Virtual Reality Therapy for Adults Post-Stroke: A Systematic Review and Meta-Analysis Exploring Virtual Environments and Commercial Games in Therapy
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{"title"=>"Virtual reality therapy for adults post-stroke: A systematic review and meta-analysis exploring virtual environments and commercial games in therapy", "type"=>"journal", "authors"=>[{"first_name"=>"Keith R.", "last_name"=>"Lohse", "scopus_author_id"=>"36097538900"}, {"first_name"=>"Courtney G.E.", "last_name"=>"Hilderman", "scopus_author_id"=>"56117836300"}, {"first_name"=>"Katharine L.", "last_name"=>"Cheung", "scopus_author_id"=>"56154743300"}, {"first_name"=>"Sandy", "last_name"=>"Tatla", "scopus_author_id"=>"55633761300"}, {"first_name"=>"H. F.Machiel", "last_name"=>"Van Der Loos", "scopus_author_id"=>"55664199200"}], "year"=>2014, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84900302218", "sgr"=>"84900302218", "pui"=>"373058028", "isbn"=>"1932-6203", "pmid"=>"24681826", "doi"=>"10.1371/journal.pone.0093318"}, "id"=>"3f3e8be9-2a0e-3753-a70d-3b063b7d58ef", "abstract"=>"BACKGROUND: The objective of this analysis was to systematically review the evidence for virtual reality (VR) therapy in an adult post-stroke population in both custom built virtual environments (VE) and commercially available gaming systems (CG).\\n\\nMETHODS: MEDLINE, CINAHL, EMBASE, ERIC, PSYCInfo, DARE, PEDro, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were systematically searched from the earliest available date until April 4, 2013. Controlled trials that compared VR to conventional therapy were included. Population criteria included adults (>18) post-stroke, excluding children, cerebral palsy, and other neurological disorders. Included studies were reported in English. Quality of studies was assessed with the Physiotherapy Evidence Database Scale (PEDro).\\n\\nRESULTS: Twenty-six studies met the inclusion criteria. For body function outcomes, there was a significant benefit of VR therapy compared to conventional therapy controls, G = 0.48, 95% CI = [0.27, 0.70], and no significant difference between VE and CG interventions (P = 0.38). For activity outcomes, there was a significant benefit of VR therapy, G = 0.58, 95% CI = [0.32, 0.85], and no significant difference between VE and CG interventions (P = 0.66). For participation outcomes, the overall effect size was G = 0.56, 95% CI = [0.02, 1.10]. All participation outcomes came from VE studies.\\n\\nDISCUSSION: VR rehabilitation moderately improves outcomes compared to conventional therapy in adults post-stroke. Current CG interventions have been too few and too small to assess potential benefits of CG. Future research in this area should aim to clearly define conventional therapy, report on participation measures, consider motivational components of therapy, and investigate commercially available systems in larger RCTs.\\n\\nTRIAL REGISTRATION: Prospero CRD42013004338.", "link"=>"http://www.mendeley.com/research/virtual-reality-therapy-adults-poststroke-systematic-review-metaanalysis-exploring-virtual-environme", "reader_count"=>333, "reader_count_by_academic_status"=>{"Unspecified"=>13, "Professor > Associate Professor"=>24, "Librarian"=>1, "Researcher"=>28, "Student > Doctoral Student"=>26, "Student > Ph. D. 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Student"=>59, "Student > Postgraduate"=>20, "Student > Master"=>61, "Other"=>19, "Student > Bachelor"=>56, "Lecturer"=>5, "Lecturer > Senior Lecturer"=>5, "Professor"=>16}, "reader_count_by_subject_area"=>{"Unspecified"=>22, "Agricultural and Biological Sciences"=>13, "Philosophy"=>1, "Arts and Humanities"=>4, "Business, Management and Accounting"=>3, "Veterinary Science and Veterinary Medicine"=>1, "Computer Science"=>43, "Earth and Planetary Sciences"=>2, "Engineering"=>44, "Nursing and Health Professions"=>48, "Biochemistry, Genetics and Molecular Biology"=>1, "Materials Science"=>2, "Mathematics"=>3, "Medicine and Dentistry"=>74, "Neuroscience"=>22, "Design"=>2, "Sports and Recreations"=>7, "Physics and Astronomy"=>2, "Psychology"=>29, "Social Sciences"=>9, "Linguistics"=>1}, "reader_count_by_subdiscipline"=>{"Materials Science"=>{"Materials Science"=>2}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>74}, "Social Sciences"=>{"Social Sciences"=>9}, "Sports and Recreations"=>{"Sports and Recreations"=>7}, "Physics and Astronomy"=>{"Physics and Astronomy"=>2}, "Psychology"=>{"Psychology"=>29}, "Mathematics"=>{"Mathematics"=>3}, "Unspecified"=>{"Unspecified"=>22}, "Arts and Humanities"=>{"Arts and Humanities"=>4}, "Design"=>{"Design"=>2}, "Engineering"=>{"Engineering"=>44}, "Neuroscience"=>{"Neuroscience"=>22}, "Earth and Planetary Sciences"=>{"Earth and Planetary Sciences"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>13}, "Computer Science"=>{"Computer Science"=>43}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>3}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>48}, "Linguistics"=>{"Linguistics"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Philosophy"=>{"Philosophy"=>1}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>1}}, "reader_count_by_country"=>{"Hong Kong"=>1, "United States"=>2, "Japan"=>1, "United Kingdom"=>3, "Switzerland"=>1, "Spain"=>5, "Turkey"=>1, "Taiwan"=>1, "Brazil"=>6, "Mexico"=>2, "Slovakia"=>1, "France"=>1, "Australia"=>1, "Germany"=>1}, "group_count"=>32}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1439895"], "description"=>"<p>The funnel plot (top) for activity outcomes showing effect-sizes (G) as a function of precision (standard error) in each commercial gaming study. The forest plot (bottom) shows the effect-sizes and 95% confidence intervals for each study and the summary effect-size from the random-effects model. Positive values show a difference in favour of CG therapy. Negative values show a difference in favour of CT. Abbreviations: CG, commercial gaming; RE, random effects.