Kim Dockx, Esther Mj Bekkers, Veerle Van den Bergh, Pieter Ginis, Lynn Rochester, Jeffrey M Hausdorff, Anat Mirelman, Alice Nieuwboer
Overview
Parkinson’s disease (PD) is a neurodegenerative condition that is best treated with medication and regular physiotherapy. Virtual reality rehabilitation is proposed as a new tool with potential added value over traditional physiotherapy methods in this context. Potentially it optimizes motor learning in a safe environment, and by replicating real-life scenarios, it could improve functional daily living activities.
Objectives:
This review aimed to summarize the best evidence for the effectiveness of virtual reality rehabilitation interventions for people with Parkinson’s disease when compared to 1) active interventions, and 2) passive interventions. Our primary objective was to assess the effect of virtual reality rehabilitation training on gait and balance. As a secondary goal, the researchers investigated the effect of virtual reality rehabilitation on global motor function, activities of daily living, quality of life, cognitive function, exercise adherence, and adverse events.
Search methods:
Our search for relevant articles included electronic searches of Cochrane Movement Disorders Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, Embase, CINAHL, the Physiotherapy Evidence Database (PEDro), online trials registers, and by hand-searching references. All searches were conducted up until 26 November 2016.
Selection criteria:
VR exercise interventions in people with PD were reviewed in randomised and quasi-randomised controlled trials. We only included trials that focused primarily on motor rehabilitation.
Data collection and analysis. Separately, two review authors searched for trials that met the predefined inclusion criteria. Every trial’s methodological quality was assessed independently by both reviewers. Conflict resolution was handled by a third reviewer when necessary.
Main results:
263 people with Parkinson’s disease were involved in 8 trials included in the review. For all but one of the included studies, the risk of bias was unclear or high. There were small study sample sizes and considerable heterogeneity between trials in terms of study design and outcome measures. Therefore, we graded the quality of the evidence as low or very low. Most of the studies compared commercially available devices with physiotherapy to improve motor function. Treatments typically lasted four to twelve weeks.
As compared to physiotherapy, VR may result in a moderate improvement in step and stride length (standardised mean difference (SMD) 0.69, 95% confidence interval (CI) 0.30 to 1.08; 3 studies; 106 participants; low‐quality evidence).VR and physiotherapy interventions may have similar effects on gait (SMD 0.20, 95% CI ‐0.14 to 0.55; 4 studies; 129 participants; low‐quality evidence), balance (SMD 0.34, 95% CI ‐0.04 to 0.71; 5 studies; 155 participants; low‐quality evidence), and quality of life (mean difference 3.73 units, 95% CI ‐2.16 to 9.61; 4 studies; 106 participants).
There were no reported adverse events associated with VR interventions, and exercise adherence was similar between VR and other intervention groups. There is less evidence available comparing VR exercise to passive control. Due to the very small sample sizes of the two studies available for this comparison, the evidence for the main outcomes of interest was very low quality.
Conclusions:
The effect of short-term VR exercise on step and stride length was found to be of low-quality. Both VR and physiotherapy may improve gait, balance, and quality of life. Comparing VR to passive control interventions has been less investigated. Further large-scale, high-quality studies are needed to confirm these findings.
The V-TIME academic research project that has led to many of these papers is implemented commercially by GaitBetter.