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虚拟现实技术对亚急性脑卒中患者上肢功能及活动能力影响的Meta分析
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Abstract:
目的：已有研究表明，VR技术能够改善脑卒中后运动功能，但针对亚急性期脑卒中患者的系统证据相对较少。因此，本研究旨在系统评价VR技术对亚急性期脑卒中患者上肢功能、平衡能力、独立性、日常生活活动及行走能力的应用效果。方法：检索PubMed、Web of Science、The Cochrane Library、Embase数据库，检索从建库至2024年1月关于VR治疗脑卒中的随机对照试验，以FMA-UE、ARAT、WMFT、BBT、TUGT、BBS、BI及FIM为观察指标，使用Review Manager 5.4软件和StataSE15.0软件进行Meta分析。结果：共纳入31项研究，总样本量1319例。与常规康复相比，VR能显著改善FMA-UE、TUGT及BI指标。两种方式在ARAT、BBS、FIM、WMFT及BBT指标上并无显著性差异。亚组分析结果显示，训练次数 > 15次，干预周期 ≥ 4周时，VR训练对FMA-UE、BBT及TUGT指标改善效果更加显著。结论：VR训练能够显著提升亚急性期脑卒中患者的上肢运动功能、步行能力及日常生活活动能力，尤其在高频次(>15次)和长周期(≥4周)干预下效果更为显著。然而，在平衡能力、手部精细运动和功能独立性方面，VR训练的改善有限，需进一步优化训练方案与设备设计，以提升全面康复效果。
Objective: Previous studies have shown that virtual reality (VR) technology can improve motor function after stroke, but the evidence specific to patients in the subacute phase of stroke remains limited. Therefore, this study aims to systematically evaluate the effects of VR technology on upper limb function, balance, independence, activities of daily living, and walking ability in subacute stroke patients. Methods: We searched PubMed, Web of Science, The Cochrane Library, and Embase databases for randomized controlled trials (RCTs) on VR therapy for stroke, published from database inception to January 2024. FMA-UE, ARAT, WMFT, BBT, TUGT, BBS, BI, and FIM were used as outcome measures. Meta-analysis was performed using Review Manager 5.4 and StataSE15.0 software. Results: A total of 31 studies with 1319 participants were included. Compared with conventional rehabilitation, VR significantly improved FMA-UE, TUGT, and BI. However, no significant differences were observed between VR and conventional rehabilitation in ARAT, BBS, FIM, WMFT, and BBT. Subgroup analysis showed that VR interventions with more than 15 sessions and intervention periods of at least 4 weeks achieved better improvements in FMA-UE, BBT, and TUGT scores. Conclusion: VR training can significantly improve upper limb function, walking ability, and activities of daily living in subacute stroke patients, especially with high-frequency (>15 sessions) and long-duration (≥4 weeks) interventions. However, the improvements in balance, fine motor skills, and functional independence remain limited, suggesting that further optimization of VR programs and equipment design is needed to enhance comprehensive rehabilitation outcomes.
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