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Dizziness can be a debilitating condition with various causes, with at least one episode reported in 17% to 30% of the international adult population. Given the effectiveness of rehabilitation in treating dizziness and the recent advancements in telerehabilitation, this systematic review aims to investigate the effectiveness of telerehabilitation in the treatment of this disorder. The search, conducted across Medline, Cochrane Central Register of Controlled Trials, and PEDro databases, included randomized controlled trials assessing the efficacy of telerehabilitation interventions, delivered synchronously, asynchronously, or via tele-support/monitoring. Primary outcomes focused on dizziness frequency/severity and disability, with secondary outcomes assessing anxiety and depression measures. Seven articles met the eligibility criteria, whereas five articles contributed to the meta-analysis. Significant findings were observed regarding the frequency and severity of dizziness (mean difference of 3.01, p < 0.001), disability (mean difference of -4.25, p < 0.001), and anxiety (standardized mean difference of -0.16, p = 0.02), favoring telerehabilitation. Telerehabilitation shows promise as a treatment for dizziness, aligning with the positive outcomes seen in traditional rehabilitation studies. However, the effectiveness of different telerehabilitation approaches requires further investigation, given the moderate methodological quality and the varied nature of existing methods and programs.
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Tontura , Telerreabilitação , Humanos , Tontura/reabilitação , Ansiedade , Resultado do TratamentoRESUMO
BACKGROUND: Humans often use co-speech gestures to promote effective communication. Attention has been paid to the cortical areas engaged in the processing of co-speech gestures. AIMS: To investigate the neural network underpinned in the processing of co-speech gestures and to observe whether there is a relationship between areas involved in language and gesture processing. METHODS & PROCEDURES: We planned to include studies with neurotypical and/or stroke participants who underwent a bimodal task (i.e., processing of co-speech gestures with relative speech) and a unimodal task (i.e., speech or gesture alone) during a functional magnetic resonance imaging (fMRI) session. After a database search, abstract and full-text screening were conducted. Qualitative and quantitative data were extracted, and a meta-analysis was performed with the software GingerALE 3.0.2, performing contrast analyses of uni- and bimodal tasks. MAIN CONTRIBUTION: The database search produced 1024 records. After the screening process, 27 studies were included in the review. Data from 15 studies were quantitatively analysed through meta-analysis. Meta-analysis found three clusters with a significant activation of the left middle frontal gyrus and inferior frontal gyrus, and bilateral middle occipital gyrus and inferior temporal gyrus. CONCLUSIONS: There is a close link at the neural level for the semantic processing of auditory and visual information during communication. These findings encourage the integration of the use of co-speech gestures during aphasia treatment as a strategy to foster the possibility to communicate effectively for people with aphasia. WHAT THIS PAPER ADDS: What is already known on this subject Gestures are an integral part of human communication, and they may have a relationship at neural level with speech processing. What this paper adds to the existing knowledge During processing of bi- and unimodal communication, areas related to semantic processing and multimodal processing are activated, suggesting that there is a close link between co-speech gestures and spoken language at a neural level. What are the potential or actual clinical implications of this work? Knowledge of the functions related to gesture and speech processing neural networks will allow for the adoption of model-based neurorehabilitation programs to foster recovery from aphasia by strengthening the specific functions of these brain networks.
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Background and Objectives: In patients with multiple sclerosis (MS), a decrease in muscle strength can lead to limitations in pulmonary functions, potentially causing respiratory complications. To address these challenges, the lung volume recruitment (LVR) maneuver has emerged as a potential intervention. This study sought to evaluate the impact of a four-week LVR protocol on respiratory function in secondary progressive MS patients. Materials and Methods: In a quasi-randomized pre/post-controlled trial, 24 patients with secondary progressive MS were recruited. Participants aged 20-70 years with an EDSS score of 2 to 9 were alternately allocated to intervention (n = 12) or control groups (n = 12). The intervention group underwent a 4-week respiratory rehabilitation training focused on LVR, using a standardized cough machine treatment protocol twice daily. The control group received no respiratory intervention. Outcomes measured included forced vital capacity (FVC), maximal insufflation capacity (MIC), and peak cough flow (PCF), using turbine spirometry and other associated equipment. All measurements were taken at baseline (T0) and after 4 weeks (T1) by a blinded assessor. Results: For the intervention group, the mean difference pre/post-treatment in MIC (mL) was 0.45 (SD 1.13) (p = 0.02), and in MIC (%), it was 0.13 (SD 0.24) (p = 0.03). Compared to the control group (n = 10), the between-group mean difference for MIC (mL) was 0.54 (p = 0.02), and for MIC (%), it was 0.15 (p = 0.02). Conclusions: The short-term daily LVR protocol notably improved passive lung capacity, despite minimal changes in active lung capacity or cough force. The LVR maneuver offers promise for enhancing respiratory function, especially passive lung capacity, in secondary progressive MS patients. Further research should explore optimal treatment durations and frequencies for more extensive respiratory gains.