</p>", "links"=>[], "tags"=>["Computer architecture", "User interfaces", "Virtual reality", "Human factors engineering", "Man-computer interface", "health care", "physiotherapy", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "outcomes", "cg"], "article_id"=>978112, "categories"=>["Biological Sciences"], "users"=>["Keith R. Lohse", "Courtney G. E. Hilderman", "Katharine L. Cheung", "Sandy Tatla", "H. F. Machiel Van der Loos"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0093318.g005", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Activity_outcomes_in_CG_studies_/978112", "title"=>"Activity outcomes in CG studies.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-03-28 02:47:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/1439893"], "description"=>"<p>The funnel plot (top) for body function outcomes showing effect-sizes (G) as a function of precision (standard error) in each commercial gaming study. The forest plot (bottom) showing the effect-sizes and 95% confidence intervals for each study and the summary effect-size from the random-effects model. Positive values show a difference in favour of CG therapy. Negative values show a difference in favour of CT. Abbreviations: CG, commercial gaming; RE, random effects.</p>", "links"=>[], "tags"=>["Computer architecture", "User interfaces", "Virtual reality", "Human factors engineering", "Man-computer interface", "health care", "physiotherapy", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "outcomes", "cg"], "article_id"=>978110, "categories"=>["Biological Sciences"], "users"=>["Keith R. Lohse", "Courtney G. E. Hilderman", "Katharine L. Cheung", "Sandy Tatla", "H. F. Machiel Van der Loos"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0093318.g003", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Body_function_outcomes_in_CG_studies_/978110", "title"=>"Body function outcomes in CG studies.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-03-28 02:47:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/1439904", "https://ndownloader.figshare.com/files/1439905", "https://ndownloader.figshare.com/files/1439906", "https://ndownloader.figshare.com/files/1439907"], "description"=>"<div><p>Background</p><p>The objective of this analysis was to systematically review the evidence for virtual reality (VR) therapy in an adult post-stroke population in both custom built virtual environments (VE) and commercially available gaming systems (CG).</p><p>Methods</p><p>MEDLINE, CINAHL, EMBASE, ERIC, PSYCInfo, DARE, PEDro, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were systematically searched from the earliest available date until April 4, 2013. Controlled trials that compared VR to conventional therapy were included. Population criteria included adults (>18) post-stroke, excluding children, cerebral palsy, and other neurological disorders. Included studies were reported in English. Quality of studies was assessed with the Physiotherapy Evidence Database Scale (PEDro).</p><p>Results</p><p>Twenty-six studies met the inclusion criteria. For body function outcomes, there was a significant benefit of VR therapy compared to conventional therapy controls, G = 0.48, 95% CI = [0.27, 0.70], and no significant difference between VE and CG interventions (P = 0.38). For activity outcomes, there was a significant benefit of VR therapy, G = 0.58, 95% CI = [0.32, 0.85], and no significant difference between VE and CG interventions (P = 0.66). For participation outcomes, the overall effect size was G = 0.56, 95% CI = [0.02, 1.10]. All participation outcomes came from VE studies.</p><p>Discussion</p><p>VR rehabilitation moderately improves outcomes compared to conventional therapy in adults post-stroke. Current CG interventions have been too few and too small to assess potential benefits of CG. Future research in this area should aim to clearly define conventional therapy, report on participation measures, consider motivational components of therapy, and investigate commercially available systems in larger RCTs.