La rehabilitación física y sus avances con realidad virtual: una revisión sistemática (Physical rehabilitation and its advances with virtual reality: a systematic review)

Autores/as

DOI:

https://doi.org/10.47197/retos.v60.109195

Palabras clave:

Realidad virtual, Rehabilitación física, Función motora, Eficacia terapéutica, Innovación tecnológica

Resumen

La rehabilitación física (RF) es crucial para tratar y recuperar a pacientes con discapacidades motoras causadas por condiciones como accidentes cerebrovasculares y lesiones musculoesqueléticas. Las técnicas convencionales de RF tienen limitaciones en accesibilidad, motivación del paciente y personalización del tratamiento. La realidad virtual (RV) ha emergido como una herramienta prometedora que puede transformar la RF mediante la creación de entornos inmersivos y personalizados, incrementando la motivación del paciente y proporcionando datos precisos sobre su progreso.

Este estudio se realizó como una revisión sistemática de la literatura reciente (2015-2023) para evaluar la eficacia de la RV en la RF. Se siguieron las directrices PRISMA, abarcando estudios controlados aleatorizados y ensayos clínicos en Scopus y PubMed. Los análisis incluyeron la Escala de Jadad para evaluar la calidad metodológica, la herramienta Cochrane para el riesgo de sesgo y GRADE para la calidad de la evidencia. La guía de JAMA se aplicó a estudios observacionales para evaluar la validez interna y externa.

Los resultados mostraron que la RV mejora significativamente la función motora, flexibilidad, coordinación, movilidad y calidad de vida comparada con la rehabilitación convencional. La mayoría de los estudios obtuvo altas puntuaciones en la Escala de Jadad y una calidad moderada a alta según GRADE, indicando solidez en la evidencia. Sin embargo, se identificaron limitaciones como la heterogeneidad de los estudios y la falta de cegamiento. Se concluye que la RV tiene el potencial de revolucionar la RF, mejorando los resultados terapéuticos y la calidad de vida de los pacientes.

Palabras clave: Realidad virtual, Rehabilitación física, Función motora, Eficacia terapéutica, Innovación tecnológica

Abstract. Physical rehabilitation (PR) is crucial to treat and recover patients with motor disabilities caused by conditions such as stroke and musculoskeletal injuries. Conventional PR techniques have limitations in accessibility, patient motivation, and treatment customization. Virtual reality (VR) has emerged as a promising tool that can transform PR by creating immersive and personalized environments, increasing patient motivation, and providing accurate data on their progress.

This study was conducted as a systematic review of recent literature (2015-2023) to assess the efficacy of VR in PR. PRISMA guidelines were followed, covering randomized controlled studies and clinical trials in Scopus and PubMed. Analyses included the Jadad Scale to assess methodological quality, the Cochrane tool for risk of bias, and GRADE for quality of evidence. The JAMA guideline was applied to observational studies to assess internal and external validity.

The results showed that VR significantly improves motor function, flexibility, coordination, mobility and quality of life compared to conventional rehabilitation. Most studies obtained high scores on the Jadad Scale and moderate to high quality according to GRADE, indicating strength of evidence. However, limitations such as heterogeneity of the studies and lack of blinding were identified. It is concluded that VR has the potential to revolutionize RF, improving therapeutic outcomes and quality of life of patients.

Keywords: Virtual reality, Physical rehabilitation, Motor function, Therapeutic efficacy, Technological innovation

Biografía del autor/a

Roberto Carlos Dávila-Morán , Universidad Continental (UC)

Ingeniero industrial y magíster en gerencia de la calidad y desarrollo humano, posee una amplia experiencia que le ha permitido participar en diversos proyectos de investigación de carácter multidisciplinario. Además, ha publicado varios artículos en revistas científicas indexadas a nivel internacional. Su capacidad para desarrollar investigaciones rigurosas, combinada con su conocimiento y experiencia en el ámbito de la ingeniería industrial, le permite realizar aportes significativos en el campo de la investigacion. En su trabajo de investigación, se destaca por su habilidad para identificar los problemas y oportunidades de mejora proponiendo soluciones innovadoras y efectivas para optimizar su desempeño. Su compromiso y dedicación en cada proyecto, sumado a su capacidad para trabajar en equipo, hacen de él un profesional altamente valorado en el ámbito académico y empresarial.

