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Effectiveness of virtual reality in children and young adults with cerebral palsy: a systematic review of randomized controlled trial
Brazilian Journal of Physical Therapy ( IF 3.4 ) Pub Date : 2020-12-05 , DOI: 10.1016/j.bjpt.2020.11.003
Junior Vitorino Fandim 1 , Bruno Tirotti Saragiotto 1 , Gustavo José Martiniano Porfírio 2 , Renato Figueiredo Santana 3
Affiliation  

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.



中文翻译:

虚拟现实对脑瘫儿童和青少年的有效性:随机对照试验的系统评价

背景

脑瘫(CP)是导致儿童残疾的主要原因之一。虚拟现实(VR)已被用作该人群的一种治疗选择,但其有效性尚不清楚。

客观的

评估 VR 对 CP 患者的有效性。

方法

我们在 EMBASE、MEDLINE、Cochrane 图书馆、PEDro、AMED、PsycoINFO 和 LILACS 数据库以及临床试验注册中心(例如 ClinicalTrials.gov 和 ICTRP)中进行了电子检索。我们纳入了随机对照试验,测试单独使用 VR 或与其他干预措施相结合,与脑瘫患者的更传统康复或常规护理进行比较。主要结果是上肢和下肢功能、姿势控制和平衡。次要结果包括整体运动功能、感知、认知和空间功能、动机、运动学习和不良事件。两名独立审稿人使用 Cochrane 偏倚风险工具提取并评估了纳入的文章的偏倚风险。我们尽可能使用随机效应模型的荟萃分析。我们使用GRADE方法分析了证据的质量。

结果

我们在本次综述中纳入了 38 项试验(共有 1233 名参与者)。非常低质量的证据表明虚拟现实加传统康复对于上肢功能优于传统康复。还有非常低质量的证据表明,单独使用 VR 并不比传统的上肢和下肢功能康复更好。提供此结果信息的 10 项试验中未观察到不良事件。

结论

目前,我们对 VR 在这一人群中的应用效果评估的信心非常有限。未来的研究可能会改变我们对结果和效果估计的信心。

协议注册

普洛斯彼罗 CRD 42018102759。

更新日期:2020-12-05
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