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Esclerose Múltipla Crônica Progressiva , Esclerose Múltipla , Humanos , Projetos Piloto , Esclerose Múltipla/complicações , Esclerose Múltipla/terapia , Tosse , Medidas de Volume Pulmonar , Pulmão , Esclerose Múltipla Crônica Progressiva/complicaçõesRESUMO
Several forms of virtual reality (VR) have shown promise in treating mental disorders. However, there is a lack of research investigating the use of multicomponent immersive VR. Therefore, this study aimed to evaluate the effectiveness of an immersive virtual reality (IVR) intervention that incorporated Japanese garden aesthetics, relaxation, and elements of Erickson's psychotherapy in alleviating depression and anxiety symptoms among elderly women. Sixty women with depressive symptoms were randomly assigned to one of two treatment groups. Both groups received eight (twice a week for four weeks) low-intensity general fitness training sessions. The IVR group (n = 30) received eight additional VR-based relaxation sessions, whereas the control group (n = 30) received eight group relaxation. As outcome measures, the geriatric depression scale (GDS; primary) and Hospital Anxiety and Depression Scale (HADS; secondary) were administered before and after the interventions. The protocol was registered in the ClinicalTrials.gov PRS database (Registration number: NCT05285501). Patients receiving IVR therapy exhibited a greater significant reduction in the GDS (adjusted mean post-difference of 4.10; 95% CI = 2.27-5.93) and HADS (2.95; 95% CI = 0.98-4.92) scores than those receiving the control intervention. In conclusion, IVR with elements of psychotherapy, relaxation, and garden aesthetics may alleviate the severity of depression and anxiety symptoms in elderly women.
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Telerehabilitation (TR) seems to be an encouraging solution for the delivery of cognitive treatments in patients with neurological disorders. This study was aimed to analyze and synthesize the evidence on the efficacy of cognitive TR interventions in patients with neurological diseases, compared with conventional face-to-face rehabilitation. From a total of 4485 records, 9 studies met the inclusion criteria for qualitative analysis. At the end of the process, 7 studies remained for quantitative analysis. By comparing TR with face-to-face treatments for cognitive impairments, we assessed improvements in global cognitive domain (Mini Mental State Exam) (MD = -0.86; 95% CI -2.43, 0.72, I2 = 0%), in learning and memory domains (SMD = 0.26, 95% CI -0.22, 0.74, I2 = 24%), in verbal fluency (SMD = 0.08, 95% CI -0.47, 0.62, I2 = 0%), and in executive functions (i.e., problem-solving, central processing speed and working memory) (SMD = 0.38, 95% CI 0.06, 0.71, I2 = 0%). In all the included studies, improvement in the performance of the TR groups was comparable to that achieved through face-to-face intervention. Significant differences between those two modalities of providing treatments were observed for working memory and total executive function comparison, in favor of TR. The results of this study can sustain the efficacy of TR and its application for the treatment of neurological patients, especially when treated for executive function impairments.
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Disfunção Cognitiva , Telerreabilitação , Cognição , Função Executiva , HumanosRESUMO
It remains unknown whether variation of scores on the Medical Research Council (MRC) scale for muscle strength is associated with operator-independent techniques: dynamometry and surface electromyography (sEMG). This study aimed to evaluate whether the scores of the MRC strength scale are associated with instrumented measures of torque and muscle activity in post-stroke survivors with severe hemiparesis both before and after an intervention. Patients affected by a first ischemic or hemorrhagic stroke within 6 months before enrollment and with complete paresis were included in the study. The pre- and post-treatment assessments included the MRC strength scale, sEMG, and dynamometry assessment of the triceps brachii (TB) and biceps brachii (BB) as measures of maximal elbow extension and flexion torque, respectively. Proprioceptive-based training was used as a treatment model, which consisted of multidirectional exercises with verbal feedback. Each treatment session lasted 1 h/day, 5 days a week for a total 15 sessions. Nineteen individuals with stroke participated in the study. A significant correlation between outcome measures for the BB (MRC and sEMG p = 0.0177, ρ = 0.601; MRC and torque p = 0.0001, ρ = 0.867) and TB (MRC and sEMG p = 0.0026, ρ = 0.717; MRC and torque p = 0.0001, ρ = 0.873) were observed post intervention. Regression models revealed a relationship between the MRC score and sEMG and torque measures for both the TB and BB. The results confirmed that variation on the MRC strength scale is associated with variation in sEMG and torque measures, especially post intervention. The regression model showed a causal relationship between MRC scale scores, sEMG, and torque assessments.
