虚拟现实技术对脑卒中患者肢体康复干预效果的系统评价再评价

doi:10.3761/j.issn.0254-1769.2025.17.017

摘要/Abstract

摘要：

目的对虚拟现实技术在脑卒中患者肢体康复中应用的系统评价进行再评价，为开展虚拟现实技术干预提供证据支持。方法系统检索Web of Science、PubMed、CINAHL、Cochrane Library、Embase、中国知网、中国生物医学文献数据库、万方数据库和维普数据库中关于虚拟现实技术在脑卒中肢体康复中应用的系统评价/Meta分析，检索时限为建库至2025年3月。由2名研究者独立筛选文献，采用系统评价方法学质量评价工具2进行文献质量评价，采用系统评价/Meta分析报告规范进行报告质量评价，应用推荐分级的评估、制订与评价系统对证据进行汇总与分级，运用校正覆盖面积法评估文献重叠度。结果共纳入15篇文献，3篇为中等质量，其余为低或极低质量。系统评价/Meta分析报告规范得分为19.5~27.0分。推荐分级的评估、制订与评价系统结果显示，1条为高等质量，6条为中等质量，其余均为低或极低质量。文献重叠度为5.3%，为轻度重叠。结论虚拟现实技术有助于改善脑卒中患者的上肢运动功能/活动能力、下肢平衡功能等指标，受纳入研究偏倚控制薄弱、异质性处理不足等方法学质量缺陷的限制，仍需规范地开展高质量研究为临床决策提供更可靠的证据支持。

关键词: 脑卒中, 虚拟现实, 肢体康复, 系统评价再评价, 循证护理学

Abstract:

Objective To re-evaluate systematic reviews on the application of virtual reality（VR） technology in limb rehabilitation for stroke patients，providing evidence to support the implementation of VR. Methods Systematic searches were conducted in Web of Science，PubMed，CINAHL，Cochrane Library，Embase，CNKI，CBM，WanFang，and VIP databases from their inception until March 2025，identifying systematic reviews/meta-analyses investigating VR for limb rehabilitation in stroke patients. 2 researchers independently screened the literature. Methodological quality was evaluated using the Assessment of Mutiple System Reviews 2（AMSTAR 2） tool；reporting quality was evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses（PRISMA） guidelines；evidence quality was graded using the Grades of Recommendations Assessment，Development，and Evaluation（GRADE） system；literature overlap was assessed using the Corrected Covered Area（CCA） method. Results A total of 15 articles were included. According to AMSTAR 2，totally 3 reviews were of moderate quality，while the remainder were rated as low or very low quality. PRISMA scores ranged from 19.5 to 27.0 points. Based on GRADE，a review was classified as high quality，6 as moderate quality，and the remainder as low or very low quality. The CCA was 5.3%，indicating slight overlap. Conclusion VR contributes to the improvement of indicators such as upper limb motor function/mobility and lower limb balance in stroke patients. However，methodological limitations，including weak control of bias and inadequate handling of heterogeneity among included studies，restrict the overall quality of evidence. Further standardized，high-quality studies are needed to provide more reliable evidence to support clinical decision-making.

Key words: Stroke, Virtual Reality, Limb Rehabilitation, Overview of Systematic Reviews, Evidence-Based Nursing

杨宏伟, 王娟, 吉辉, 李中建, 兰冰花, 李雪颖. 虚拟现实技术对脑卒中患者肢体康复干预效果的系统评价再评价[J]. 中华护理杂志, 2025, 60(17): 2150-2157.

YANG Hongwei, WANG Juan, JI Hui, LI Zhongjian, LAN Binghua, LI Xueying. Virtual reality for post-stroke limb rehabilitation：an overview of systematic reviews[J]. Chinese Journal of Nursing, 2025, 60(17): 2150-2157.

