Introduction
Methods
Participants
Procedures
Instruments
Primary Outcome Measures
Statistical Analysis
Results
Effect of Treatment
Age | Gender | Time since lesion (years) | Side of dominancea
| Side of hemiparesis | Lesion site | |
---|---|---|---|---|---|---|
Conventional therapy
| ||||||
1 | 55.0 | F | 3.1 | R | R | BG, IC |
2 | 58.0 | M | 4.5 | R | R | – |
3 | 75.0 | M | 3.8 | R | R | BG, IC |
4 | 70.0 | F | 2.7 | R | L | Corona radiata |
5 | 68.0 | M | 3.7 | R | L | – |
6 | 33.0 | F | 5.0 | R | L | Frontotemporal, BG |
Mean | 59.8 | 3.8 | ||||
SD | 15.1 | 0.9 | ||||
Virtual reality therapy
| ||||||
1 | 63.5 | F | 3.0 | L | R | – |
2 | 66.0 | M | 3.7 | R | L | – |
3 | 80.0 | M | 2.0 | L | R | Frontal–parietal, BG, IC |
4 | 50.0 | M | 2.0 | R | R | Posterior IC |
5 | 39.0 | F | 3.8 | R | L | Subcortical |
6 | 50.0 | F | 0.8 | R | R | Parietal–occipital |
Mean | 58.1 | 2.6 | ||||
SD | 14.6 | 1.2 |
Pre-test 1 | Pre-test 2 | Post-test | Follow-up test | |
---|---|---|---|---|
Body Structure and Function Level: Impairment
| ||||
FMA (66)
| ||||
Conventional | 42.3 | 43.9 | 44.9 | 48.0 |
(13.6) | (13.0) | (11.7) | (11.6) | |
Virtual reality | 40.1 | 42.3 | 47.3 | 46.3 |
(13.6) | (11.8) | (11.9) | (10.0) | |
CSI (16)
| ||||
Conventional | 8.5 | 9.2 | 8.7 | 7.5 |
(2.7) | (2.2) | (1.4) | (1.0) | |
Virtual reality | 7.7 | 7.2 | 6.2 | 6.0 |
(1.9) | (1.7) | (2.9) | (2.3) | |
RPSS (18)
| ||||
Conventional | 11.5 | 10.5 | 12.8 | 13.6 |
(4.7) | (4.1) | (3.6) | (4.0) | |
Virtual reality | 13.3 | 13.7 | 15.0 | 14.3 |
(4.1) | (3.1) | (3.0) | (3.2) | |
Activity Level: Function
| ||||
BBT (% less-affected side) | ||||
Conventional | 20.5 | 23.8 | 23.9 | 30.1 |
(18.6) | (21.1) | (21.2) | (23.8) | |
Virtual reality | 29.5 | 29.8 | 30.3 | 32.2 |
(26.9) | (26.7) | (27.7) | (28.0) | |
WMFT (total)
| ||||
Conventional | 47.5 | 50.2 | 53.2 | 55.3 |
(13.6) | (13.8) | (20.0) | (17.7) | |
Virtual reality | 47.0 | 48.2 | 54.3 | 55.7 |
(16.4) | (14.0) | (16.1) | (16.3) | |
WMFT (time; s)
| ||||
Conventional | 14.3 | 12.0 | 14.8 | 12.4 |
(11.5) | (8.4) | (13.4) | (10.9) | |
Virtual reality | 15.4 | 14.5 | 14.8 | 12.4 |
(9.1) | (9.4) | (10.5) | (7.5) | |
Participation Level: Participation
| ||||
MAL-QOM
| ||||
Conventional | 1.18 | 1.27 | 1.72 | 1.80 |
(1.53) | (1.51) | (1.84) | (2.06) | |
Virtual reality | 1.22 | 1.18 | 1.08 | 1.37 |
(1.14) | (1.15) | (1.08) | (1.32) | |
MAL-AOU
| ||||
Conventional | 1.18 | 1.23 | 1.65 | 1.57 |
(1.57) | (1.53) | (1.87) | (1.92) | |
Virtual reality | 1.10 | 1.13 | 1.08 | 1.20 |
(1.06) | (1.05) | (1.12) | (1.15) |
Conventional | Virtual reality | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Subject | Pre-test | Post-test | Difference post–pre | ES | Follow-up | Difference FUP-pre | ES | Pre-test | Post-test | Difference post–pre | ES | Follow-up | Difference FUP-pre | ES |
Fugl–Meyer Assessment (FMA)
| ||||||||||||||
1 | 61.0 | 59.5 | −1.5 | −0.12 | 61.5 | 0.5 | 0.04 | 44.0 | 47.0 | 3.0 | 0.25 | 44.5 | 0.5 | 0.04 |
2 | 29.0 | 38.0 | 9.0 |
0.69
| 43.0 | 14.0 |
1.08
| 24.0 | 28.0 | 4.0 |
0.34
| 33.0 | 9.0 |
0.76
