J. Fandim1, B. Saragiotto1, G. Porfírio2, R. Santana3
1Universidade Cidade de São Paulo, Masters and Doctoral Programs in Physical Therapy, São Paulo, Brazil, 2Universidade Municipal de São Caetano do Sul, Faculty of Medicine, Sao Paulo, Brazil, 3Universidade Cidade de São Paulo, Physical Therapy Department, Sao Paulo, Brazil
Background: Cerebral Palsy is one of the main causes of disability in childhood. Virtual reality (VR) based interventions have been used in the treatment in children with cerebral palsy (CP). The research on VR are progressing, however its effectiveness as an supplementary treatment remains uncertain.
Purpose: We aim to eveluate the effectiveness of virtual reality to improve upper and lower limb function, postural control and balance compared to other type of treatments, usual care, waiting list, no treatment or placebo in children with cerebral palsy.
Methods: This review was prospectively registered on PROSPERO (CRD: 42018102759). We conducted electronic searches in EMBASE, Medline, CENTRAL, four other databases and two trials registries up to March 2020. We included randomized controlled trials that analyzing VR alone or associated with other treatments in patients with cerebral palsy compared to placebo, waiting list, non-treatment groups, usual care, conventional rehabilitation or other types of treatment. The primary outcomes were upper and lower limb function, postural control and balance. The secondary outcomes such as global motor function, perception, cognition and spatial functions, motivation, motor learning and adverse events. Two independent reviewers assessed the risk of bias using the Cochrane risk of bias tool and extracted the data. We use meta-analysis with random effect model whenever possible. We calculated the mean difference (MD) or standardized mean difference (SMD) and 95% confidence intervals (CI) for continuous outcomes. We analyzed the quality of evidence using the GRADE approach for each comparation and time point.
Results: We included 38 trials (n = 1233 participants) of both sex with ages between 3 and 20 years old in this review. The most adhered risk of bias items were random allocation, allocation concealment, selective reporting and others. There is very low quality of evidence that VR plus conventional rehabilitation may result in an increase in upper limb function compared to conventional rehabilitation at post intervention (SMD = 1.06; 95% CI 0.42 to 1.69) and lower limb strength at post intervention (SMD = 0.66, 95% CI 0.01 to 1.32). There is very low quality of evidence that VR may result in an increase in postural control and balance compared to conventional rehabilitation at post intervention (SMD = 1.43, 95% CI 0.61 to 2.24). There is very low quality that VR alone may result in little to no difference in upper and lower limb function compared to conventional rehabilitation at post intervention. No adverse events were observed among the 10 trials that provided information on this outcome.
Conclusion(s): Our findings suggest that VR may provide some benefits in upper and lower limb function and postural control and balance outcomes. However, the quality of evidence ranged from very low to low. At present we have very limited to limited confidence in effect estimation, and future studies may probably change our confidence in results and effect estimates.
Implications: VR has been used in clinical practice rehabilitation by health care providers for the past two decades. VR may result in a slight increase in upper and lower limb function and postural control and balance outcomes.
Funding, acknowledgements: None
Keywords: Cerebral palsy, VR, Outcomes
Topic: Neurology
Did this work require ethics approval? No
Institution: UNICID
Committee: Comité de Ética em Humanos-Unicid
Reason: It is a systematic review study not involving any participants
All authors, affiliations and abstracts have been published as submitted.
