Impact of virtual reality-based rehabilitation on functional outcomes in patients with acute stroke: a retrospective case-matched study
Background and objectives
To date, the efficacy of the virtual reality (VR) application for acute stroke compared with conventional therapy (CT) remains unclear. This retrospective study aims to assess the impact of adjuvant VR technology on multidimensional therapy for patients with acute-stage stroke.
100 acute ischemic stroke patients with onset within 7 days who underwent combined adjuvant VR-based rehabilitation program and CT (intervention group–VR + CT) were compared to an equal number of cross-matched patients who received CT alone. While the intervention group received 40-min CT plus 20-min VR program (seven times for 1 week), the comparison group received time-matched CT alone. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), medical cost-effectiveness, and shortening of hospital stay were used as outcome measures.
Posttreatment, the VR + CT group revealed significantly improved NIHSS and mRS (P < 0.001), whereas only the mRS improvement was remarkable in the CT group. In between-group comparisons, the intervention group had better improvements of symptom severity (NIHSS percentage improvement from the baseline; 20.18% vs. 4.59%, P < 0.005), functional outcomes (mRS improvement from the baseline; − 0.58 vs. − 0.23, P < 0.001), and reduced medical cost (Taiwan dollar; 49474 vs. 66306, P < 0.005). Furthermore, the VR + CT group reached markedly higher proportion of functional independence in activities of daily living (mRS, 0–2) at discharge compared with the CT group (68% vs. 60%, P < 0.001).
This study suggests that the combination of VR-based rehabilitation and traditional therapy could be more effective for neurorehabilitation than CT alone in the early improvement of symptom severity, functional outcomes, and lower medical expenditure in acute stroke patients.
KeywordsVirtual reality Neurorehabilitation Acute stroke National Institutes of Health Stroke Scale Modified Rankin Scale Activities of daily living Lower medical expenditure
The authors wish to acknowledge Mr. Ray Chen and the Long Good team for developing the software programs for acute stroke rehabilitation.
J-TL and F-CY designed the study and prepared the ethics application documents. T-HH compiled the majority of the manuscript. R-CL, S-LC, C-HC, C-KT, C-LT, and Y-KL participated in study design meetings. W-CC and C-HC carried out the data analysis; All authors read and approve the final manuscript.
This study was supported in part by grants from the Ministry of Science and Technology (MOST 106-2314-B-016-007- MY2; MOST 107-2314-B-016 -017), Ministry of National Defense Medical Affairs Bureau (MAB-106-041; MAB-106-042; MAB-107-025), Tri-Service General Hospital (TSGH-C107-073; TSGH-C107-072), Teh-Tzer Study Group for Human Medical Research Foundation (A1061038), and Cheng Hsin General Hospital (CH-NDMC-106-13). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Compliance with ethical standards
The study was approved by the Institutional Review Board on Human Subjects Research and Ethics Committees of Tri-Service General Hospital, National Defense Medical Center, Taiwan. (TSGHIRB No. 1-106-05-041).
Conflicts of interest
The authors declar no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- 9.Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M (2017) Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev 11:CD008349Google Scholar
- 10.da Silva Cameirão M, Bermúdez I, Badia S, Duarte E, Verschure PF (2011) Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: a randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system. Restor Neurol Neurosci 29:287–298Google Scholar
- 14.Bergmann J, Krewer C, Bauer P, Koenig A, Riener R, Müller F (2018) Virtual reality to augment robot-assisted gait training in non-ambulatory patients with a subacute stroke: a pilot randomized controlled trial. Eur J Phys Rehabil Med 54:397–407Google Scholar
- 15.Kwon JS, Park MJ, Yoon IJ, Park SH (2012) Effects of virtual reality on upper extremity function and activities of daily living performance in acute stroke: a double-blind randomized clinical trial. NeuroRehabilitation 31:379–385Google Scholar