|
3 | 35.5 | 39.0 | 3.5 | 0.27 | 46.5 | 11.0 |
0.85
| 52.0 | 56.0 | 4.0 |
0.34
| 55.0 | 3.0 | 0.25 |
4 | 48.0 | 45.0 | −3.0 | −0.23 | 47.0 | −1.0 | −0.08 | 57.0 | 63.0 | 6.0 |
0.51
| 60.0 | 3.0 | 0.25 |
5 | 56.0 | 58.0 | 2.0 | 0.15 | 60.0 | 4.0 |
0.31
| 41.0 | 44.0 | 3.0 | 0.25 | 39.0 | −2.0 | −0.18 |
6 | 34.0 | 30.0 | −4.0 |
−0.31
| 30.0 | −4.0 |
−0.31
| 35.5 | 46.0 | 10.5 |
0.89
| 46.0 | 10.5 |
0.89
|
Composite Spasticity Index (CSI)
| ||||||||||||||
1 | 10.0 | 7.0 | −3.0 |
−1.36
| 6.0 | −4.0 |
−1.82
| 6.0 | 6.0 | 0.0 | 0.00 | 9.0 | 3.0 |
1.77
|
2 | 10.0 | 10.0 | 0.0 | 0.00 | 8.0 | −2.0 |
−0.91
| 5.0 | 3.0 | −2.0 |
−1.18
| 4.0 | −1.0 |
−0.59
|
3 | 12.0 | 9.0 | −3.0 |
−1.36
| 8.0 | −4.0 |
−1.82
| 7.0 | 4.0 | −3.0 |
−1.76
| 4.0 | −3.0 |
−1.77
|
4 | 6.0 | 9.0 | 3.0 |
1.36
| 7.0 | 1.0 |
0.46
| 7.0 | 5.0 | −2.0 |
−1.18
| 4.0 | −3.0 |
−1.77
|
5 | 7.0 | 7.0 | 0.0 | 0.00 | 7.0 | 0.0 | 0.00 | 8.0 | 8.0 | 0.0 | 0.00 | 8.0 | 0.0 | 0.00 |
6 | 10.0 | 10.0 | 0.0 | 0.00 | 9.0 | −1.0 |
−0.46
| 10.0 | 11.0 | 1.0 |
0.59
| 7.0 | −3.0 |
−1.77
|
Reaching Performance Scale for Stroke (RPSS)-close target
| ||||||||||||||
1 | 13.0 | 16.0 | 3.0 |
0.73
| 17.5 | 4.5 |
1.10
| 13.0 | 16.0 | 3.0 |
0.97
| 12.0 | −1.0 |
−0.32
|
2 | 6.0 | 10.0 | 4.0 |
0.98
| 10.0 | 4.0 |
0.98
| 12.0 | 10.0 | −2.0 |
−0.65
| 10.0 | −2.0 |
−0.65
|
3 | 11.0 | 12.0 | 1.0 | 0.24 | 14.0 | 3.0 |
0.73
| 17.0 | 18.0 | 1.0 |
0.32
| 18.0 | 1.0 |
0.32
|
4 | 9.0 | 13.0 | 4.0 |
0.98
| 14.0 | 5.0 |
1.22
| 18.0 | 18.0 | 0.0 | 0.00 | 18.0 | 0.0 | 0.00 |
5 | 17.0 | 17.5 | 0.5 | 0.12 | 18.0 | 1.0 | 0.24 | 12.0 | 14.0 | 2.0 |
0.65
| 14.0 | 2.0 |
0.65
|
6 | 7.0 | 8.0 | 1.0 | 0.24 | 8.0 | 1.0 | 0.24 | 10.0 | 14.0 | 4.0 |
1.29
| 14.0 | 4.0 |
1.29
|
Conventional | Virtual reality | |||||||
---|---|---|---|---|---|---|---|---|
Subject | Difference post–pre | ES | Difference FUP-pre | ES | Difference post–pre | ES | Difference FUP-pre | ES |
BBT
| ||||||||
1 | −1.92 | −0.09 | 5.74 | 0.27 | −4.34 | −0.16 | −6.44 | −0.24 |
2 | 0.00 | 0.00 | 0.00 | 0.00 | −3.28 | −0.12 | −2.91 | −0.11 |
3 | 0.20 | 0.01 | −3.46 | −0.16 | −0.13 | 0.00 | 12.95 |
0.49
|
4 | −3.01 | −0.14 | −2.63 | −0.13 | 5.39 | 0.20 | 2.31 | 0.09 |
5 | 5.46 | 0.26 | 7.97 |
0.38
| −3.86 | −0.14 | −0.89 | −0.03 |
6 | 0.00 | 0.00 | 0.00 | 0.00 | 9.45 |
0.35
| 9.45 |
0.35
|
WMFT (mean)
| ||||||||
1 | 11.0 |
0.59
| 14.0 |
0.75
| 6.0 |
0.43
| 4.0 | 0.29 |
2 | 1.0 | 0.05 | 4.0 | 0.22 | 6.0 |
0.43
| 8.0 |
0.57
|
3 | 9.0 |
0.48
| 5.0 | 0.27 | 10.0 |
0.71
| 14.0 |
1.00
|
4 | 0.0 | 0.00 | 4.0 | 0.22 | 8.0 |
0.57
| 8.0 |
0.57
|
5 | 7.0 |
0.38
| 6.0 |
0.32
| 6.0 |
0.43
| 10.0 |
0.71
|
6 | −10.0 |
−0.54
| −2.0 | −0.11 | 1.0 | 0.07 | 1.0 | 0.07 |
WMFT (time)
| ||||||||
1 | −1.26 | −0.15 | −1.53 | −0.18 | −2.95 |
−0.31
| 1.10 | 0.12 |
2 | 4.26 |
0.51
| 1.63 | 0.19 | 4.46 |
0.47
| −1.47 | −0.16 |
3 | −7.30 |
−0.87
| −6.41 |
−0.76
| −0.30 | −0.03 | −1.16 | −0.12 |
4 | 6.80 |
0.81
| 0.97 | 0.12 | −0.89 | −0.10 | −0.71 | −0.08 |
5 | 0.15 | 0.02 | 0.69 | 0.08 | 2.49 | 0.26 | −4.36 |
−0.46
|
6 | 14.07 |
1.67
| 7.18 |
0.86
| −0.86 | −0.09 | −5.79 |
−0.62
|