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Força Muscular , Músculo Esquelético , Eletromiografia , Humanos , Amplitude de Movimento Articular , Sobreviventes , TorqueRESUMO
OBJECTIVE: To compare results of the observational Wisconsin Gait Scale (WGS) and global gait indexes such as Gait Deviation Index (GDI) and Gait Variability Index (GVI), constituting an objective method of assessing gait, and taking into account parameters identified during 3-dimensional gait analysis (3DGA). DESIGN: A validation study. SETTING: Rehabilitation clinic. PARTICIPANTS: A total of 50 individuals poststroke and 50 individuals without stroke and without gait disorders (N=100). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Gait was evaluated using the WGS. GDI and GVI values were acquired using a movement analysis system. The global gait indexes GDI and GVI were determined based on the kinematic and spatiotemporal parameters, respectively. RESULTS: The study showed statistically significant correlations between the parameters of GDI affected leg and WGS total score (R=-0.87), GVI affected leg and WGS total score (R=-0.93), GVI unaffected leg and WGS total score (R=-0.88), GVI affected/unaffected leg and the total score in the assessment of spatiotemporal parameters on the WGS (R=-0.81) as well as GDI affected leg and the total score in the assessment of kinematics parameters on the WGS (R=-0.85). All correlations were strong (0.7<|R|<0.9) or very strong (0.9<|R|<1). CONCLUSIONS: WGS scores have a strong or very strong correlation with GDI and GVI. The WGS may be recommended as a substitute tool to be used when 3DGA is unavailable, as it is a useful ordinal scale, enabling simple and accurate observational assessment of gait in patients poststroke, with effectiveness that is comparable to the GDI and GVI.
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Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Acidente Vascular Cerebral/complicações , Caminhada/fisiologia , Idoso , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To evaluate the effectiveness of reinforced feedback in virtual environment (RFVE) treatment combined with conventional rehabilitation (CR) in comparison with CR alone, and to study whether changes are related to stroke etiology (ie, ischemic, hemorrhagic). DESIGN: Randomized controlled trial. SETTING: Hospital facility for intensive rehabilitation. PARTICIPANTS: Patients (N=136) within 1 year from onset of a single stroke (ischemic: n=78, hemorrhagic: n=58). INTERVENTIONS: The experimental treatment was based on the combination of RFVE with CR, whereas control treatment was based on the same amount of CR. Both treatments lasted 2 hours daily, 5d/wk, for 4 weeks. MAIN OUTCOME MEASURES: Fugl-Meyer upper extremity scale (F-M UE) (primary outcome), FIM, National Institutes of Health Stroke Scale (NIHSS), and Edmonton Symptom Assessment Scale (ESAS) (secondary outcomes). Kinematic parameters of requested movements included duration (time), mean linear velocity (speed), and number of submovements (peak) (secondary outcomes). RESULTS: Patients were randomized in 2 groups (RFVE with CR: n=68, CR: n=68) and stratified by stroke etiology (ischemic or hemorrhagic). Both groups improved after treatment, but the experimental group had better results than the control group (Mann-Whitney U test) for F-M UE (P<.001), FIM (P<.001), NIHSS (P≤.014), ESAS (P≤.022), time (P<.001), speed (P<.001), and peak (P<.001). Stroke etiology did not have significant effects on patient outcomes. CONCLUSIONS: The RFVE therapy combined with CR treatment promotes better outcomes for upper limb than the same amount of CR, regardless of stroke etiology.
