Virtual Reality on Par with Conventional Stroke Therapy

CAST | December 20, 2017 | by Donna Childress

Study finds the two equally good at improving stroke patients’ arm and hand function—but experts disagree.

A recent study that found virtual reality to be a solid therapy tool has also raised some debate about virtual reality’s effectiveness.
The study found that virtual reality training is as effective as, but not better than, conventional therapy for improving stroke patients’ arm and hand function. This finding holds true when both therapies were added to standard rehabilitation in the subacute phase of stroke recovery, according to “Virtual Reality Training Rivals Conventional Therapy After Stroke,” an article in MedPage Today.
The phase III VIRTUES study, initially reported online in Neurology, was conducted at five rehabilitation hospitals in Europe. It involved 120 patients with an average age of 62 who, an average of one month before the study began, had strokes that left them with mild-to-severe upper extremity impairment in their wrists, hands, or upper arms.
After the four-week intervention and three months later, the patients’ arm and hand mobility had improved significantly, but the two study groups’ results showed no difference. The outcomes were similar for patients with mild/moderate and severe impairment.

Future Studies

Experts agreed that a future study should draw distinctions between recovery on an impairment level and compensation. Two doctors who were not involved in the study, however, are divided on virtual reality's effectiveness.
Danielle Levac, MD, PhD, PT, of Northeastern University in Boston, said to MedPage Today that neither patient engagement nor motivation were "subjectively or objectively measured here, which seriously detracts from the author's conclusions that VR constitutes 'motivating' training."
She pointed to a recent large trial in subacute stroke patients, which did not find virtual reality to be better than conventional training and used a commercial gaming system. "It is the low cost and easy accessibility of off-the-shelf gaming systems that have made them so pervasive and attractive in clinical practice, despite the disadvantages for tailoring to individual patient needs noted by the authors," Levac was quoted as saying. Many small studies showing the benefits of virtual reality used rehab-specific systems.
Yet Robert Teasell MD, of Western University in London, Ontario, and head of the Stroke Rehabilitation Writing Group for the Canadian Stroke Best Practice Recommendations, told MedPage Today he believes this new study is significant.
The new VIRTUES study "is important because it is comparatively larger, employs a multi-site design, and has an active control group which gets an equal amount of 'conventional' therapy and not just 'usual care,'" Teasell said in the article. "It demonstrates effectiveness—although not superiority—of virtual reality as a promising adjunct treatment."