Evaluation instruments for physical therapy using virtual reality in stroke patients: a systematic review.

BACKGROUND: Physiotherapeutic rehabilitation is essential to improve functional mobility, muscular strength, balance and quality of life of stroke patients, but conventional techniques using repeated physical activities can soon become monotonous. The use of virtual reality (VR) in rehabilitation offers a possible alternative to the traditional methods of promoting improvements in muscle strength and balance. However, there is not yet consensus about which instruments should be used to assess the effectiveness of VR in stroke rehabilitation. OBJECTIVE: To conduct a systematic review to identify the types of evaluation tools used for different VR interventions to rehabilitate stroke patients, considering balance, strength, function, quality of life, cognition and motivation. DATA SOURCES: A comprehensive literature search using MEDLINE-PubMed, Web of Science, Scopus, Lilacs and IEEE Xplore was undertaken. STUDY SELECTION: Studies on stroke patients who had undergone VR therapy and an assessment of its effectiveness using evaluative instruments. STUDY APPRAISAL AND SYNTHESIS METHODS: Data were extracted by a single reviewer using standardised forms, and were checked by a second reviewer. The extracted information included study design, number of participants, type of stroke, items that were evaluated (balance, muscle strength, functional evaluation), console used, number of rehabilitation sessions, results and conclusions. RESULTS: In total, 1836 articles were identified; of these, 29 were included in this review after consideration of the inclusion and exclusion criteria. The selected articles rated one or more of the following factors: balance (n=12), grip strength (with or without devices for direct measurement) (n=8), functionality (n=12) and quality of life (n=12). LIMITATIONS: The full text of one article was not available, despite a request to the authors to send it via email. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: The Berg Balance Scale, the Fugl-Meyer Assessment and the Stroke Impact Scale were the instruments used most frequently to assess balance, function and quality of life, respectively, in stroke patients who underwent rehabilitation using VR. Systematic review registration PROSPERO number: 87546.