Physical rehabilitation and its advances with virtual reality: a systematic review
DOI:
https://doi.org/10.47197/retos.v60.109195Keywords:
Virtual reality, Physical rehabilitation, Motor function, Therapeutic efficacy, Technological innovationAbstract
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
References
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
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Retos
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.