Is Pathology-Specific Virtual Reality Rehabilitation Better Than Commercial Virtual Reality to Improve Balance and Functional Mobility in Parkinson’s Disease Patients?

Lheureux, Alexis [UCL] Lejeune, Thierry [UCL] Simons, Alexane [UCL] Gillis, Aurore [UCL] Everard, Gauthier [UCL]

Background Virtual Reality (VR) rehabilitation is an innovative way to treat balance and mobility impairments in Parkinson’s Disease (PD) individuals. Studies use VR designed for rehabilitation (Specific Virtual Reality; SVR) and others use commercial VR (Non- Specific Virtual Reality; NSVR). Also, neurorehabilitation principles have been proposed to identify what potentially make VR interventions effective. Objective To perform a systematic review with meta-analysis comparing VR effectiveness versus Conventional Therapy (CT) for balance, functional mobility and quality of life in PD. Second objectives are to assess SVR over NSVR effect and analyze fulfilled neurorehabilitation principles across included studies. Methods Randomized control trials studying VR versus CT effects on balance, functional mobility and quality of life outcomes in PD adults were selected from PubMed and Embase. Subgroup analyses were conducted according to VR type, disease severity and treatment duration. Risk of bias was assessed using PEDro checklist and Cochrane’s Risk of Bias tool 2 (RoB-2). Percentages of fulfilled neurorehabilitation principles across studies were extracted. GRADE approach was used to define certainty of evidence. Results Twenty studies were included for quantitative analysis. VR results were superior to CT for balance but similar for functional mobility and quality of life. SVR and NSVR were 10 similar for balance and functional mobility outcomes. Finally, SVR studies did not fulfill more neurorehabilitation principles than NSVR studies. Conclusions VR could enhance balance rehabilitation in PD but with a low certainty of evidence. SVR solutions were not superior to NSVR and should fulfill more relevant neurorehabilitation principles in the future.