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Terapia por Exercício/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/etiologia , Terapia de Exposição à Realidade Virtual/métodos , Idoso , Fenômenos Biomecânicos , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Método Simples-Cego , Estatísticas não Paramétricas , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento , Extremidade Superior/fisiopatologiaRESUMO
The effect of practice schedule on retention and transfer has been studied since the first publication on contextual interference (CI) in 1966. However, strongly advocated by scientists and practitioners, the CI effect also aroused some doubts. Therefore, our objective was to review the existing literature on CI and to determine how it affects retention in motor learning. We found 1255 articles in the following databases: Scopus, EBSCO, Web of Science, PsycINFO, ScienceDirect, supplemented by the Google Scholar search engine. We screened full texts of 294 studies, of which 54 were included in the meta-analysis. In the meta-analyses, two different models were applied, i.e., a three-level mixed model and random-effects model with averaged effect sizes from single studies. According to both analyses, high CI has a medium beneficial effect on the whole population. These effects were statistically significant. We found that the random practice schedule in laboratory settings effectively improved motor skills retention. On the contrary, in the applied setting, the beneficial effect of random practice on the retention was almost negligible. The random schedule was more beneficial for retention in older adults (large effect size) and in adults (medium effect size). In young participants, the pooled effect size was negligible and statically insignificant.
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Aprendizagem , Destreza Motora , Humanos , Aprendizagem/fisiologia , Destreza Motora/fisiologia , Retenção Psicológica/fisiologiaRESUMO
Virtual reality therapy has been shown to be effective in coping with psychological disorders accompanied by cardiovascular disease. Age appears to be a factor that can affect the effectiveness of psychological therapy in a virtual environment. Therefore, the aim of the study was to explore whether there are age-related differences in the effectiveness of reducing levels of depression and anxiety during a virtual reality psychological intervention implemented for rehabilitation. The study included 25 younger (< 65 years) and 25 older (65 +) patients with cardiovascular disease who participated in virtual reality therapy to cope with anxiety and depression. The Hospital Anxiety and Depression Scale was used to assess anxiety and depressive disorders before and after intervention. Significant reductions in anxiety and depression scores after intervention were observed in both age-matched groups, and no significant differences were found between the younger and older participants. Further evaluation of patient age as a predictor of the effectiveness of psychological intervention in virtual reality did not show a significant effect of age on effectiveness in reducing anxiety and depressive disorders. The results obtained suggest that older patients benefit similarly to younger patients from psychological intervention in a virtual environment. Furthermore, age does not appear to be considered a predictor of effectiveness in reducing the level of anxiety and depression in patients with cardiovascular disease using virtual reality therapy.
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Reabilitação Cardíaca , Doenças Cardiovasculares , Realidade Virtual , Humanos , Reabilitação Cardíaca/métodos , Doenças Cardiovasculares/terapia , Ansiedade/terapia , Ansiedade/psicologia , Transtornos de Ansiedade/psicologiaRESUMO
Force platforms and motion capture are commonly used as feedback mechanisms in exergaming; nevertheless, their therapeutic effectiveness may vary. Therefore, the primary objective of this study was to evaluate the effectiveness of commercially available virtual reality (VR) exergaming systems on balance and functional mobility, with a supplementary analysis considering the administered dose of exergaming. The search was conducted in five databases. Commercially available exergaming platforms were classified into two categories: VR exergaming with a balance board (including Wii Balance Board) and motion capture (including Xbox Kinect). Two categories of control interventions (treatment as usual [TAU] and no treatment [NT]) were extracted. The meta-analysis was performed separately for static, dynamic, and proactive balance outcomes and for the aggregated results of all included outcomes with subgroup analysis of lower, moderate, and higher doses. In total, 28 studies with 1457 participants were included. Both exergaming systems were particularly effective in improving the single leg stance outcome. VR exergaming with motion capture was found to be more effective than TAU with a standardized mean difference (SMD) of 0.48 (P = 0.006) and NT (SMD = 0.86; P = 0.02). In conclusion, commercially available VR exergaming with a motion capture feedback mechanism has demonstrated effectiveness as an intervention for balance training when compared with NT. Specifically, high doses (above 134 minutes per week) appear to be more beneficial for healthy older adults. Moreover, the findings provide some weak evidence supporting the effectiveness of VR exergaming with a balance board for improving functional mobility, particularly when compared with NT.