</p><p>Trial Registration</p><p>Prospero <a href=\"http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013004338\" target=\"_blank\">CRD42013004338</a></p></div>", "links"=>[], "tags"=>["Computer architecture", "User interfaces", "Virtual reality", "Human factors engineering", "Man-computer interface", "health care", "physiotherapy", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "adults", "systematic", "exploring", "environments", "games"], "article_id"=>978118, "categories"=>["Biological Sciences"], "users"=>["Keith R. Lohse", "Courtney G. E. Hilderman", "Katharine L. Cheung", "Sandy Tatla", "H. F. Machiel Van der Loos"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0093318.s001", "https://dx.doi.org/10.1371/journal.pone.0093318.s002", "https://dx.doi.org/10.1371/journal.pone.0093318.s003", "https://dx.doi.org/10.1371/journal.pone.0093318.s004"], "stats"=>{"downloads"=>9, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Virtual_Reality_Therapy_for_Adults_Post_Stroke_A_Systematic_Review_and_Meta_Analysis_Exploring_Virtual_Environments_and_Commercial_Games_in_Therapy_/978118", "title"=>"Virtual Reality Therapy for Adults Post-Stroke: A Systematic Review and Meta-Analysis Exploring Virtual Environments and Commercial Games in Therapy", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-03-28 02:47:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/1439898"], "description"=>"<p>Note. A \"1\" indicates that a study met that particular criterion, a \"0\" indicates that a study did not meet that criterion or that not enough information was given to make an assessment. C1  =  Eligibility criteria were specified; C2  =  Participants were randomly allocated to groups; C3  =  Treatment allocation was concealed; C4  =  Groups were similar at baseline; C5  =  Blinding of participants; C6  =  Blinding of therapists administering treatment; C7  =  Blinding of assessors for outcome measures; C8  =  Measurement of key outcome from >85% of participants; C9  =  Intention to treat analysis; C10  =  Between-groups statistical comparison is reported for key outcome; C11  =  Measures of central tendency and variability are provided. As per PEDro guidelines, the \"total\" score is based on C2 through C11.</p>", "links"=>[], "tags"=>["Computer architecture", "User interfaces", "Virtual reality", "Human factors engineering", "Man-computer interface", "health care", "physiotherapy", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "pedro"], "article_id"=>978115, "categories"=>["Biological Sciences"], "users"=>["Keith R. Lohse", "Courtney G. E. Hilderman", "Katharine L. Cheung", "Sandy Tatla", "H. F. Machiel Van der Loos"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0093318.t002", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Studies_that_meet_the_criteria_of_the_PEDro_scale_/978115", "title"=>"Studies that meet the criteria of the PEDro scale.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-03-28 02:47:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/1439897"], "description"=>"<p>Abbreviations: ACT, activity; ARAT, Action Research Arm Test; BBA, Brunel Balance Assessment; BBS, Berg Balance Scale; BBT, Box and Block Test; BF, body function; CAHAI, Chedoke Arm and Hand Activity Inventory; CG, commercial gaming; CT, conventional therapy; FES, Functional Electrical Stimulation; FIM, Functional Independence Measure; FMA, Fugl-Meyer Assessment; ICF, International Classification of Function, Disability, and Health; JTHF, Jebsen-Taylor Hand Function Test; MBI, Modified Barthel Index; MFT, Manual Function Test; MMAS, Modified Motor Assessment Scale; MSS, Motor Status Scale; MVPT, Motor-free Visual Perception Test; OT, occupational therapy; PART, participation; PASS, Postural Assessment Scale; PT, physiotherapy; RA, robotic assisted therapy; RPSS, Reaching Performance for Stroke Scale; SIS, Stroke Impact Scale; SLP, speech and language therapy; TUG, Time Up-and-Go test; UL, upper limb; VE, virtual environments; VR, virtual reality; WMFT, Wolf Motor Function Test; 10mWT, 10-metre Walk Test.</p><p>*  =  control group was not matched for time to the experimental group.</p>", "links"=>[], "tags"=>["Computer architecture", "User interfaces", "Virtual reality", "Human factors engineering", "Man-computer interface", "health care", "physiotherapy", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "trials", "comparing", "adults"], "article_id"=>978114, "categories"=>["Biological Sciences"], "users"=>["Keith R. Lohse", "Courtney G. E. Hilderman", "Katharine L. Cheung", "Sandy Tatla", "H. F. Machiel Van der Loos"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0093318.t001", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_trials_comparing_virtual_reality_therapy_to_conventional_therapy_in_adults_post_stroke_/978114", "title"=>"Characteristics of trials comparing virtual reality therapy to conventional therapy in adults post-stroke.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-03-28 02:47:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/1439892"], "description"=>"<p>The funnel plot (top) for body function outcomes showing effect-sizes (G) as a function of precision (standard error) in each virtual environment study. The forest plot (bottom) showing the effect-sizes and 95% confidence intervals for each study and the summary effect-size from the random-effects model. Positive values show a difference in favour of VE therapy. Negative values show a difference in favour of CT. Abbreviations: VE, virtual environments; RE, random effects.