完全沉浸式虚拟现实技术对脑卒中患者肢体功能影响的Meta分析

doi:10.3761/j.issn.0254-1769.2023.17.015

摘要/Abstract

摘要：

目的评价完全沉浸式虚拟现实技术对脑卒中患者肢体功能的影响。方法计算机检索PubMed、Embase、Cochrane Library、CINAHL、Web of Science、中国知网等中英文数据库和临床试验注册平台中关于完全沉浸式虚拟现实技术对脑卒中患者肢体功能干预的随机对照试验，并补充检索纳入研究的参考文献和灰色文献，检索时限为建库至2022年10月。由2名研究者独立筛选文献，对纳入文献进行数据提取、质量评价。采用RevMan 5.4软件进行Meta分析。结果最终纳入9篇文献，包括252例患者。Meta分析结果显示，完全沉浸式虚拟现实技术能够显著改善脑卒中患者上肢的运动功能[MD=5.35，95%CI（3.04，7.67），P<0.01]和灵活性[MD=8.26，95%CI（5.09，11.43），P<0.01]，增强患者下肢的平衡功能[MD=6.30，95%CI（3.14，9.46），P<0.01]、步态协调性[MD=-4.97，95%CI（-6.76，-3.18），P<0.01]，但步态速度[MD=10.29，95%CI（-4.03，24.62），P=0.16]差异无统计学意义。描述性分析显示，完全沉浸式虚拟现实技术对脑卒中患者下肢活动耐力具有改善作用。根据干预时间进行亚组分析发现，当干预时间≥4周时，试验组上肢灵活性[MD=9.06，95%CI（5.69，12.43），P<0.01]及下肢步态协调性[MD=-5.25，95%CI（-7.24，-3.26），P<0.01]有改善。结论完全沉浸式虚拟现实技术可改善脑卒中患者的肢体功能，但在改善步态速度方面效果不显著，对相应评价指标进行亚组分析提示，需要保证足够的干预时间。未来仍需更多、更高质量的研究进一步验证以上结论。

关键词: 虚拟现实, 脑卒中, 肢体功能, 循证护理学, Meta分析, 康复护理

Abstract:

Objective To evaluate the effect of fully immersive virtual reality technology on limb function of stroke patients. Methods We searched Chinese and English databases including PubMed，Embase，Cochrane Library，CINAHL，Web of Science，CNKI etc.，and clinical trials registry platforms from inception until October 2020. Randomized controlled trials that reported the effects of fully immersive virtual reality technology for limb function in stroke patients were retrieved. The references and grey literature included in the study were also retrieved. There were 2 researchers who independently retrieved articles，evaluated quality and extracted data. RevMan 5.4 software was used for Meta-analysis. Results A total of 9 studies involving 252 patients were finally included. Meta-analysis indicated that fully immersive virtual reality technology could improve upper limb motor function[MD=5.35，95%CI（3.04，7.67），P<0.01]，dexterity[MD=8.26，95%CI（5.09，11.43），P<0.01]，enhance lower limb balance function[MD=6.30，95%CI（3.14，9.46），P<0.01]，gait coordination[MD=-4.97，95%CI（-6.76，-3.18），P<0.01]. But there was no statistically significant difference in gait velocity[MD=10.29，95%CI（-4.03，24.62），P=0.16]. Descriptive analysis indicated that fully immersive virtual reality technology could significantly improve exercise endurance. Subgroup analysis according to intervention time found that when intervention time≥4 weeks，the experimental group had statistically significant differences on the upper limb dexterity[MD=9.06，95%CI（5.69，12.43），P<0.01] and lower limb gait coordination[MD=-5.25，95%CI（-7.24，-3.26），P<0.01]. Conclusion Fully immersive virtual reality technology can improve the limb function of stroke patients，but the effect on gait velocity was not significant. The subgroup analysis of evaluation indicators suggests that sufficient intervention time should be guaranteed. More and higher quality studies are needed to further verify this in the future.

Key words: Virtual Reality, Stroke, Limb Function, Evidence-Based Nursing, Meta-Analysis, Rehabili-tation Nursing

周雯露, 余姜璇, 王俊杰, 单雪琪, 许娅文. 完全沉浸式虚拟现实技术对脑卒中患者肢体功能影响的Meta分析[J]. 中华护理杂志, 2023, 58(17): 2158-2165.

ZHOU Wenlu, YU Jiangxuan, WANG Junjie, SHAN Xueqi, XU Yawen. Effects of fully immersive virtual reality on extremity function of stroke patients：a meta analysis[J]. Chinese Journal of Nursing, 2023, 58(17): 2158-2165.

图/表 7

图1 文献筛选流程

Figure 1 Flow diagram of the selection process of literature

表1 纳入文献的基本特征（n=9）

Table 1 Basic characteristics of included studies（n=9）

表2 纳入文献的质量评价结果（n=9）

Table 2 Quality evaluation results of included studies（n=9）

图2 完全沉浸式虚拟现实技术对脑卒中患者上肢运动功能的影响

Figure 2 The effects of fully immerse VR technology on upper limb motor function with stroke patients

图3 完全沉浸式虚拟现实技术对脑卒中患者上肢灵活性的影响

Figure 3 The effects of fully immerse VR technology on upper limb dexterity with stroke patients

图4 完全沉浸式虚拟现实技术对脑卒中患者下肢步态协调性的影响

Figure 4 The effects of fully immerse VR technology on lower limb gait coordination with stroke patients

图5 完全沉浸式虚拟现实技术对脑卒中患者下肢平衡的影响

Figure 5 The effects of fully immerse VR technology on lower limb balance with stroke patients

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