De Miguel-Rubio, AmarantaRubio, M. DoloresAlba-Rueda, AlvaroSalazar, AlejandroMoral-Munoz, Jose A.Lucena-Anton, David2022-11-282022-11-282020-12-03De Miguel-Rubio A, Rubio MD, Alba-Rueda A, Salazar A, Moral-Munoz JA, Lucena-Anton D. Virtual Reality Systems for Upper Limb Motor Function Recovery in Patients With Spinal Cord Injury: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth. 2020 Dec 3;8(12):e22537http://hdl.handle.net/10668/4417Background: Patients with spinal cord injury (SCI) usually present with different motor impairments, including a deterioration of upper limb motor function (ULMF), that limit their performance of activities of daily living and reduce their quality of life. Virtual reality (VR) is being used in neurological rehabilitation for the assessment and treatment of the physical impairments of this condition. Objective: A systematic review and meta-analysis was conducted to evaluate the effectiveness of VR on ULMF in patients with SCI compared with conventional physical therapy. Methods: The search was performed from October to December 2019 in Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and Cochrane Central Register of Controlled Trials. The inclusion criteria of selected studies were as follows: (1) comprised adults with SCI, (2) included an intervention with VR, (3) compared VR intervention with conventional physical therapy, (4) reported outcomes related to ULMF, and (5) was a controlled clinical trial. The Cochrane Collaboration’s tool was used to evaluate the risk of bias. The RevMan 5.3 statistical software was used to obtain the meta-analysis according to the standardized mean difference (SMD) and 95% CIs. Results: Six articles were included in this systematic review. Four of them contributed information to the meta-analysis. A total of 105 subjects were analyzed. All of the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed nonsignificant results for the Nine-Hole Peg Test (SMD –0.93, 95% CI –1.95 to 0.09), muscle balance test (SMD –0.27, 95% CI –0.82 to 0.27), Motricity Index (SMD 0.16, 95% CI −0.37 to 0.68), Jebsen-Taylor Hand Function Test (JTHFT) subtests (writing, SMD –0.10, 95% CI –4.01 to 3.82; simulated page turning, SMD –0.99, 95% CI –2.01 to 0.02; simulated feeding, SMD –0.64, 95% CI –1.61 to 0.32; stacking checkers, SMD 0.99, 95% CI –0.02 to 2.00; picking up large light objects, SMD –0.42, 95% CI –1.37 to 0.54; and picking up large heavy objects, SMD 0.52, 95% CI –0.44 to 1.49), range of motion of shoulder abduction/adduction (SMD –0.23, 95% CI –1.48 to 1.03), shoulder flexion/extension (SMD 0.56, 95% CI –1.24 to 2.36), elbow flexion (SMD –0.36, 95% CI –1.14 to 0.42), elbow extension (SMD –0.21, 95% CI –0.99 to 0.57), wrist extension (SMD 1.44, 95% CI –2.19 to 5.06), and elbow supination (SMD –0.18, 95% CI –1.80 to 1.44). Favorable results were found for the JTHFT subtest picking up small common objects (SMD –1.33, 95% CI –2.42 to –0.24). Conclusions: The current evidence for VR interventions to improve ULMF in patients with SCI is limited. Future studies employing immersive systems to identify the key aspects that increase the clinical impact of VR interventions are needed, as well as research to prove the benefits of the use of VR in the rehabilitation of patients with SCI in the clinical setting.enAtribución 4.0 Internacionalhttp://creativecommons.org/licenses/by/4.0/Virtual realitySpinal cord injuriesNeurological rehabilitationMotor functionPhysical therapyRealidad virtualTraumatismos de la médula espinalRehabilitación neurológicaMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Rehabilitation::Activities of Daily LivingMedical Subject Headings::Persons::Persons::Age Groups::AdultMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Anthropology, Education, Sociology and Social Phenomena::Social Sciences::Quality of LifeMedical Subject Headings::Phenomena and Processes::Biological Phenomena::Recovery of FunctionMedical Subject Headings::Anatomy::Body Regions::Extremities::Upper ExtremityMedical Subject Headings::Diseases::Nervous System Diseases::Central Nervous System Diseases::Spinal Cord Diseases::Spinal Cord InjuriesMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Psychiatry and Psychology::Behavioral Disciplines and Activities::Psychotherapy::Behavior Therapy::Desensitization, Psychologic::Virtual Reality Exposure TherapyMedical Subject Headings::Anatomy::Body Regions::Extremities::Upper Extremity::ElbowMedical Subject Headings::Anatomy::Body Regions::Extremities::Upper Extremity::ShoulderMedical Subject Headings::Phenomena and Processes::Musculoskeletal and Neural Physiological Phenomena::Musculoskeletal Physiological Phenomena::Musculoskeletal Physiological Processes::Movement::Motor Activity::SupinationMedical Subject Headings::Anatomy::Body Regions::Extremities::Upper Extremity::Hand::WristMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Physical Therapy ModalitiesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Physical Examination::Range of Motion, ArticularMedical Subject Headings::Information Science::Information Science::Computing Methodologies::SoftwareMedical Subject Headings::Information Science::Information Science::Communication::Language::Language Arts::WritingMedical Subject Headings::Anatomy::Musculoskeletal System::MusclesMedical Subject Headings::Information Science::Information Science::Information Storage and Retrieval::Databases as Topic::Databases, Bibliographic::PubMedMedical Subject Headings::Information Science::Information Science::Communications Media::Publications::Bibliography as Topic::BibliometricsMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Epidemiologic Study Characteristics as Topic::Clinical Trials as Topic::Controlled Clinical Trials as Topic::Randomized Controlled Trials as Topicreview article33270040Acceso abierto10.2196/225372291-5222PMC7746495