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Effects of Virtual Reality Program on Recovery of Functional in individuals Stroke: A Systematic Review and Meta Analysis

뇌졸중 환자 대상의 가상현실 운동프로그램이 기능회복에 미치는 효과: 체계적 문헌고찰 및 메타분석

  • 박서아 (경북보건대학교 간호학과) ;
  • 김혜영 (계명대학교 간호학과)
  • Received : 2019.02.14
  • Accepted : 2019.05.20
  • Published : 2019.05.28

Abstract

This study was carried out to evaluate the efficacy of Virtual Reality(VR) program on recovery of functional in Stroke through systematic literature review and meta-analysis. The following databases were used to search the literature: RISS, KISS, KMbase. Keywords included 'stroke', 'CVA' 'virtual reality', 'rehabilitation', 'virtual reality program' and the evaluated articles were published from 2009 to November 2018. The statistical was used R program, the effect size of upper limb, balance and ADL were calculated by random-effects model. As a result, 9 RCT studies were meta-analyzed and were evaluated for the risk of bias by the RoB of Cochrane Collaboration; the overall risk of bias was low. The effect sizes of VR program was balance(g=.77), ADL(g=.80) as indicated by a "large effect size". Therefore, VR program is large effective in reducing balance and ADL in strokes. It is necessary to develop and apply a virtual reality-based program using more efficient program development.

본 연구는 뇌졸중 환자의 기능회복에 대한 가상현실 운동프로그램의 효과를 검증하기 위해 수행된 체계적 문헌고찰 및 메타분석 연구이다. 데이터베이스는 학술연구정보서비스(RISS), 한국학술정보(Korean studies Information Service System, KISS), 한국 의학논문데이터베이스(KMbase)를 활용하여 '뇌졸중', '뇌경색', '상지기능', '균형', '일상생활능력', '운동훈련', '운동중재' '재활' '가상현실', '가상현실 교육', '가상현실 프로그램'을 검색어로 최근 10년(2009년~2018년)간 문헌을 검토하였다. 분석은 R을 이용한 임의효과모형을 적용하여 상지기능, 균형과 일상생활능력의 효과 크기를 각각 산출하였다. 최종적으로는 RCT 9편을 분석하였다. 개별문헌은 Cochrane Collaboration의 RoB (Risk of Bias) 도구를 통해 비뚤림 위험을 평가하였으며, 전반적인 비뚤림 위험은 낮았다. 본 연구결과 균형에 대한 효과크기(g=.77), 일상생활 활동에 대한 효과크기(g=.80)로 "큰 효과크기"를 나타내었다. 따라서, 뇌졸중 환자의 균형과 일상생활능력 향상을 위한 가상현실 운동프로그램이 효과적임을 확인하게 되었다. 향후 가상현실 운동프로그램 이용한 보다 효과적인 프로그램 개발과 적용에 대한 연구가 필요하다고 생각된다.

Keywords

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Fig. 1. Flow diagram of study screening

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Fig. 2. Summary of Bias in Overall Trials

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Fig. 3. Forest plots of the effects of Virtual Reality program

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Fig. 4. Forest plots of the effects of Virtual Reality program by program type

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Fig. 5. Forest plots of the effects of Virtual Reality program by intervention time

