The effectiveness of virtual reality for rehabilitation of Parkinson disease: an overview of systematic reviews with meta-analyses

Abstract

Background: An increasing number of systematic reviews (SRs) and meta-analyses (MAs) of clinical trials have begun to investigate the effects of virtual reality (VR) in patients with Parkinson disease (PD). The aim of this overview was to systematically summarize the current best evidence for the effectiveness of VR therapy for the rehabilitation of people with PD.

Methods: We searched SR-MAs based on randomized controlled trials (RCTs) for relevant literature in PubMed, Embase, and Cochrane library databases for systematic reviews from inception to December 5, 2020, and updated to January 26, 2022. The methodological quality of included SR-MAs was evaluated with the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and the certainty of evidence for outcomes with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We created an evidence map using a bubble plot format to represent the evidence base in 5 dimensions: effect size of VR therapy versus active intervention (AT), clinical outcome area, number of trials, statistical significance, and certainty of evidence.

Results: From a total of 585 reports, 12 reviews were identified, of which only one was rated moderate quality, three were rated low quality, and eight were rated critically low quality by AMSTAR 2. Compared with AT, VR therapy induced increased benefits on stride/step length, balance, and neuropsychiatric symptoms. Compared with passive intervention (PT), VR therapy had greater effects on gait speed, stride/step length, balance, activities of daily living, and postural control in people with PD. Certainty of evidence varied from very low to moderate.

Conclusions: We found the methodological quality of the reviews was poor, and certainty of the most evidence within them was low to very low. We were therefore unable to conclude with any confidence that, in people with PD, VR therapy is harmful or beneficial for gait, balance, motor function, quality of life, activities of daily living, cognitive function, neuropsychiatric symptoms, and postural control. In the future, rigorous-designed, high-quality RCTs with larger sample sizes are needed to further verify the effectiveness of VR therapy in the treatment of PD.

Keywords: Effectiveness; Meta-analyses; Overview; Parkinson disease; Systematic reviews; Virtual reality.