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OBJECTIVE: To systematically review the effectiveness of psychologically-enhanced cardiac rehabilitation (CR) in improving psychological and functional outcomes in patients with cardiovascular disease. DATA SOURCES: A systematic search was performed in PubMed, Scopus, Cochrane Library, Embase, and Web of Science, up to January 31, 2024. STUDY SELECTION: Two reviewers independently identified randomized clinical trials that evaluated the effectiveness of psychologically-enhanced CR in improving psychological and functional outcomes in patients with cardiovascular disease. The search yielded 1848 results. Finally, data from 14 studies (1531 participants) were included in the review. DATA EXTRACTION AND DATA SYNTHESIS: Information regarding cardiac rehabilitation phase, duration of the intervention, group characteristics, measured outcomes, and the conclusions drawn by the authors was extracted. The Revised Cochrane risk-of-bias tool for Randomized Trials was used to evaluate the methodological quality. RESULTS: Pooled results indicate that psychologically-enhanced CR is more effective than specific cardiac training alone in maintaining lower resting blood pressure, with a mean difference of -3.09 (95% CI: -5.18 to -1.00). Furthermore, psychologically-enhanced CR shows superiority in improving patients' quality of life compared to specific cardiac training alone, with a standardized mean difference of 0.15 (95% CI: 0.01 to 0.31). Analyses of depression and anxiety level, exercise tolerance, and blood lipid profile did not show significant differences between the two treatment conditions. CONCLUSION: Psychologically-enhanced CR shows a positive effect on reducing resting blood pressure and improving the quality of life. However, the supportive methods were of limited effectiveness in addressing the psychological aspects of health. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022304063. CONTRIBUTION OF THE PAPER.
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Telerehabilitation (TR) seems to be a viable and feasible solution to face the rehabilitative challenges posed by neurological impairments and to improve patients' quality of life (QoL). This review aims to synthesize and analyze the evidence on the impact of physiotherapy intervention through TR on QoL in patients with stroke, Parkinson's disease (PD), and multiple sclerosis (MS), together with an evaluation of their satisfaction and technology acceptance levels. Through a systematic search of the literature and a screening process, treatment effects were assessed with meta-analyses using the standardized mean difference, setting the confidence interval at 95%. We included 28 studies in the review, which were analyzed for methodological quality, whereas 16 studies were included in the meta-analyses. The results suggest a significant improvement in QoL in patients who underwent TR. We were unable to perform analyses for satisfaction and technology acceptance outcomes due to insufficient data. Overall, motor TR has a positive impact on the QoL of patients with neurological diseases, especially in stroke patients; although caution is needed in the interpretation of the results due to the high heterogeneity found. For PD and MS, TR seems to yield comparable results to in-person treatment.
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Using virtual reality (VR) for Muscular Dystrophy (MD) rehabilitation promises to be a novel therapeutic approach, potentially enhancing motor learning, functional outcomes, and overall quality of life. This systematic review primarily aimed to provide a comprehensive summary of the current understanding regarding the application of VR in supporting MD rehabilitation. A systematic search was performed in PubMed, Scopus, Cochrane Library, and Web of Science to identify relevant articles. The inclusion criteria encompassed studies involving individuals diagnosed with MD who underwent VR interventions, with a primary focus on assessing functional improvement. Methodological quality of the studies was assessed by using the Physiotherapy Evidence Database (PEDro) scale. Seven studies, involving 440 individuals with Duchenne Muscular Dystrophy (DMD), were included in the review. Among these studies, six primarily explored the motor learning potential of VR, while one study investigated the impact of VR training on functional abilities. In conclusion, the qualitative synthesis supports VR-based interventions' potential positive effects on motor learning, performance improvement, and functional outcomes in individuals with DMD. However, current usage mainly focuses on assessing the potential mechanisms' benefits, suggesting the importance of expanding clinical adoption to harness their therapeutic potential for MD patients.
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Technological innovation has revolutionized healthcare, particularly in neurological rehabilitation, where it has been used to address chronic conditions. Smart home and building automation (SH&BA) technologies offer promising solutions for managing chronic disabilities associated with such conditions. This single group, pre-post longitudinal pilot study, part of the H2020 HosmartAI project, aims to explore the integration of smart home technologies into neurorehabilitation. Eighty subjects will be enrolled from IRCCS San Camillo Hospital (Venice, Italy) and will receive rehabilitation treatment through virtual reality (VR) and robotics devices for 15 h per day, 5 days a week for 3 weeks in the HosmartAI Room (HR), equipped with SH&BA devices measuring the environment. The study seeks to optimize patient outcomes and refine rehabilitation practices. Findings will be disseminated through peer-reviewed publications and scientific meetings, contributing to advancements in neurological rehabilitation and guiding future research.