Citas

Adamovich, S. V., Fluet, G. G., Tunik, E., & Merians, A. S. (2009). Sensorimotor training in virtual reality: A re-view. NeuroRehabilitation, 25(1), 29-44. https://doi.org/10.3233/NRE-2009-0497

Arnoni, J. L. B., Kleiner, A. F. R., Lima, C. R. G., de Campos, A. C., & Rocha, N. A. C. F. (2021). Nonimmersive Virtual Reality as Complementary Rehabilitation on Functional Mobility and Gait in Cerebral Palsy: A Randomized Controlled Clinical Trial. Games for Health Journal, 10(4), 254-263. https://doi.org/10.1089/g4h.2021.0009

Bisson, E., Contant, B., Sveistrup, H., & Lajoie., Y. (2007). Functional Balance and Dual-Task Reaction Times in Older Adults Are Improved by Virtual Reality and Biofeedback Training. CyberPsychology & Behavior, 10(1), 16-23. https://doi.org/10.1089/cpb.2006.9997

Brox, E., Fernandez-Luque, L., Evertsen, G., & González-Hernández, J. (2011). Exergames For Elderly: Social exer-games to persuade seniors to increase physical activity. Proceedings of the 5th International ICST Conference on Pervasive Computing Technologies for Healthcare. 5th International ICST Conference on Pervasive Computing Technologies for Healthcare, Dublin, Republic of Ireland. https://doi.org/10.4108/icst.pervasivehealth.2011.246049

Burdea, G. C. (2003). Virtual rehabilitation—Benefits and challenges. Methods of Information in Medicine, 42(5), 519-523.

Cameron, M. H. (2012). Physical Agents in Rehabilitation: From Research to Practice. Elsevier Health Sciences.

Campo-Prieto, P., Cancela-Carral, J. M., Alsina-Rey, B., & Rodríguez-Fuentes, G. (2022). Immersive Virtual Reality as a Novel Physical Therapy Approach for Nonagenarians: Usability and Effects on Balance Outcomes of a Game-Based Exercise Program. Journal of Clinical Medicine, 11(13), 3911. https://doi.org/10.3390/jcm11133911

Campo-Prieto, P., Cancela-Carral, J. M., & Rodríguez-Fuentes, G. (2022). Wearable Immersive Virtual Reality Device for Promoting Physical Activity in Parkinson’s Disease Patients. Sensors, 22(9), 3302. https://doi.org/10.3390/s22093302

Chang, Y.-J., Chen, S.-F., & Huang, J.-D. (2011). A Kinect-based system for physical rehabilitation: A pilot study for young adults with motor disabilities. Research in Developmental Disabilities, 32(6), 2566-2570. https://doi.org/10.1016/j.ridd.2011.07.002

Choukou, M.-A., He, E., & Moslenko, K. (2023). Feasibility of a Virtual-Reality-Enabled At-Home Telerehabilitation Program for Stroke Survivors: A Case Study. Journal of Personalized Medicine, 13(8), 1230. https://doi.org/10.3390/jpm13081230

Corbetta, D., Imeri, F., & Gatti, R. (2015). Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: A systematic review. Journal of Physio-therapy, 61(3), 117-124. https://doi.org/10.1016/j.jphys.2015.05.017

Crosbie, J. H., Lennon, S., Basford, J. R., & McDonough, S. M. (2007). Virtual reality in stroke rehabilitation: Still more virtual than real. Disability and Rehabilitation, 29(14), 1139-1146. https://doi.org/10.1080/09638280600960909

Cruz-Neira, C., Sandin, D. J., & DeFanti, T. A. (1993). Surround-screen projection-based virtual reality: The design and implementation of the CAVE. Proceedings of the 20th Annual Conference on Computer Graphics and Interactive Tech-niques, 135-142. https://doi.org/10.1145/166117.166134

DeLisa, J. A., & Gans, B. M. (1998). Rehabilitation Medicine: Principles and Practice. Lippincott-Raven.

