Efeitos da realidade virtual comparada à reabilitação convencional na função motora de pacientes com doença de Parkinson: uma revisão sistemática com metanálise e metaregressão

Abstract

Introduction: As part of the consequences of Parkinson's disease (PD), patients may experience motor impairments such as bradykinesia, resting tremor, rigidity, and postural instability that affect functionality and quality of life. Virtual reality treatment has been implemented to improve participation in daily activities and functionality. Objective: To assess the effects of virtual reality treatment on the motor function of patients with Parkinson's disease compared to conventional physical rehabilitation, conventional physiotherapeutic treatment, or no intervention. Methods: A meta-analysis and meta-regression review study using data from participants in controlled and randomized clinical trials. A search was conducted in the MEDLINE (PubMed), Embase, Scopus, Cochrane Library, Web of Science, and PEDro databases from October 2020 to July 2021. Eligible studies included interventions using virtual reality equipment as a form of treatment for the physical rehabilitation of patients with PD. Twenty-five randomized clinical trials involving 1008 participants were included. Results: The random-effects meta-analysis showed that virtual reality interventions, compared to control groups, significantly improved balance (14 studies, standardized mean difference = 0.59; 95% CI = 0.3 – 0.88; P < 0.0001) and gait speed (six studies, standardized mean difference = 0.41; 95% CI = 0.05 – 0.25; P = 0.03) in patients with PD. Additionally, meta-regression demonstrated a positive and statistically significant association between training volume and patients' balance (coefficient = 0.0566; 95% CI = 0.0165 – 0.0966; P = 0.057). Moreover, a negative and statistically significant association was observed between training volume and gait speed (coefficient = 0.0647; 95% CI = -0.1135 – 0.158; P = 0.0094). Conclusion: The use of virtual reality as a component of physical rehabilitation positively influenced the motor outcomes of balance and gait speed in patients when compared to traditional treatment approaches. However, it was not possible to differentiate the effects of interventions on mobility, gait performance, freezing of gait, and fear of falls. This review was registered in PROSPERO under the number CRD42020187320.