Are virtual reality technologies effective in improving lower limb outcomes for patients following stroke - a systematic review with meta-analysis

Background: Stroke is one of the leading causes of disability worldwide with many survivors restricted to their immediate environment secondary to various impairments. Objectives: To review existing studies assessing effects of virtual reality (VR) on lower limb outcomes in stroke patients. Data sources: We searched MEDLINE, CINAHL, EMBASE, PEDro, and Cochrane Library from their beginning to August 2015. Eighteen meta-analyses were performed using weighted mean differences (WMD) and standardized mean differences (SMD) and 95% confidence intervals (CI) to summarize results. Study selection: Randomized control trials using VR interventions within adult stroke populations for lower limb outcomes. Trials were screened by two independent authors for eligibility and bias. Data extraction: Trials were grouped according to acute-subacute and chronic stroke populations and outcomes were classified as functional balance, static balance, functional gait/mobility, spatiotemporal gait parameters, or motor function. Results: 22 studies with 552 participants were included. Significant differences in favor of VR group were found for functional balance (SMD 0.42, 95% CI 0.11-0.73), gait velocity (WMD 0.12, 95% CI 0.03-0.22), cadence (WMD 11.91, 95% CI 2.05-21.78), and stride length (WMD 9.79, 95% CI 0.74-18.84) within the chronic population. Conclusions: VR improves functional balance and various aspects of gait in chronic populations. Evidence also suggests that VR is just as effective as conventional therapy, hence its' use in practice is determined by affordability, and patient/practitioner preferences.