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Virtual Reality for Upper Limb Rehabilitation in Patients With Obstetric Brachial Palsy: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND: Obstetric brachial palsy (OBP) is a pathology caused by complications during childbirth because of cervical spine elongation, affecting the motor and sensory innervation of the upper limbs. The most common lesion occurs on the C5 and C6 nerve branches, known as Erb-Duchenne palsy. The le...

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Autores principales: De Miguel-Rubio, Amaranta, Alba-Rueda, Alvaro, Millán-Salguero, Elena María, De Miguel-Rubio, M Dolores, Moral-Munoz, Jose A, Lucena-Anton, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10365570/
https://www.ncbi.nlm.nih.gov/pubmed/37389922
http://dx.doi.org/10.2196/47391
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author De Miguel-Rubio, Amaranta
Alba-Rueda, Alvaro
Millán-Salguero, Elena María
De Miguel-Rubio, M Dolores
Moral-Munoz, Jose A
Lucena-Anton, David
author_facet De Miguel-Rubio, Amaranta
Alba-Rueda, Alvaro
Millán-Salguero, Elena María
De Miguel-Rubio, M Dolores
Moral-Munoz, Jose A
Lucena-Anton, David
author_sort De Miguel-Rubio, Amaranta
collection PubMed
description BACKGROUND: Obstetric brachial palsy (OBP) is a pathology caused by complications during childbirth because of cervical spine elongation, affecting the motor and sensory innervation of the upper limbs. The most common lesion occurs on the C5 and C6 nerve branches, known as Erb-Duchenne palsy. The least common lesion is when all nerve roots are affected (C5-T1), which has the worst prognosis. Virtual reality (VR) is commonly used in neurological rehabilitation for the evaluation and treatment of physical deficits. OBJECTIVE: This systematic review aims to assess the efficacy of VR in the rehabilitation of upper limb function in patients with OBP. METHODS: A search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines in several scientific databases—PubMed, Web of Science, PEDro, Cochrane, MEDLINE, Scopus, and CINAHL—without language or date restrictions and including articles published up to April 2023. The inclusion criteria were established according to the population, intervention, comparison, outcome, and study (PICOS) design framework: children aged <18 years diagnosed with OBP, VR therapy used in addition to conventional therapy or isolated, VR therapy compared with conventional therapy, outcomes related to OBP rehabilitation therapy, and randomized controlled trials (RCTs). The PEDro scale was used to assess the methodological quality of the RCTs, and the Cochrane Collaboration tool was used to assess the risk of bias. The Review Manager statistical software (version 5.4; The Cochrane Collaboration) was used to conduct the meta-analysis. The results were synthesized through information extraction and presented in tables and forest plots. RESULTS: In total, 5 RCTs were included in this systematic review, with 3 (60%) providing information for the meta-analysis. A total of 138 participants were analyzed. All the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed no favorable results for all outcomes except for the hand-to-mouth subtest of the Mallet scoring system (functional activity; standardized mean difference −0.97, 95% CI −1.67 to −0.27; P=.007). CONCLUSIONS: The evidence for the use of VR therapy for upper limb rehabilitation outcomes in patients with OBP was insufficient to support its efficacy and strongly recommend its use. Nevertheless, scientific literature supports the use of VR technologies for rehabilitation as it provides several advantages, such as enhancing the patient’s motivation, providing direct feedback, and focusing the patient’s attention during the intervention. Thus, the use of VR for upper limb rehabilitation in patients with OBP is still in its first stages. Small sample sizes; limited long-term analysis; lack of testing of different doses; and absence of International Classification of Functioning, Disability, and Health–related outcomes were present in the included RCTs, so further research is needed to fully understand the potential of VR technologies as a therapeutic approach for patients with OBP. TRIAL REGISTRATION: PROSPERO CRD42022314264; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=314264
