虚拟现实技术对帕金森病患者综合平衡能力改善的Meta分析

doi:10.3969/j.issn.1006-9771.2021.09.008

摘要/Abstract

摘要：

目的综合评价虚拟现实技术(VR)对帕金森病患者综合平衡能力改善的效果。方法计算机检索Web of Science、PubMed、Cochrane Library、EMBASE、Scopus、维普数据库、万方数据库、中国知网(CNKI)数据库,搜集VR对帕金森病患者干预的随机对照研究,时间范围自建库至2020年11月。由2名研究者独立筛选文献、提取资料并评价文献质量后,采用Review Manager 5.3软件进行Meta分析。结果共纳入24篇文献,与对照组相比,结果显示VR干预能显著改善帕金森病患者的静态平衡能力(SMD = -0.49, 95%CI -0.64~-0.35, P < 0.001),单一VR干预显著改善帕金森病患者的Berg平衡量表评分(SMD = 0.83, 95%CI 0.43~1.23, P < 0.001),联合VR干预显著改善帕金森病患者的Berg平衡量表评分(SMD = 0.75, 95%CI 0.53~0.96, P < 0.001)和计时起立-行走测试时间(SMD = -0.87, 95%CI -1.52~-0.22, P = 0.008),单一VR干预计时起立-行走测试时间与对照组无显著性差异(SMD = -0.36, 95%CI -0.74~0.03, P = 0.07)。结论 VR可以改善帕金森病患者的综合平衡能力,建议与常规康复或平衡训练联合进行。

关键词: 帕金森病, 虚拟现实, 平衡, Meta分析

Abstract:

Objective To evaluate the effect of virtual reality (VR) on comprehensive balance for patients with Parkinson's disease (PD).Methods The databases of Web of Science, PubMed, Cochrane Library, EMBASE, Scopus, VIP, Wanfang Data and CNKI were retrieved to collect randomized controlled trials about VR intervention for PD patients, from establishment to November, 2020. Two researchers independently screened the literature, extracted the data and evaluated the quality of the literature, and then used Review Manager 5.3 software for meta-analysis.Results A total of 24 documents were included. Compared with the control group, VR intervention might improve the static balance (SMD = -0.49, 95%CI -0.64 to -0.35, P < 0.001) of PD patients. Simple VR intervention might improve the Berg Balance Scale score (SMD = 0.83, 95%CI 0.43 to 1.23, P < 0.001) for PD patients, while combination of VR intervention might improve the Berg Balance Scale score (SMD = 0.75, 95%CI 0.53 to 0.96, P < 0.001) and Timed 'Up and Go' Test time (SMD = -0.87, 95%CI -1.52 to -0.22, P = 0.008) for PD patients; however, simple VR intervention might do little in improving Timed 'Up and Go' Test time (SMD = -0.36, 95%CI -0.74 to 0.03, P = 0.07).Conclusions VR can improve the comprehensive balance for PD patients, especially combine with conventional or balance training.

Key words: Parkinson's disease, virtual reality, balance, meta-analysis

刘阳,张孝权,王恒,齐莉萍. 虚拟现实技术对帕金森病患者综合平衡能力改善的Meta分析[J]. 《中国康复理论与实践》, 2021, 27(9): 1048-1058.

LIU Yang,ZHANG Xiao-quan,WANG Heng,QI Li-ping. Effects of Virtual Reality on Balance for Patients with Parkinson's Disease: A Meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(9): 1048-1058.

图/表 9

图1

表1

纳入文献的基本特征"