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BACKGROUND: Recent evidence has demonstrated the efficacy of Virtual Reality (VR) for stroke rehabilitation nonetheless its benefits and limitations in large population of patients have not yet been studied. OBJECTIVES: To evaluate the effectiveness of non-immersive VR treatment for the restoration of the upper limb motor function and its impact on the activities of daily living capacities in post-stroke patients. METHODS: A pragmatic clinical trial was conducted among post-stroke patients admitted to our rehabilitation hospital. We enrolled 376 subjects who had a motor arm subscore on the Italian version of the National Institutes of Health Stroke Scale (It-NIHSS) between 1 and 3 and without severe neuropsychological impairments interfering with recovery. Patients were allocated to two treatments groups, receiving combined VR and upper limb conventional (ULC) therapy or ULC therapy alone. The treatment programs consisted of 2 hours of daily therapy, delivered 5 days per week, for 4 weeks. The outcome measures were the Fugl-Meyer Upper Extremity (F-M UE) and Functional Independence Measure (FIM) scales. RESULTS: Both treatments significantly improved F-M UE and FIM scores, but the improvement obtained with VR rehabilitation was significantly greater than that achieved with ULC therapy alone. The estimated effect size of the minimal difference between groups in F-M UE and FIM scores was 2.5 ± 0.5 (P < 0.001) pts and 3.2 ± 1.2 (P = 0.007) pts, respectively. CONCLUSIONS: VR rehabilitation in post-stroke patients seems more effective than conventional interventions in restoring upper limb motor impairments and motor related functional abilities. TRIAL REGISTRATION: Italian Ministry of Health IRCCS Research Programme 2590412.
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Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral , Extremidade Superior/fisiopatologia , Terapia de Exposição à Realidade Virtual/métodos , Atividades Cotidianas , Idoso , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Resultado do TratamentoRESUMO
This study aimed to evaluate the differences in patient satisfaction between telerehabilitation and traditional face-to-face rehabilitation and to identify the impact of personality traits on patient satisfaction with the remote form of rehabilitation. Eighty participants with musculoskeletal pain were recruited for the study. The telerehabilitation group (n = 40) completed a single remote session of rehabilitation, whereas the traditional rehabilitation group (n = 40) completed a single face-to-face session. After therapy, each participant was asked to complete a tailored satisfaction survey using Google Forms. The Health Care Satisfaction Questionnaire (HCSQ) and the International Personality Item Pool-Big Five Markers-20 (IPIP-BFM-20) were used as outcome measures. Considering the results of patient satisfaction with healthcare service, there were no statistically significant differences between telerehabilitation and traditional rehabilitation groups in the total HCSQ score and its subscales. For the complete HCSQ, agreeableness, conscientiousness, and extraversion were essential predictor variables, accounting for 51% of the variance in patient satisfaction. In conclusion, there were no differences in patient satisfaction between telerehabilitation and traditional rehabilitation groups. In the telerehabilitation group, higher agreeableness levels and lower conscientiousness and extraversion level could predict patients' satisfaction with telerehabilitation.
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COVID-19 , Telerreabilitação , Humanos , Satisfação do Paciente , Controle de Doenças Transmissíveis , Avaliação de Resultados em Cuidados de SaúdeRESUMO
Background: Appropriately selected complementary therapies, such as virtual reality (VR) and active video games (AVG), provide support to young patients during the process of cancer treatment. Therefore, this systematic review with meta-analysis aimed to analyze the effects of VR and AVG on fear, physical functions, and quality of life. Methods: A systematic search was performed independently in Scopus, PubMed, Embase, Web of Science and Cochrane Library electronic databases for relevant randomized controlled and crossover studies. From a total of 5,963 records, 11 met the inclusion criteria. After full-text screening two publications were excluded, yet six studies were included in the quantitative analysis because three studies had a large discrepancy in their measured outcomes. For methodological quality assessments, the RoB2 software program was used, while RevMan 5.4.1 was used for statistical analysis and meta-analysis. Standard Mean Difference (SMD) outcome measures were used for the analysis. Statistical heterogeneity was assessed using the I2 statistic with a cut-off value of 50% considering intervention and outcome measures. Results: Our systematic review includes six randomized controlled studies and three randomized crossover studies. The participants represented both sexes and were children and adolescents (<18 years old) with a diagnosis of cancer. The analysis of the results allows for a careful conclusion that VR has the potential to become an accessory tool in rehabilitation and oncologic treatment. All of the included studies noted a significant advantage of this intervention. Conclusion: VR has the potential to be an effective and important tool in the oncologic treatment of children. VR immerses the patient, and as a result, produces a distraction that effectively reduces pain associated with standard oncologic care procedures in children. However, this systematic review and meta-analysis highlights the need for more research into the use of VR as support for pediatric oncologic care. Systematic review registration: PROSPERO database (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319000), CRD42022319000.
