title: Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review.
abstract: OBJECTIVE
  In people after stroke, does virtual reality based rehabilitation (VRBR) improve walking speed, balance and mobility more than the same duration of standard rehabilitation? In people after stroke, does adding extra VRBR to standard rehabilitation improve the effects on gait, balance and mobility?
  
  
  METHODS
  Systematic review with meta-analysis of randomised trials.
  
  
  METHODS
  Adults with a clinical diagnosis of stroke.
  
  
  METHODS
  Eligible trials had to include one these comparisons: VRBR replacing some or all of standard rehabilitation or VRBR used as extra rehabilitation time added to a standard rehabilitation regimen.
  
  
  METHODS
  Walking speed, balance, mobility and adverse events.
  
  
  RESULTS
  In total, 15 trials involving 341 participants were included. When VRBR replaced some or all of the standard rehabilitation, there were statistically significant benefits in walking speed (MD 0.15 m/s, 95% CI 0.10 to 0.19), balance (MD 2.1 points on the Berg Balance Scale, 95% CI 1.8 to 2.5) and mobility (MD 2.3 seconds on the Timed Up and Go test, 95% CI 1.2 to 3.4). When VRBR was added to standard rehabilitation, mobility showed a significant benefit (0.7 seconds on the Timed Up and Go test, 95% CI 0.4 to 1.1), but insufficient evidence was found to comment about walking speed (one trial) and balance (high heterogeneity).
  
  
  CONCLUSIONS
  Substituting some or all of a standard rehabilitation regimen with VRBR elicits greater benefits in walking speed, balance and mobility in people with stroke. Although the benefits are small, the extra cost of applying virtual reality to standard rehabilitation is also small, especially when spread over many patients in a clinic. Adding extra VRBR time to standard rehabilitation also has some benefits; further research is needed to determine if these benefits are clinically worthwhile.
authors.affiliation: Rehabilitation Department, San Raffaele Hospital, Milan.
authors.forename: Davide
authors.initials: D
authors.lastname: Corbetta
authors.affiliation: Private Practice.
authors.forename: Federico
authors.initials: F
authors.lastname: Imeri
authors.affiliation: Laboratory of Analysis and Rehabilitation of Motor Function, Neuroscience Division, San Raffaele Hospital, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gatti
mesh_terms: D005684:Gait / Q000502:physiology; D006801:Humans; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology*; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation / Q000379:methods*; D014584:User-Computer Interface; D016138:Walking / Q000502:physiology*
keywords: Postural balance; Stroke rehabilitation; Virtual reality exposure therapy; Walking