文献	国家或地区	样本量 (女性数)	年龄(岁)	患病程度	干预措施		干预剂量	结局指标
文献	国家或地区	样本量 (女性数)	年龄(岁)	患病程度	T	C	干预剂量	结局指标
Yuan (2020)^[35]	中国台湾	T = 12(10) C = 12(3)	67.8±5.5 66.5±8.8	H＆Y T: 1期4例,2期5例,3期3例 C: 1期3例,2期4例,3期5例	VR	无干预	前6周,每周3次,每次30 min	①
Pazzaglia (2020)^[36]	意大利	T = 25(7) C = 26(9)	72±7 70±10	UPDRS-3 T: 23±9 C: 25±10	C+VR	常规康复	6周,每周3次,每次40 min	①
夏敏(2020)^[37]	中国	T = 15(4) C = 15(3)	65.99 ±4.30 66.00±8.55	UPDRS-3 T: 16.60±2.47 C: 18.27±3.63	C+VR	常规康复	4周,每周3次,每次40 min,T在C的基础上再VR干预15~20 min	①
刘静 (2020)^[38]	中国	T = 21(9) C = 21(10)	60.9±7.20 63.90±5.82	病程(年) T: 7.76±3.99 C: 8.10±3.42	C+VR	平衡训练	5周,每周4次,每次30 min	①
Moon (2020)^[39]	韩国	T = 8(5) C = 7(5)	63.38±5.37 62.14±5.55	H＆Y T: 2.63±0.52 C: 2.71±0.49	C+VR	作业疗法	8周,每周3次,每次30 min,T在C的基础上再VR干预30 min	①②
Feng (2019)^[40]	中国	T = 14(7) C = 14(6)	67.47±4.79 66.93±4.64	H＆Y T: 3.03±0.55 C: 2.97±0.58	VR	常规康复	12周,每周5次,每次45 min	①②
Santos (2019)^[30]	巴西	T = 13(2) C = 14(3)	61.7±7.3 64.5±9.8	H＆Y T: 1.4±0.6 C: 1.3±0.3	VR	常规康复	8周,每周2次,每次50 min	①②
Santos (2019)^[30]	巴西	T = 14(5) C = 14(3)	66.6±8.2 64.5±9.8	H＆Y T: 1.5±0.4 C: 1.3±0.3	C+VR	常规康复	8周,每周2次,每次50 min	①②
Tollár (2019)^[41]	匈牙利	T = 25(13) C = 24(11)	70.0±4.69 67.5±4.28	H＆Y T: 2.3±0.48 C: 2.4±0.51	VR	健康教育	5周,每周5次,每次60 min	①③
Tollár (2019)^[41]	匈牙利	T = 25(13) C = 25(14)	70.0±4.69 70.6±4.10	H＆Y T: 2.3±0.48 C: 2.4±0.51	VR	自行车	5周,每周5次,每次60 min	①③
秦灵芝 (2019)^[42]	中国	T = 43(18) C = 40(16)	65.9±4.9 66.1±6.2	H＆Y T: 2.6±0.5 C: 2.6±0.4	C+VR	常规康复	6周,每周5次,每次60 min	①
冯浩 (2019)^[43]	中国	T = 14(6) C = 14(5)	67.47±4.79 66.93±4.64	病程(年) T: 7.07±1.44 C: 6.60±1.45	VR	常规康复	12周,每日1次,每次45 min	②
程元元(2019)^[44]	中国	T = 20(12) C = 20(11)	59.2±7.3 58.6±7.5	病程(年) T: 6.1±1.4 C: 6.2±1.7	C+VR	常规康复	8周,每周2次,每次60 min	①②
Song (2018)^[45]	澳大利亚	T = 28(16) C = 25(20)	68±7 65±7	病程(年) T: 7±4 C: 9±6	家庭VR	无干预	12周,每周3次,每次不少于15 min	②
Ribas (2017)^[46]	巴西	T = 10(6) C = 10(6)	61.70±6.83 60.20±11.29	H＆Y T: 1期5例,1.5期2例,2期2例,2.5期1例 C: 1期3例,1.5期4例,2期2例,2.5期1例	C+VR	常规康复	12周,每次30 min	①
Carpinella (2017)^[47]	意大利	T = 17(3) C = 20(11)	73±7.1 75.6±8.2	H＆Y T: 2.7±0.7 C: 2.9±0.5	VR	平衡训练	每周3次,每次45 min,共20次	①②③
Gandolfi (2017)^[48]	意大利	T = 38(15) C = 38(10)	67.45±7.18 69.84±9.41	H＆Y（范围） T: 2.5~2.5 C: 2.5~3.0	家庭VR	平衡训练	7周,每周3次,每次50 min	①
陈思 (2017)^[49]	中国	T = 23(9) C = 23(11)	62.09±6.11 64.65±5.06	H＆Y T: 2.52±0.51 C: 2.57±0.50	VR	平衡训练	6周,每周5次,每次50 min	①②③
Yang (2016)^[50]	中国台湾	T = 11(4) C = 12(5)	72.5±8.4 75.4±6.3	H＆Y（范围） T: 2~3 C: 2~3	家庭VR	平衡训练	6周,每周3次,每次50 min	①②
Shih (2016)^[51]	中国台湾	T = 10(1) C = 10(3)	67.5±9.96 68.8±9.67	H＆Y T: 1.6±0.84 C: 1.4±0.52	C+VR	平衡训练	8周,每周2次,每次50 min	①②
Özgönenel (2016)^[52]	土耳其	T = 15(10) C = 18(12)	64 65	H＆Y T: 1期3例,2期10例,3期2例 C: 1期4例,2期6例,3期8例	C+VR	平衡训练	5周,每周3次,每次60 min	①②
林志诚 (2016)^[53]	中国	T = 17(6) C = 14(5)	61.4±8.2 62.1±6.3	H＆Y T: 2.7±0.9 C: 2.9±0.7	VR	平衡训练	5周,每周3次,每次60 min	①②
Lee (2015)^[54]	韩国	T = 10(5) C = 10(5)	68.4±2.9 70.1±3.3	无数据	C+VR	功能治疗	6周,每周2次,每次45 min	①
van den Heuvel (2014)^[55]	荷兰	T = 17(5) C = 16(8)	66.3±6.39 68.8±9.68	H＆Y T: 2期6例,2.5期8例,3期3例 C: 2期5例,2.5期5例,3期6例	VR	平衡训练	5周,每周2次,每次60 min	①
Laio (2014)^[56]	中国台湾	T = 12(6) C = 12(7)	67.3±7.1 64.6±8.6	H＆Y T: 1~1.5期5例,2~2.5期4例,3期3例 C: 1~1.5期5例,2~2.5期4例,3期3例	C+VR	跑步机	6周,每周2次,每次60 min	②
Pompeu (2012)^[57]	巴西	T = 16 C = 16	None data	H＆Y（范围） T: 1~2 C: 1~2	VR	平衡训练	7周,每周2次,每次60 min	①

