脳卒中後の片麻痺患者に対する手の機能に対する仮想現実の効果：ランダム化比較試験のメタアナリシス

BackgroundHemiplegia resulting from a stroke frequently causes considerable difficulties in hand function. Virtual reality (VR) therapy has evolved as an innovative and engaging method to facilitate sensorimotor rehabilitation.ObjectiveThis meta-analysis assessed the efficacy of VR-based therapies on hand function in post-stroke hemiplegic patients. The study evaluated the impact of treatment duration, type of VR (immersive, semi-immersive, non-immersive), and stroke stage (subacute versus chronic) on outcomes.MethodsA comprehensive search of six databases until September 2024 identified randomized controlled trials (RCTs) that compared VR therapy with conventional rehabilitation or sham control. The primary outcomes consisted of validated, hand-specific performance metrics, including the Fugl-Meyer upper extremity subscale, Action Research Arm Test, Box and Block Test, Jebsen-Taylor Hand Function Test and Box and Block Test.ResultsTwenty-five RCTs involving 844 participants were evaluated. VR therapy significantly enhanced hand function (SMD = 0.68; 95% CI: 0.41-0.95; p < 0.00001), while there was considerable heterogeneity (I² = 71%). Subgroup analysis indicated that semi-immersive VR had the most significant benefit (SMD = 1.03), whereas interventions with a cumulative training duration beyond 12 h, along with those administered to subacute patients, demonstrated greater effect size in hand function relative to shorter interventions (pooled SMD for >12 h = 0.94; 95% CI: 0.66-1.23).ConclusionThis meta-analysis suggests that semi-immersive VR therapy improves hand function in post-stroke patients, especially when the total cumulative treatment duration exceeds 12 h. Future research should determine the principal treatment elements, establish uniform dosing methods, and evaluate long-term results, including activities of daily living and quality of life.