Junior Vitorino Fandim1, Bruno Tirotti Saragiotto2, Gustavo José Martiniano Porfírio3, Renato Figueiredo Santana4. 1. Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil. Electronic address: junior_fandim@hotmail.com. 2. Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil. 3. Faculty of Medicine, Universidade Municipal de São Caetano do Sul, São Caetano do Sul, SP, Brazil. 4. Physical Therapy Department, Universidade Cidade de São Paulo, São Paulo, SP, Brazil.
Abstract
BACKGROUND: Cerebral palsy (CP) is one of the main causes of disability in childhood. Virtual reality (VR) has been used as a treatment option in this population, however its effectiveness is unclear. OBJECTIVE: To evaluate the effectiveness of VR in patients with CP. METHODS: We conducted electronic searches in EMBASE, MEDLINE, Cochrane library, PEDro, AMED, PsycoINFO, and LILACS databases and trial site registries such as ClinicalTrials.gov and ICTRP. We included randomized controlled trials that tested the use of VR alone or in combination with other interventions compared to more conventional rehabilitation or usual care in individuals with CP. The primary outcomes were upper and lower limb function, postural control, and balance. The secondary outcomes included global motor function, perception, cognition and spatial functions, motivation, motor learning, and adverse events. Two independent reviewers extracted and assessed included articles for risk of bias using the Cochrane risk of bias tool. We use a meta-analysis with random effect model whenever possible. We analyzed the quality of evidence using theGRADE approach. RESULTS: We included 38 trials (pooled n = 1233 participants) in this review. There is very low quality of evidence that VR plus conventional rehabilitation is better than conventional rehabilitation for upper limb function. There is also very low quality evidence that VR alone is no better than conventional rehabilitation for upper and lower limb function. No adverse events were observed among the 10 trials that provided information on this outcome. CONCLUSION: At present we have very limited to limited confidence in effect estimation for utilization of VR in this population. Future studies may change our confidence in results and effect estimates. PROTOCOL REGISTRATION: PROSPERO CRD 42018102759.
BACKGROUND: Cerebral palsy (CP) is one of the main causes of disability in childhood. Virtual reality (VR) has been used as a treatment option in this population, however its effectiveness is unclear. OBJECTIVE: To evaluate the effectiveness of VR in patients with CP. METHODS: We conducted electronic searches in EMBASE, MEDLINE, Cochrane library, PEDro, AMED, PsycoINFO, and LILACS databases and trial site registries such as ClinicalTrials.gov and ICTRP. We included randomized controlled trials that tested the use of VR alone or in combination with other interventions compared to more conventional rehabilitation or usual care in individuals with CP. The primary outcomes were upper and lower limb function, postural control, and balance. The secondary outcomes included global motor function, perception, cognition and spatial functions, motivation, motor learning, and adverse events. Two independent reviewers extracted and assessed included articles for risk of bias using the Cochrane risk of bias tool. We use a meta-analysis with random effect model whenever possible. We analyzed the quality of evidence using theGRADE approach. RESULTS: We included 38 trials (pooled n = 1233 participants) in this review. There is very low quality of evidence that VR plus conventional rehabilitation is better than conventional rehabilitation for upper limb function. There is also very low quality evidence that VR alone is no better than conventional rehabilitation for upper and lower limb function. No adverse events were observed among the 10 trials that provided information on this outcome. CONCLUSION: At present we have very limited to limited confidence in effect estimation for utilization of VR in this population. Future studies may change our confidence in results and effect estimates. PROTOCOL REGISTRATION: PROSPERO CRD 42018102759.
Authors: Catherine E Lang; Jillian R Macdonald; Darcy S Reisman; Lara Boyd; Teresa Jacobson Kimberley; Sheila M Schindler-Ivens; T George Hornby; Sandy A Ross; Patricia L Scheets Journal: Arch Phys Med Rehabil Date: 2009-10 Impact factor: 3.966
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