图/表 3

图1 PubMed检索策略

Figure 1 PubMed search strategies

表1 纳入文献的基本特征（n=15）

Table 1 Basic characteristics of the included studies（n=15）

表2 推荐分级的评估、制订与评价系统证据等级评价结果

Table 2 GRADE evidence quality of outcomes included in the literature

参考文献 28

[1]	Collaborators G2S. Global,regional,and national burden of stroke and its risk factors,1990-2019:a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021, 20(10):795-820.
[2]	《中国脑卒中防治报告2021》编写组. 《中国脑卒中防治报告2021》概要[J]. 中国脑血管病杂志, 2023, 20(11):783-793.
	Report on Stroke Prevention and Treatment in China Writing Group. Brief report on stroke prevention and treatment in China,2021[J]. Chin J Cerebrovasc Dis, 2023, 20(11):783-793.
[3]	董蕾, 刘佳, 赵琴, 等. 脑卒中患者虚拟现实康复体验质性研究的Meta整合[J]. 中华护理杂志, 2024, 59(9):1130-1137.
	Dong L, Liu J, Zhao Q, et al. Experience of virtual reality rehabilitation of stroke patients:a meta-synthesis of qualitative study[J]. Chin J Nurs, 2024, 59(9):1130-1137.
[4]	张远星, 何磊, 靳千胜, 等. 虚拟现实语言训练对卒中后失语患者干预效果的Meta分析[J]. 中华护理杂志, 2023, 58(3):296-303. DOI
	Zhang YX, He L, Jin QS, et al. Effects of virtual reality-based language training for people with post-stroke aphasia:a meta-analysis[J]. Chin J Nurs, 2023, 58(3):296-303.
[5]	叶磊, 夏广惠, 陈方梅, 等. 虚拟现实技术在癌症相关认知障碍患者中应用的范围综述[J]. 中华护理杂志, 2024, 59(7):882-889. DOI
	Ye L, Xia GH, Chen FM, et al. A scoping review of virtual reality on the effects on patients of cancer-related cognitive impairment[J]. Chin J Nurs, 2024, 59(7):882-889. DOI
[6]	周雯露, 余姜璇, 王俊杰, 等. 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. DOI
	Zhou WL, Yu JX, Wang JJ, et al. Effects of fully immersive virtual reality on extremity function of stroke patients:a meta analysis[J]. Chin J Nurs, 2023, 58(17):2158-2165.
[7]	Zhang BH, Li D, Liu Y, et al. Virtual reality for limb motor function,balance,gait,cognition and daily function of stroke patients:a systematic review and meta-analysis[J]. J Adv Nurs, 2021, 77(8):3255-3273.
[8]	李江, 肖月, 张俊华, 等. 动态系统评价撰写注意事项[J]. 中国药物评价, 2022, 39(1):11-15.
	Li J, Xiao Y, Zhang JH, et al. Introduction to the writing method of living systematic review[J]. Chin J Drug Eval, 2022, 39(1):11-15.
[9]	陶欢, 杨乐天, 平安, 等. 随机或非随机防治性研究系统评价的质量评价工具AMSTAR 2解读[J]. 中国循证医学杂志, 2018, 18(1):101-108.
	Tao H, Yang LT, Ping A, et al. Interpretation of AMSTAR 2:a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interven-tions[J]. Chin J Evid Based Med, 2018, 18(1):101-108.
[10]	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA state-ment[J]. PLoS Med, 2009, 6(7):e1000097.
[11]	梁士楚, 张静, 李静, 等. 药物干预措施预防冠心病介入术后对比剂相关急性肾损伤效果的系统评价再评价[J]. 中国循证医学杂志, 2022, 22(5):575-584.
	Liang SC, Zhang J, Li J, et al. Efficacy of different phar-macological interventions in the prevention of contrast-indu-ced acute kidney injury after percutaneous coronary interven-tion:an overview of systematic reviews[J]. Chin J Evid Based Med, 2022, 22(5):575-584.
[12]	Holger S, Jan B, Gordon G, et al. GRADE handbook[EB/OL].(2013-10)[2025-03-12]. https://gdt.gr-adepro.org/app/handbook/handbook.html.
[13]	马宁, 潘蓓, 邓锡源, 等. 伞形评价中文献重叠的评估及处理[J]. 中国循证医学杂志, 2024, 24(10):1212-1218.
	Ma N, Pan B, Deng XY, et al. The evaluation and handling of overlapping in umbrella reviews[J]. Chin J Evid Based Med, 2024, 24(10):1212-1218.
[14]	The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions(version 5.0.1)[EB/OL].(2008-09)[2025-03-01]. https://www.cochrane.org/authors/handbooks-and-manuals/handbook/archive/v5.0.1.