Feng, H., Li, C., Liu, J., Wang, L., Ma, J., Li, G., ... Wu, Z. (2019). Virtual Reality Rehabilitation Versus Conventional Physical Therapy for Improving Balance and Gait in Parkinson’s Disease Patients: A Randomized Controlled Trial. Medical Science Monitor, 25, 4186-4192. https://doi.org/10.12659/MSM.916455

Garay-Sánchez, A., Marcén-Román, Y., Ferrando-Margelí, M., Franco-Sierra, M. Á., & Suarez-Serrano, C. (2023). Effect of Physiotherapy Treatment with Immersive Virtual Reality in Subjects with Stroke: A Protocol for a Random-ized Controlled Trial. Healthcare, 11(9), 1335. https://doi.org/10.3390/healthcare11091335

Gouveia, É. R., Campos, P., França, C. S., Rodrigues, L. M., Martins, F., França, C., ... Gouveia, B. R. (2023). Virtual Reality Gaming in Rehabilitation after Musculoskeletal Injury—User Experience Pilot Study. Applied Sciences, 13(4), 2523. https://doi.org/10.3390/app13042523

Holden, M. K. (2005). Virtual Environments for Motor Rehabilitation: Review. CyberPsychology & Behavior, 8(3), 187-211. https://doi.org/10.1089/cpb.2005.8.187

Ikbali Afsar, S., Mirzayev, I., Umit Yemisci, O., & Cosar Saracgil, S. N. (2018). Virtual Reality in Upper Extremity Rehabilitation of Stroke Patients: A Randomized Controlled Trial. Journal of Stroke and Cerebrovascular Diseases, 27(12), 3473-3478. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.08.007

Kashif, M., Ahmad, A., Bandpei, M. A. M., Gilani, S. A., Hanif, A., & Iram, H. (2022). Combined effects of virtual reality techniques and motor imagery on balance, motor function and activities of daily living in patients with Parkin-son’s disease: A randomized controlled trial. BMC Geriatrics, 22(1), 381. https://doi.org/10.1186/s12877-022-03035-1

Kayes, N. M., McPherson, K. M., Taylor, D., Schlüter, P. J., & Kolt, G. S. (2011). Facilitators and barriers to engage-ment in physical activity for people with multiple sclerosis: A qualitative investigation. Disability and Rehabilita-tion, 33(8), 625-642. https://doi.org/10.3109/09638288.2010.505992

Keshner, E. A. (2004). Virtual reality and physical rehabilitation: A new toy or a new research and rehabilitation tool? Journal of NeuroEngineering and Rehabilitation, 1(1), 8. https://doi.org/10.1186/1743-0003-1-8

Laver, K. E., Adey-Wakeling, Z., Crotty, M., Lannin, N. A., George, S., & Sherrington, C. (2020). Telerehabilitation services for stroke. Cochrane Database of Systematic Re-views, 2020(1). https://doi.org/10.1002/14651858.CD010255.pub3

Laver, K. E., Lange, B., George, S., Deutsch, J. E., Saposnik, G., & Crotty, M. (2017). Virtual reality for stroke rehabil-itation. Cochrane Database of Systematic Reviews, 2018(1). https://doi.org/10.1002/14651858.CD008349.pub4

Laver, K., George, S., Thomas, S., Deutsch, J. E., & Crotty, M. (2012). Cochrane review: Virtual reality for stroke rehabilitation. European Journal of Physical and Rehabilitation Medicine, 48(3), 523-530.

Lee, J.-A., Kim, J.-G., & Kweon, H. (2023). A Study on Rehabilitation Specialists’ Perception of Experience with a Virtual Reality Program. Healthcare, 11(6), 814. https://doi.org/10.3390/healthcare11060814

Liao, Y.-Y., Tseng, H.-Y., Lin, Y.-J., Wang, C.-J., & Hsu, W.-C. (2020). Using virtual reality-based training to improve cognitive function, instrumental activities of daily living and neural efficiency in older adults with mild cognitive im-pairment. European Journal of Physical and Rehabilitation Medicine, 56(1). https://doi.org/10.23736/S1973-9087.19.05899-4

Liepert, J., Bauder, H., Miltner, W. H. R., Taub, E., & Weiller, C. (2000). Treatment-Induced Cortical Reorganization After Stroke in Humans. Stroke, 31(6), 1210-1216. https://doi.org/10.1161/01.STR.31.6.1210