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spelling pubmed-103655702023-07-25 Virtual Reality for Upper Limb Rehabilitation in Patients With Obstetric Brachial Palsy: Systematic Review and Meta-Analysis of Randomized Controlled Trials De Miguel-Rubio, Amaranta Alba-Rueda, Alvaro Millán-Salguero, Elena María De Miguel-Rubio, M Dolores Moral-Munoz, Jose A Lucena-Anton, David J Med Internet Res Review BACKGROUND: Obstetric brachial palsy (OBP) is a pathology caused by complications during childbirth because of cervical spine elongation, affecting the motor and sensory innervation of the upper limbs. The most common lesion occurs on the C5 and C6 nerve branches, known as Erb-Duchenne palsy. The least common lesion is when all nerve roots are affected (C5-T1), which has the worst prognosis. Virtual reality (VR) is commonly used in neurological rehabilitation for the evaluation and treatment of physical deficits. OBJECTIVE: This systematic review aims to assess the efficacy of VR in the rehabilitation of upper limb function in patients with OBP. METHODS: A search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines in several scientific databases—PubMed, Web of Science, PEDro, Cochrane, MEDLINE, Scopus, and CINAHL—without language or date restrictions and including articles published up to April 2023. The inclusion criteria were established according to the population, intervention, comparison, outcome, and study (PICOS) design framework: children aged <18 years diagnosed with OBP, VR therapy used in addition to conventional therapy or isolated, VR therapy compared with conventional therapy, outcomes related to OBP rehabilitation therapy, and randomized controlled trials (RCTs). The PEDro scale was used to assess the methodological quality of the RCTs, and the Cochrane Collaboration tool was used to assess the risk of bias. The Review Manager statistical software (version 5.4; The Cochrane Collaboration) was used to conduct the meta-analysis. The results were synthesized through information extraction and presented in tables and forest plots. RESULTS: In total, 5 RCTs were included in this systematic review, with 3 (60%) providing information for the meta-analysis. A total of 138 participants were analyzed. All the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed no favorable results for all outcomes except for the hand-to-mouth subtest of the Mallet scoring system (functional activity; standardized mean difference −0.97, 95% CI −1.67 to −0.27; P=.007). CONCLUSIONS: The evidence for the use of VR therapy for upper limb rehabilitation outcomes in patients with OBP was insufficient to support its efficacy and strongly recommend its use. Nevertheless, scientific literature supports the use of VR technologies for rehabilitation as it provides several advantages, such as enhancing the patient’s motivation, providing direct feedback, and focusing the patient’s attention during the intervention. Thus, the use of VR for upper limb rehabilitation in patients with OBP is still in its first stages. Small sample sizes; limited long-term analysis; lack of testing of different doses; and absence of International Classification of Functioning, Disability, and Health–related outcomes were present in the included RCTs, so further research is needed to fully understand the potential of VR technologies as a therapeutic approach for patients with OBP. TRIAL REGISTRATION: PROSPERO CRD42022314264; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=314264 JMIR Publications 2023-06-30 /pmc/articles/PMC10365570/ /pubmed/37389922 http://dx.doi.org/10.2196/47391 Text en ©Amaranta De Miguel-Rubio, Alvaro Alba-Rueda, Elena María Millán-Salguero, M Dolores De Miguel-Rubio, Jose A Moral-Munoz, David Lucena-Anton. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.06.2023. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Review
De Miguel-Rubio, Amaranta
Alba-Rueda, Alvaro
Millán-Salguero, Elena María
De Miguel-Rubio, M Dolores
Moral-Munoz, Jose A
Lucena-Anton, David
Virtual Reality for Upper Limb Rehabilitation in Patients With Obstetric Brachial Palsy: Systematic Review and Meta-Analysis of Randomized Controlled Trials
title Virtual Reality for Upper Limb Rehabilitation in Patients With Obstetric Brachial Palsy: Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_full Virtual Reality for Upper Limb Rehabilitation in Patients With Obstetric Brachial Palsy: Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_fullStr Virtual Reality for Upper Limb Rehabilitation in Patients With Obstetric Brachial Palsy: Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_full_unstemmed Virtual Reality for Upper Limb Rehabilitation in Patients With Obstetric Brachial Palsy: Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_short Virtual Reality for Upper Limb Rehabilitation in Patients With Obstetric Brachial Palsy: Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_sort virtual reality for upper limb rehabilitation in patients with obstetric brachial palsy: systematic review and meta-analysis of randomized controlled trials
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10365570/
https://www.ncbi.nlm.nih.gov/pubmed/37389922
http://dx.doi.org/10.2196/47391
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