[15]	Soleimani M, Ghazisaeedi M, Heydari S. The efficacy of virtual reality for upper limb rehabilitation in stroke patients:a systematic review and meta-analysis[J]. BMC Med Inform Decis Mak, 2024, 24(1):135.
[16]	Zhang JL, Jiang X, Xu QZ, et al. Effect of virtual reality-based training on upper limb dysfunction during post-stroke rehabi-litation:a meta-analysis combined with meta-regression[J]. J Integr Neurosci, 2024, 23(12):225.
[17]	Kiper P, Godart N, Cavalier M, et al. Effects of immersive vir-tual reality on upper-extremity stroke rehabilitation:a syste-matic review with meta-analysis[J]. J Clin Med, 2023, 13(1):146.
[18]	Okamura R, Nakashima A, Moriuchi T, et al. Effects of a vir-tual reality-based mirror therapy system on upper extremity rehabilitation after stroke:a systematic review and meta-analysis of randomized controlled trials[J]. Front Neurol, 2024, 14:1298291.
[19]	孔云, 钟克龙, 安雪梅. 虚拟现实技术改善脑卒中病人运动功能效果的Meta分析[J]. 循证护理, 2023, 9(22):3991-3997.
	Kong Y, Zhong KL, An XM. Effect of virtual reality techno-logy on improving motor function in stroke patients:a meta-analysis[J]. Chin Evid Based Nurs, 2023, 9(22):3991-3997.
[20]	Fang ZW, Wu TT, Lü MN, et al. Effect of traditional plus vir-tual reality rehabilitation on prognosis of stroke survivors:a systematic review and meta-analysis of randomized controlled trials[J]. Am J Phys Med Rehabil, 2022, 101(3):217-228.
[21]	Leong SC, Tang YM, Toh FM, et al. Examining the effective-ness of virtual,augmented,and mixed reality(VAMR) therapy for upper limb recovery and activities of daily living in stroke patients:a systematic review and meta-analysis[J]. J Neuroeng Rehabil, 2022, 19(1):93. DOI PMID
[22]	Chen JY, Or CK, Chen TR. Effectiveness of using virtual rea-lity-supported exercise therapy for upper extremity motor rehabilitation in patients with stroke:systematic review and meta-analysis of randomized controlled trials[J]. J Med Inter-net Res, 2022, 24(6):e24111.
[23]	Mekbib DB, Han JW, Zhang L, et al. Virtual reality therapy for upper limb rehabilitation in patients with stroke:a meta-analysis of randomized clinical trials[J]. Brain Inj, 2020, 34(4):456-465.
[24]	Domínguez-Téllez P, Moral-Muñoz JA, Salazar A, et al. Game-based virtual reality interventions to improve upper limb motor function and quality of life after stroke:systematic review and meta-analysis[J]. Games Health J, 2020, 9(1):1-10. DOI PMID
[25]	梁明, 魏珍, 谢荣, 等. 虚拟现实技术改善脑卒中患者平衡与步行功能的系统评价[J]. 中华物理医学与康复杂志, 2020, 42(7):632-639.
	Liang M, Wei Z, Xie R, et al. A meta-analysis of the effec-tiveness of virtual reality training for improving balance and walking after a stroke[J]. Chin J Phys Med Rehabil, 2020, 42(7):632-639.
[26]	Iruthayarajah J, McIntyre A, Cotoi A, et al. The use of virtual reality for balance among individuals with chronic stroke:a systematic review and meta-analysis[J]. Top Stroke Rehabil, 2017, 24(1):68-79. PMID
[27]	Gibbons EM, Thomson AN, de Noronha M, et al. Are virtual reality technologies effective in improving lower limb out-comes for patients following stroke:a systematic review with meta-analysis[J]. Top Stroke Rehabil, 2016, 23(6):440-457.
[28]	萧演清, 白洪铭, 郑佳, 等. 虚拟现实技术在神经运动康复中的应用综述[J]. 计算机辅助设计与图形学学报, 2024, 36(9):1311-1327.
	Xiao YQ, Bai HM, Zheng J, et al. Review of the application of virtual reality in neuromotor rehabilitation[J]. J Comput Aided Des Comput Graph, 2024, 36(9):1311-1327.