Table 1. General characteristics of included studies

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References

  1. S. A. Sharp & B. J. Brouwer. (1997). Isokinetic strength training of the hemiparetic knee: effects on function and spasticity. Archives of physical medicine and rehabilitation, 78(11), 1231-1236. https://doi.org/10.1016/S0003-9993(97)90337-3
  2. P. W. Duncan, R. D. Horner, D. M. Reker, G. P. Samsa, H. Hoenig, B. Hamilton, J. Barbara, LaClair & T. K. Dudley. (2002). Adherence to postacute rehabilitation guidelines is associated with functional recovery in stroke. Stroke, 33(1), 167-178. https://doi.org/10.1161/hs0102.101014
  3. J. Hochstenbach, G. Prigatano & T. Mulder. (2005). Patients' and relatives' reports of disturbances 9 months after stroke: subjective changes in physical functioning, cognition, emotion, and behavior. Archives of physical medicine and rehabilitation, 86(8), 1587-1593. https://doi.org/10.1016/j.apmr.2004.11.050
  4. S. L. Wolf, P. A. Catlin, M. Ellis, A. L. Archer, B. Morgan & A. Piacentino. (2001). Assessing Wolf motor function test as outcome measure for research in patients after stroke. Stroke, 32(7), 1635-1639. https://doi.org/10.1161/01.STR.32.7.1635
  5. H. C. Dijkerman, M. Ietswaart, M. Johnston & R. S. MacWalter. (2004). Does motor imagery training improve hand function in chronic stroke patients? A pilot study. Clinical rehabilitation, 18(5), 538-549. https://doi.org/10.1191/0269215504cr769oa
  6. H. M. Kim. (2015). A study on the development of a force sensor and finger rehabilitation robot for stroke patients, Doctoral dissertation, Gyeon gsang University, Jinju.
  7. H. K. Shin. (2008). The recovery of hand function induced by EMG-triggered electrical stimulation in hemiplegic finger extensor. J Korean Soc Occup Ther, 16, 61-69.
  8. P. S. Buyn & M. Y. Chon. (2012). The effects of rehabilitation training using video game on improvement range of motion for upper-extremity, shoulder pain and stress in stroke patients with hemiplegia. Journal of muscle and joint health, 19(1), 46-56. https://doi.org/10.5953/JMJH.2012.19.1.046
  9. B. H. Lee, E. J. Chung & S. H. Lee. (2012). The effects of virtual reality-based with EMG triggered-functional electric stimulation on muscle tone and gait capability in stroke. J Rehabil Res Dev, 16, 361-378.
  10. P. C. Kung, C. C. K. Lin & M. S. Ju. (2010). Neuro-rehabilitation robot-assisted assessments of synergy patterns of forearm, elbow and shoulder joints in chronic stroke patients. Clinical Biomechanics, 25(7), 647-654. https://doi.org/10.1016/j.clinbiomech.2010.04.014
  11. C. R. Senesac, S. Davis & L. Richards. (2010). Generalization of a modified form of repetitive rhythmic bilateral training in stroke. Human movement science, 29(1), 137-148. https://doi.org/10.1016/j.humov.2009.05.004
  12. V. Sirtori, D. Corbetta, L. Moja & R. Gatti. (2009). Constraint-induced movement therapy for upper extremities in stroke patients. Cochrane Database Syst Rev, 4(4). https://doi.org/10.1002/14651858.CD004433.pub2
  13. G. Yavuzer, A. Senel, M. B. Atay & H. J. Stam. (2008). ''Playstation eyetoy games''improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial. European journal of physical and rehabilitation medicine, 44(3), 237-244.
  14. E. K. Kim, J. H. Kang & H. M. Lee. (2010). Effects of virtual reality based game on balance and upper extremity function in chronic stroke patients. Journal of Special Education & Rehabilitation Science, 49(3), 131-149.
  15. H. H. Kim, K. M. Kim & M. Y. Chang. (2012). Interventions to promote upper limb recovery in stroke patients: a systematic review. J Korean Soc Occup Ther, 129-145.
  16. Y. R. Yang, M. P. Tsai, T. Y. Chuang, W. H. Sung & R. Y. Wang. (2008). Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial. Gait & posture, 28(2), 201-206. https://doi.org/10.1016/j.gaitpost.2007.11.007
  17. A. A. Rizzo, J. G. Buckwalter & U. Neumann. (1997). Virtual reality and cognitive rehabilitation: A brief review of the future. The Journal of Head Trauma Rehabilitation. http://dx.doi.org/10.1097/00001199-199712000-00002
  18. C. Walker, B. J. Brouwer & E. G. Culham. (2000). Use of visual feedback in retraining balance following acute stroke. Physical therapy, 80(9), 886-895. https://doi.org/10.1093/ptj/80.9.886