Lloréns, R., Noé, E., Colomer, C., & Alcañiz, M. (2015). Effectiveness, Usability, and Cost-Benefit of a Virtual Reality–Based Telerehabilitation Program for Balance Recovery After Stroke: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 96(3), 418-425.e2. https://doi.org/10.1016/j.apmr.2014.10.019

Lohse, K. R., Hilderman, C. G. E., Cheung, K. L., Tatla, S., Van Der Loos, H. F. M. (2014). Virtual Reality Therapy for Adults Post-Stroke: A Systematic Review and Meta-Analysis Exploring Virtual Environments and Commercial Games in Therapy. PLoS ONE, 9(3), e93318. https://doi.org/10.1371/journal.pone.0093318

Lohse, K. R., Lang, C. E., & Boyd, K. A. (2013). Using meta-data to explore dose-response relationships in stroke ther-apy. Journal of Exercise, Movement, and Sport (SCAPPS Refereed Abstracts Repository), 45(1), Article 1. https://www.scapps.org/jems/index.php/1/article/view/584

Lu, Y., Ge, Y., Chen, W., Xing, W., Wei, L., Zhang, C., ... Yang, Y. (2022). The effectiveness of virtual reality for rehabilitation of Parkinson disease: An overview of systematic reviews with meta-analyses. Systematic Reviews, 11(1), 50. https://doi.org/10.1186/s13643-022-01924-5

Maranesi, E., Casoni, E., Baldoni, R., Barboni, I., Rinaldi, N., Tramontana, B., ... Bevilacqua, R. (2022). The Effect of Non-Immersive Virtual Reality Exergames versus Traditional Physiotherapy in Parkinson’s Disease Older Patients: Preliminary Results from a Randomized-Controlled Trial. International Journal of Environmental Research and Pub-lic Health, 19(22), 14818. https://doi.org/10.3390/ijerph192214818

Maskeliūnas, R., Damaševičius, R., Blažauskas, T., Canbulut, C., Adomavičienė, A., & Griškevičius, J. (2023). Bioma-cVR: A Virtual Reality-Based System for Precise Human Posture and Motion Analysis in Rehabilitation Exercises Us-ing Depth Sensors. Electronics, 12(2), 339. https://doi.org/10.3390/electronics12020339

Mirich, R., Kyvelidou, A., & Greiner, B. S. (2021). The Effects of Virtual Reality Based Rehabilitation on Upper Ex-tremity Function in a Child with Cerebral Palsy: A Case Report. Physical & Occupational Therapy In Pediatrics, 41(6), 620-636. https://doi.org/10.1080/01942638.2021.1909688

Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097

Parsons, T. D. (2015). Virtual Reality for Enhanced Ecological Validity and Experimental Control in the Clinical, Affec-tive and Social Neurosciences. Frontiers in Human Neuroscience, 9. https://doi.org/10.3389/fnhum.2015.00660

Paul, R., Elango, S., Chakravarthy, S., Sinha, A., P R, S., Raju, B., ... Sylaja, P. N. (2024). Feasibility and efficacy of virtual reality rehabilitation compared with conventional physiotherapy for upper extremity impairment due to is-chaemic stroke: Protocol for a randomised controlled trial. BMJ Open, 14(7), e086556. https://doi.org/10.1136/bmjopen-2024-086556

Pazzaglia, C., Imbimbo, I., Tranchita, E., Minganti, C., Ricciardi, D., Lo Monaco, R., Parisi, A., & Padua, L. (2020). Comparison of virtual reality rehabilitation and conventional rehabilitation in Parkinson’s disease: A randomised con-trolled trial. Physiotherapy, 106, 36-42. https://doi.org/10.1016/j.physio.2019.12.007

Pérez, V. Z., Yepes, J. C., Vargas, J. F., Franco, J. C., Escobar, N. I., Betancur, L., ... Betancur, M. J. (2022). Virtual Reality Game for Physical and Emotional Rehabilitation of Landmine Victims. Sensors, 22(15), 5602. https://doi.org/10.3390/s22155602

Phu, S., Vogrin, S., Al Saedi, A., & Duque, G. (2019). Balance training using virtual reality improves balance and physi-cal performance in older adults at high risk of falls. Clinical Interventions in Aging, Volume 14, 1567-1577. https://doi.org/10.2147/CIA.S220890

Pichierri, G., Murer, K., & De Bruin, E. D. (2012). A cognitive-motor intervention using a dance video game to en-hance foot placement accuracy and gait under dual task conditions in older adults: A randomized controlled trial. BMC Geriatrics, 12(1), 74. https://doi.org/10.1186/1471-2318-12-74

Rizzo, A. A., & Buckwalter, J. G. (1997). Virtual reality and cognitive assessment and rehabilitation: The state of the art. Studies in Health Technology and Informatics, 44, 123-145.

