虚拟现实技术对帕金森病患者认知功能和生活质量影响的Meta分析

doi:10.3969/j.issn.1006-9771.2024.06.004

Abstract

Abstract:

Objective To evaluate the effect of virtual reality (VR) on cognitive function and quality of life in patients with Parkinson's disease.

Methods A systematic search of CBM, CNKI, Wanfang data, VIP, Cochrane Library, Web of Science, Embase, and PubMed was carried out to identify randomized control trials (RCT) about the effect of VR technology on patients with Parkinson's disease from inception to February 29th, 2024. The control group received routine cognitive training, balance training or physical therapy, and the experimental group received VR technology. The quality of articles was evaluated using the Cochrane Collaboration's 5.1.0 RCT risk assessment tool for bias. The meta-analysis was performed using Revman5.4. GRADE was used to evaluate the evidence quality of outcome indicators.

Results A total of 13 literatures involving 426 patients were included. Allocation concealment and blind methods were not described in most literatures, and selective reporting of research results or other biases was unclear. VR technology could improve the Motreal Cognitive Assessment (MoCA) score (MD = 1.11, 95%CI 0.31 to 1.90, P = 0.006), Trail Making Test (TMT)-A score (MD = -6.25, 95%CI -11.71 to -0.78, P = 0.030) and depression scale score (SMD = -0.56, 95%CI -0.95 to 0.18, P = 0.004) of patients with Parkinson's disease; however, it did not improve TMT-B score (MD = -6.01, 95%CI -28.16 to 16.14, P = 0.590), Unified Parkinson's Disease Rating Scale (UPDRS)-Part II score (MD = -2.11, 95%CI -4.97 to 0.75, P = 0.150) and Parkinson's Disease Questionnaire (PDQ-39) score (MD = -0.92, 95%CI -4.03 to 2.19, P = 0.560). For quality of evidence, MoCA score, UPDRS-Part II score and PDQ-39 score were low, and depression score and TMT score were moderate.

Conclusion VR technology can improve the cognitive function and depression of patients with Parkinson's disease; however, no significant improvement is found in activities of daily living and quality of life.

Key words: Parkinson's disease, virtual reality, cognitive function, quality of life, meta-analysis

CLC Number:

R742.5

LÜ Meiling, WANG Jie, ZENG Weisi, WEN Xiaoting, CHU Xin. Effect of virtual reality on cognitive function and quality of life in patients with Parkinson's disease: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(6): 648-656.

Figures/Tables 6

Table 1

Figure 1

Figure 2

Table 2

Characteristics of included literatures"

纳入文献	国家	n(T/C)	平均年龄(T/C)/岁	干预措施	干预疗程	结局指标
Carpinella等^[16](2017)	意大利	17/20	(73.00±7.10)/(75.60±8.20)	T：完全沉浸式VR干预：基于Gamepad穿戴设备进行平衡训练 C：物理治疗	每次45 min，每周3次，共7周	⑤
Van Den Heuvel等^[17](2014)	荷兰	16/12	(66.30±6.39)/(68.80±9.68)	T：半沉浸式VR干预：基于增强视觉反馈的平衡训练 C：常规平衡训练	每次60 min，每周2次，共5周	③⑤
Maggio等^[18](2018)	意大利	10/10	(69.90±6.30)/(68.90±10.05)	T：半沉浸式VR干预：基于BTS Nirvana系统的认知训练 C：常规认知训练	每次60 min，每周3次，共8周	③
Santos等^[19](2019)	巴西	13/14	(61.70±7.30)/(64.50±9.80)	T：非沉浸式VR干预：基于Wii系统的平衡训练 C：常规平衡训练	每次50 min，每周2次，共8周	⑤
Allen等^[20](2017)	澳大利亚	18/19	(67.50±7.30)/(68.40±8.50)	T：非沉浸式VR干预：基于平板电脑游戏训练上肢运动功能 C：常规运动训练上肢功能	每周3次，共12周	①②⑤
Lee等^[21](2015)	韩国	10/10	(68.40±2.90)/(70.10±3.30)	T：非沉浸式VR干预：基于Wii系统的平衡训练 C：功能性电刺激	每次30 min，每周5次，共6周	③
Kashif 等^[22](2022)	巴基斯坦	22/22	(63.86±4.57)/(62.32±4.61)	T：非沉浸式VR干预：基于Wii系统的平衡训练 C：常规物理治疗	每次40 min，每周3次，共12周	④
Maggio等^[23](2024)	意大利	12/10	(59.70±9.70)/(66.80±6.50)	T：非沉浸式VR干预：基于VR应用程序的认知训练 C：常规认知训练	每次30 min，每周3次，共6周	①②③
Tollár等^[24](2019)	荷兰	25/25	(70.00±4.69)/(70.60±4.10)	T：非沉浸式VR干预：基于X-box系统的平衡训练 C：动感单车平衡训练	每次60 min，每周5次，共5周	④⑤
Pompeu等^[25](2012)	巴西	16/16	(60~85)/ (60~85)	T：非沉浸式VR干预：基于Wii系统的平衡和认知训练 C：常规平衡训练	每次60 min，每周2次，共7周	①④
Song等^[26](2018)	澳大利亚	28/25	(68±7)/ (65±7)	T：非沉浸式VR干预：基于视频游戏的步态平衡训练 C：常规平衡训练	每次15 min，每周3次，共12周	①②
Pedreira等^[27](2013)	巴西	16/16	(61.10±8.20)/(66.20±8.50)	T：非沉浸式VR干预：基于Wii系统的平衡训练 C：常规平衡训练	每次40 min，每周3次，共4周	⑤
Hajebrahimi等^[28](2022)	土耳其	11/13	(66.36±8.04)/(65.53±9.93)	T：非沉浸式VR干预：基于Wii系统的平衡训练 C：常规平衡训练	每次60 min，每周3次，共4周	①③⑤

Table 2

Table 3

Table 4

References 40

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结局指标	纳入研究数/n	异质性检验		效应模型	Meta分析结果
结局指标	纳入研究数/n	I²值/%	P值	效应模型	MD/SMD(95%CI)	P值
MoCA评分^{[20,23,25-26,28]}	5	0	0.550	固定效应模型	1.11(0.31, 1.90)	0.006
TMT-A评分^[20,23,26]	3	0	0.440	固定效应模型	-6.25(-11.71, -0.78)	0.030
TMT-B评分^[20,23,26]	3	0	0.880	固定效应模型	-6.01(-28.16, 16.14)	0.590
抑郁评分^{[17-18,21,23,28]}	5	22	0.280	固定效应模型	-0.56(-0.95, -0.18)	0.004
UPDRS-Part II评分^[22,24-25]	3	81	0.005	随机效应模型	-2.11(-4.97, 0.75)	0.150
PDQ-39评分^{[16-17,19-20,24,27-28]}	7	2	0.410	固定效应模型	-0.92(-4.03, 2.19)	0.560

结局指标	研究数量/n	样本量/n	不一致性	不精确性	证据等级
MoCA评分^{[20,23,25-26,28]}	5	168	降一级^a	降一级^b	低
TMT-A评分^[20,23,26]	3	112	0	降一级^b	中等
TMT-B评分^[20,23,26]	3	112	0	降一级^b	中等
抑郁评分^{[17-18,21,23,28]}	5	114	0	降一级^b	中等
UPDRS-Part II评分^[22,24-25]	3	126	降一级^a	降一级^b	低
PDQ-39评分^{[16-17,19-20,24,27-28]}	7	235	降一级^a	降一级^b	低

Effect of virtual reality on cognitive function and quality of life in patients with Parkinson's disease: a meta-analysis

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