  19. Y. Y. You, B. H. Lee, S. H. Kim, J. H. Jung & Y. H. Bae. (2011). The Effect of Stroke Patients Balance and Visual Perception for Interactive Games of Using Visual Concentration, Journal of Rehabilitation Research, 15(1), 1-17.
  20. J. H. Kim, S. H. Jang, C. S. Kim, J. H. Jung & J. H. You. (2009). Use of virtual reality to enhance balance and ambulation in chronic stroke: a double-blind, randomized controlled study. American Journal of physical medicine & rehabilitation, 88(9), 693-701. https://doi.org/10.1097/PHM.0b013e3181b33350
  21. J. H. Kim, M. H. Oh, J. S. Lee & H. S. Ahn. (2011). The effects of training using virtual reality games on stroke patients' functional recovery. J Korean Soc Occup Ther, 19, 101-114.
  22. H. G. Kim, M. Y. Lee & Y. A. Yang. (2018). Literature Research on the Clinical Effect of the Virtual Reality-based Rehabilitation Program. The Journal of Occupational Therapy for the Aged and Dementia, 1(12), 1-11.
  23. A. Liberati, D. G.Altman, J. Tetzlaff, C. Mulrow, P. C. Gotzsche, J. P. Ioannidis, M. Clarke, P. J. Devereaux, J. Kleijnen & D. Moher. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine, 6(7), e1000100. https://doi.org/10.1371/journal.pmed.1000100
  24. S. H. Kim, H. G. Kim & J. H. Lee. (2013). Effect of virtual reality based exercise program on the upper extremity function and activities of daily living in stroke patients. Journal of Rehabilitation Research, 17(2), 373-391.
  25. E. D. De Bruin, D. Schoene, G. Pichierri & S. T. Smith. (2010). Use of virtual reality technique for the training of motor control in the elderly. Zeitschrift fur Gerontologie und Geriatrie, 43(4), 229-234. https://doi.org/10.1007/s00391-010-0124-7
  26. G. N. Lewis, C. Woods, J. A. Rosie & K. M. Mcpherson. (2011). Virtual reality games for rehabilitation of people with stroke: perspectives from the users. Disability and Rehabilitation: Assistive Technology, 6(5), 453-463. https://doi.org/10.3109/17483107.2011.574310
  27. S. Y. Kim, J. E. Park, H. J. Seo, Y. J. Lee, B. H. Jang, H. J. Son, et al.(2011). NECA s guidance' for undertaking systematic reviews and meta-analyses for intervention. National Evidence-based Healthcare Collaborating Agency.
  28. B. J. Becker. (1988). Synthesizing standardized meanchange measures. British Journal of Mathematical and Statistical Psychology, 41(2), 257-278. https://doi.org/10.1111/j.2044-8317.1988.tb00901
  29. S. B. Morris & R. P. DeShon. (2002). Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological methods, 7(1), 105. http://dx.doi.org/10.1037/1082-989X.7.1.105
  30. Y. Netz, M. J. Wu, B. J. Becker & G. Tenenbaum. (2005). Physical activity and psychological well-being in advanced age: a meta-analysis of intervention studies. Psychology and aging, 20(2), 272. http://dx.doi.org/10.1037/0882-7974.20.2.272
  31. J. P. Higgins. (2011). Cochrane handbook for systematic reviews of interventions. Version 5.1. 0 [updated March 2011]. The Cochrane Collaboration. www.cochrane-handbook.org.
  32. J. Cohen. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: L. Lawrence Earlbaum Associates, 2.
  33. A. A. Timmermans, J. A. Verbunt, R. van Woerden, M. Moennekens, D. H. Pernot & H. A. Seelen. (2013). Effect of mental practice on the improvement of function and daily activity performance of the upper extremity in patients with subacute stroke: a randomized clinical trial. Journal of the American Medical Directors Association, 14(3), 204-212. https://doi.org/10.1016/j.jamda.2012.10.010
  34. Y. N. Kim & D. K. Lee. (2013). Effects of Dance Sports in Virtual Reality on Balance, Depression and ADL in Stroke Patients. JKPT, 25(5), 360-365.
  35. A. Turolla, M. Dam, L. Ventura, P. Tonin, M. Agostini, C. Zucconi, P. Kiper, A. Cagnin & L. Piron. (2013). Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. Journal of NeuroEngineering and Rehabilitation, 10(1), 85-93. https://doi.org/10.1186/1743-0003-10-85
  36. T. S. Park, J. H. Kang & I. B. Kim. (2018). Analysis of Muscle On-set Time of Fully Immersive Virtual Reality Motions and Actual Motions in Healthy Adults. Journal of Convergence Information Technology, 8(1), 173-177. https://doi.org/10.22156/CS4SMB.2018.8.1.173