</p>", "links"=>[], "tags"=>["Computer architecture", "User interfaces", "Virtual reality", "Human factors engineering", "Man-computer interface", "health care", "physiotherapy", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "outcomes", "ve"], "article_id"=>978109, "categories"=>["Biological Sciences"], "users"=>["Keith R. Lohse", "Courtney G. E. Hilderman", "Katharine L. Cheung", "Sandy Tatla", "H. F. Machiel Van der Loos"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0093318.g002", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Body_function_outcomes_in_VE_studies_/978109", "title"=>"Body function outcomes in VE studies.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-03-28 02:47:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/1439891"], "description"=>"<p>Four-phase PRISMA flow-diagram for study collection <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0093318#pone.0093318-Moher1\" target=\"_blank\">[24]</a>, showing the number of studies identified, screened, eligible, and included in the review and analysis.</p>", "links"=>[], "tags"=>["Computer architecture", "User interfaces", "Virtual reality", "Human factors engineering", "Man-computer interface", "health care", "physiotherapy", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews"], "article_id"=>978108, "categories"=>["Biological Sciences"], "users"=>["Keith R. Lohse", "Courtney G. E. Hilderman", "Katharine L. Cheung", "Sandy Tatla", "H. F. Machiel Van der Loos"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0093318.g001", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Screening_of_articles_/978108", "title"=>"Screening of articles.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-03-28 02:47:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/1439899"], "description"=>"<p>Note. Time scheduled for the VR intervention is given as (min/day) * (days/week) * (weeks)  =  total time in minutes. NR  =  ‘not reported’.</p>†<p> =  this study did not report an average time post-stroke, so the minimum time was used instead.</p>‡<p> =  control group was not matched for time to the experimental group.</p>", "links"=>[], "tags"=>["Computer architecture", "User interfaces", "Virtual reality", "Human factors engineering", "Man-computer interface", "health care", "physiotherapy", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "included"], "article_id"=>978116, "categories"=>["Biological Sciences"], "users"=>["Keith R. Lohse", "Courtney G. E. Hilderman", "Katharine L. Cheung", "Sandy Tatla", "H. F. Machiel Van der Loos"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0093318.t003", "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Demographic_statistics_for_the_included_studies_/978116", "title"=>"Demographic statistics for the included studies.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-03-28 02:47:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/1439896"], "description"=>"<p>The funnel plot (top) for participation outcomes showing effect-sizes (G) as a function of precision (standard error) in each study. The forest plot (bottom) shows the effect-sizes and 95% confidence intervals for each study and the summary effect-size from the random-effects model. Positive values show a difference in favour of VE therapy. Negative values show a difference in favour of CT. Abbreviations: VE, virtual environments; RE, random effects.</p>", "links"=>[], "tags"=>["Computer architecture", "User interfaces", "Virtual reality", "Human factors engineering", "Man-computer interface", "health care", "physiotherapy", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "outcomes", "ve"], "article_id"=>978113, "categories"=>["Biological Sciences"], "users"=>["Keith R. Lohse", "Courtney G. E. Hilderman", "Katharine L. Cheung", "Sandy Tatla", "H. F. Machiel Van der Loos"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0093318.g006", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Participation_outcomes_in_VE_studies_/978113", "title"=>"Participation outcomes in VE studies.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-03-28 02:47:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/1439894"], "description"=>"<p>The funnel plot (top) for activity outcomes showing effect-sizes (G) as a function of precision (standard error) in each virtual environment study. The forest plot (bottom) shows the effect-sizes and 95% confidence intervals for each study and the summary effect-size from the random-effects model. Positive values show a difference in favour of VE therapy. Negative values show a difference in favour of CT. Abbreviations: RE, random effects.</p>", "links"=>[], "tags"=>["Computer architecture", "User interfaces", "Virtual reality", "Human factors engineering", "Man-computer interface", "health care", "physiotherapy", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "outcomes", "ve"], "article_id"=>978111, "categories"=>["Biological Sciences"], "users"=>["Keith R. Lohse", "Courtney G. E. Hilderman", "Katharine L. Cheung", "Sandy Tatla", "H. F. Machiel Van der Loos"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0093318.g004", "stats"=>{"downloads"=>2, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Activity_outcomes_in_VE_studies_/978111", "title"=>"Activity outcomes in VE studies.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-03-28 02:47:59"}

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