysis studies. The size of exergames effects on walking capacity is moderate, but significant (SMD -0.56; 95 % CI: -0.90, -0.21; p = 0.002). Effectiveness was greater to recover the ability to transfer from one position or place to another (SMD -1.02; CI 95 %: -1.70, -0.35; P = 0.003). The intervention protocols, their duration and intensity varied considerably. The lack of masking, the allocation concealment, the absence of assessor blinding were the main causes of bias so the final grade of evidence has been low for walking and very low for transfers.

CONCLUSIONS

Positive clinical effects of exergames have been found to improve walking capacity, but the quality of evidence to refute its effectiveness is weak with risk of bias. Further research is needed in order to know the actual magnitude of its effect.

Improving Self-Perceived Emotional Intelligence in Occupational Therapy Students Through Practical Training

Background: In the field of healthcare, higher skills in emotional intelligence (EI) have been proven to have a positive impact on healthcare professionals in general and occupational therapists in particular and also on teamwork and patient care. The purpose of this research was to determine whether performing practical work included in the undergraduate Occupational Therapy program improves students' self-perceived EI, and whether there are any differences in the latter depending on the area in which this practical training is performed.

Methods: It was conducted a multicenter, quasi-experimental, pre-post study with Occupational Therapy undergraduate students in the 2016–2017 academic year. A total of 184 students met the inclusion criteria. Of these, 10 (5.40%) declined to participate; therefore, the participation rate was 94.60% and the initial sample comprised 174 students. Mean age was 21.34 years (SD = 2.54) and 84.50% (n = 147) were women. Students' self-perceived EI was measured with the Trait Meta-Mood Scale-24 (TMMS-24). This measure was completed in the two weeks prior to the start of the practical training period and one week after the end of it. McNemar-Bowker and McNemar tests were used to analyze the differences in self-perceived EI between these two points in time.

Results: After the practical training, an improvement in self-perceived EI was observed in women (Emotional Attention, Emotional Clarity, and Emotional Regulation dimensions). Regarding areas of practical training, results showed an improvement in EI in women who had received practical training in the areas of Physical Rehabilitation, Mental Health and Geriatrics and Gerontology.

Conclusions: The findings contribute to a better understanding of the relation between practical training and an improvement in self-perceived EI. This insight can help make changes in the teaching methodology to enhance the emotional skills needed for a better professional performance.

Anatomical prosection practices in the Occupational Therapy degree. Student anxiety levels and academic effectiveness

CONTEXT

The practice of anatomical dissection and/or prosection on human cadavers is an essential component of human anatomy training programmes. However, this activity can be stressful for inexperienced students when exposed to cadavers for the first time, and it may generate high anxiety levels. The aims of this study are threefold: 1) to analyse the thoughts and feelings of first-year students of the Occupational Therapy degree about prosection practices; 2) to examine their anxiety levels in relation to these practices; and 3) to evaluate how useful and effective they are as an educational tool for anatomy training.

METHODS

This is a before-and-after cross-sectional study of first-year students of the Occupational Therapy degree at the Universidad de Castilla-La Mancha, Spain. These students had not previously participated in prosection practices. An anonymous questionnaire was distributed among the students before and after the practice, in order to examine their feelings and perceptions during the practice. To examine their anxiety levels, we used a State-Trait Anxiety Inventory (STAI) questionnaire. To assess their learning outcomes the students had to complete two practical tests of recognition of anatomical structures, one before attending the practice and one immediately afterwards.

RESULTS

Basal anxiety levels, measured as trait anxiety (TA), remained stable and did not show significant differences during the practice (p>0.05). Their emotional anxiety, measured as state anxiety (SA), dropped from 14.7 to 10 points (p<0.05) after the practice. Before the start of the practice 11 students (19%) showed signs of anxiety, and these remained so at the end of the practical session (p>0.05). As for their academic performance, we observed that the number of students able to pass the test after attending the prosection practice increased notably (by more than 60%). Additionally, 100% of the students recommended that the practice be retained for future courses, giving it an approval rate of 9.1 out of 10.

CONCLUSION

Although anatomy is usually an attractive subject for Occupational Therapy students and they value prosection practices positively, they remain a potentially complex and stressful experience. Some students find that their experiences in the dissecting room can upset their emotional balance, however, the implementation of coping mechanisms could be a very effective strategy to reduce their anxiety and also to improve their learning outcomes, helping to strengthen their practical knowledge of anatomy as we have observed in this study. The students not only value positively these practices, they also believe that they are an extremely useful tool for both teaching and learning anatomy, and they recommend their routine use as part of the training process.