Rogers, J. M., Duckworth, J., Middleton, S., Steenbergen, B., & Wilson, P. H. (2019). Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: Evidence from a randomized controlled pilot study. Journal of NeuroEngineering and Rehabilitation, 16(1), 56. https://doi.org/10.1186/s12984-019-0531-y

Rutkowski, S., Rutkowska, A., Kiper, P., Jastrzebski, D., Racheniuk, H., Turolla, A., ... Casaburi, R. (2020). Virtual Reality Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. In-ternational Journal of Chronic Obstructive Pulmonary Disease, Volume 15, 117-124. https://doi.org/10.2147/COPD.S223592

Sadeghi, H., Jehu, D. A., Daneshjoo, A., Shakoor, E., Razeghi, M., Amani, A., ... Yusof, A. (2021). Effects of 8 Weeks of Balance Training, Virtual Reality Training, and Combined Exercise on Lower Limb Muscle Strength, Balance, and Functional Mobility Among Older Men: A Randomized Controlled Trial. Sports Health: A Multidisciplinary Ap-proach, 13(6), 606-612. https://doi.org/10.1177/1941738120986803

Saposnik, G., Levin, M., & for the Stroke Outcome Research Canada (SORCan) Working Group. (2011). Virtual Reali-ty in Stroke Rehabilitation: A Meta-Analysis and Implications for Clinicians. Stroke, 42(5), 1380-1386. https://doi.org/10.1161/STROKEAHA.110.605451

Seel, T., Raisch, J., & Schauer, T. (2014). IMU-Based Joint Angle Measurement for Gait Analysis. Sensors, 14(4), 6891-6909. https://doi.org/10.3390/s140406891

Sip, P., Kozłowska, M., Czysz, D., Daroszewski, P., & Lisiński, P. (2023). Perspectives of Motor Functional Upper Extremity Recovery with the Use of Immersive Virtual Reality in Stroke Patients. Sensors, 23(2), 712. https://doi.org/10.3390/s23020712

Slater, M. (2009). Place illusion and plausibility can lead to realistic behaviour in immersive virtual environ-ments. Philosophical Transactions of the Royal Society B: Biological Sciences, 364(1535), 3549-3557. https://doi.org/10.1098/rstb.2009.0138

Tao, W., Liu, T., Zheng, R., & Feng, H. (2012). Gait Analysis Using Wearable Sensors. Sensors, 12(2), 2255-2283. https://doi.org/10.3390/s120202255

Tokgöz, P., Wähnert, D., Elsner, A., Schack, T., Cienfuegos Tellez, M. A., Conrad, J., ... Dockweiler, C. (2023). Virtual Reality for Upper Extremity Rehabilitation—A Prospective Pilot Study. Healthcare, 11(10), 1498. https://doi.org/10.3390/healthcare11101498

Webster, D., & Celik, O. (2014). Systematic review of Kinect applications in elderly care and stroke rehabilita-tion. Journal of NeuroEngineering and Rehabilitation, 11(1), 108. https://doi.org/10.1186/1743-0003-11-108

You, S. H., Jang, S. H., Kim, Y.-H., Hallett, M., Ahn, S. H., Kwon, Y.-H., ... Lee, M. Y. (2005). Virtual Reality–Induced Cortical Reorganization and Associated Locomotor Recovery in Chronic Stroke: An Experimenter-Blind Randomized Study. Stroke, 36(6), 1166-1171. https://doi.org/10.1161/01.STR.0000162715.43417.91

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2024-10-02

Cómo citar

Dávila-Morán, R. C. (2024). La rehabilitación física y sus avances con realidad virtual: una revisión sistemática (Physical rehabilitation and its advances with virtual reality: a systematic review). Retos, 60, 467–476. https://doi.org/10.47197/retos.v60.109195

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Revisiones teóricas sistemáticas y/o metaanálisis

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