表1

表2

纳入文献的质量情况"

文献	随机序列生成	分配隐藏	参与者盲法	评定者盲法	数据不完整	选择性报告	其他偏倚	质量分数
Yuan (2020)^[35]	不清楚	低风险	低风险	高风险	低风险	低风险	不清楚	B
Pazzaglia (2020)^[36]	低风险	低风险	低风险	高风险	低风险	低风险	不清楚	B
夏敏 (2020)^[37]	低风险	不清楚	不清楚	不清楚	高风险	低风险	高风险	B
刘静 (2020)^[38]	低风险	不清楚	不清楚	不清楚	低风险	低风险	不清楚	B
Moon (2020)^[39]	不清楚	不清楚	不清楚	不清楚	低风险	低风险	不清楚	B
Feng (2019)^[40]	不清楚	低风险	低风险	高风险	低风险	低风险	不清楚	B
Santos (2019)^[30]	高风险	不清楚	低风险	低风险	低风险	低风险	低风险	B
Tollár (2019)^[41]	低风险	低风险	低风险	高风险	低风险	低风险	不清楚	B
秦灵芝 (2019)^[42]	低风险	不清楚	不清楚	不清楚	低风险	低风险	不清楚	B
冯浩 (2019)^[43]	不清楚	不清楚	不清楚	不清楚	低风险	低风险	不清楚	B
程元元 (2019)^[44]	低风险	不清楚	不清楚	不清楚	低风险	低风险	不清楚	B
Song (2018)^[45]	低风险	低风险	低风险	不清楚	高风险	低风险	高风险	B
Ribas (2017)^[46]	不清楚	低风险	低风险	低风险	低风险	低风险	低风险	B
Carpinella (2017)^[47]	低风险	低风险	低风险	低风险	低风险	低风险	低风险	A
Gandolfi (2017)^[48]	低风险	低风险	低风险	高风险	高风险	低风险	不清楚	B
陈思 (2017)^[49]	低风险	不清楚	不清楚	不清楚	低风险	低风险	不清楚	B
Yang (2016)^[50]	低风险	不清楚	不清楚	不清楚	低风险	低风险	不清楚	B
Shih (2016)^[51]	低风险	低风险	低风险	高风险	低风险	低风险	不清楚	B
Özgönenel (2016)^[52]	高风险	高风险	不清楚	高风险	低风险	低风险	不清楚	B
林志诚 (2016)^[53]	低风险	低风险	不清楚	不清楚	低风险	低风险	不清楚	B
Lee (2015)^[54]	不清楚	不清楚	不清楚	不清楚	低风险	低风险	高风险	B
van den Heuvel (2014)^[55]	不清楚	不清楚	不清楚	不清楚	低风险	低风险	低风险	B
Laio (2014)^[56]	低风险	低风险	低风险	不清楚	低风险	低风险	不清楚	B
Pompeu (2012)^[57]	不清楚	不清楚	低风险	不清楚	高风险	低风险	高风险	B

表2

图2

图3

图4

图5

表3

表4

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指标	分组	研究数	效应量	95%CI	P值	I²	P值
BBS	VR vs. 常规康复	7	4.20	3.11~5.29	< 0.001	27%	0.21
	VR vs. 平衡训练	10	3.00	1.63~4.37	< 0.001	64%	0.003
	VR vs. 无特殊训练	2	5.02	-5.36~15.41	0.34	94%	< 0.001
	VR vs. 特殊干预	2	1.47	0.60~2.34	0.0009	39%	0.20
TUGT	VR vs. 常规康复	5	-0.74	-1.36~-0.13	0.02	73%	0.002
	VR vs. 平衡训练	6	-0.48	-0.94~-0.03	0.04	57%	0.04
	VR vs. 无特殊训练	1	0.29	-0.25~0.83	0.29
	VR vs. 特殊干预	1	-0.69	-1.74~0.37	0.20

分组		研究数量	效应量	95%CI	P值
BBS	H&Y < 2	4	0.54	0.13~0.96	0.01
	H&Y 2~3	12	0.94	0.56~1.32	< 0.001
	H&Y > 3	2	1.00	0.50~1.50	< 0.001
TUGT	H&Y ≤ 2.5	7	-0.54	-1.09~0.02	0.06
TUGT	H&Y > 2.5	7	-0.43	-0.86~0.00	0.05