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Neoplasias , Realidade Virtual , Criança , Masculino , Adolescente , Feminino , Humanos , Qualidade de Vida , Medo , Avaliação de Resultados em Cuidados de Saúde , Dor , Neoplasias/terapiaRESUMO
BACKGROUND: The large-scale digitalization of healthcare has induced shifts in patient preferences, prompting the introduction of therapies utilizing novel technologies. In this context, the targeted application of these interventions is deemed as crucial as assessing their overall effectiveness. The aim of this study was to characterize the patient profile who benefited most from immersive virtual reality (VR) therapy. METHODS: Based on the results from the previous randomized controlled trial study, we employed an exploratory study design to determine the factors associated with the most significant mental health improvement. A secondary analysis was conducted on a sample of 83 participants, with further analysis of participants with elevated depression symptoms, as indicated by a score of > 10 on the 30-item Geriatric Depression Scale (GDS-30). Both groups participated in a similar post-stroke rehabilitation program; however, the experimental group also received additional VR therapy through an immersive VR garden intervention. The GDS-30 was used to assess mood and depressive symptoms, and sociodemographic, cognitive status as well as stroke-related variables were considered as potential factors. RESULTS: In both the experimental (mean change 5.3) and control groups (mean change 2.8), interventions significantly reduced depressive symptoms, with a more pronounced difference in the experimental group (p < 0.05). When examining gender differences, women exhibited greater improvement in the GDS, with mean between-group differences of 5.0 for the total sample and 6.0 for those with elevated depressive symptoms. Sociodemographic factors, cognitive status, and time from stroke were not found to be factors that alter the effectiveness of VR therapy. CONCLUSIONS: While VR therapy as an adjunctive treatment for post-stroke rehabilitation seems especially effective for women with elevated depressive symptoms, the results should be interpreted with caution due to the study's small experimental group size. Traditional methods showed reduced effectiveness in women compared to men; thus, developing technologically advanced and gender-specific approaches can lead to more tailored therapy. TRIAL REGISTRATION: NCT03830372 (February 5, 2019).
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Technological advancements facilitate feedback adaptation in rehabilitation through virtual reality (VR) exergaming, serious gaming, wearables, and telerehabilitation for older adults fall prevention. Although studies have evaluated these technologies, no comparisons of their effectiveness have been conducted to date. Thus, this study aims to assess the differences in effectiveness of these interventions on balance and functional mobility in the older adults. A systematic review and network meta-analysis (NMA) were conducted to identify the most effective interventions for improving balance and functional mobility in adults aged 60 and over. The search was conducted in five databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science) up to June 10, 2023. The eligibility criteria were: (1) older adults, (2) functional mobility, balance, or gait as the primary outcome, (3) new technology intervention, and (4) randomized study design. New technology interventions were classified into five categories: exergaming with balance platforms or motion capture technologies, other serious gaming, interventions with wearables, and telerehabilitation. Additionally, two categories of control interventions (conventional exercises and no treatment) were extracted. The NMA was performed for the aggregated results of all outcomes, and separately for clinical functional scales, functional mobility, and gait speed results. Fifty-two RCTs with 3081 participants were included. Exergaming with motion capture was found to be statistically significant in producing a better effect than no treatment in the analysis of the functional mobility with an SMD of -0.70 (P < 0.01). The network meta-analysis revealed that exergaming with motion capture offers greater therapeutic benefits for functional mobility and balance compared to no treatment control. The effectiveness of this approach is similar to that of conventional exercises. Further RCTs are needed to provide a more definitive conclusion, particularly with respect to the effectiveness of serious games, telerehabilitation, and interventions with wearables.