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      The effectiveness of virtual reality for people with mild cognitive impairment or dementia: a meta-analysis

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          Abstract

          Background

          Virtual Reality (VR) is increasingly used in health-related fields and interventions using VR have the potential to be powerful tools in patient management. The aim of this study was to synthesize the effects of VR interventions for people with mild cognitive impairment (MCI) or dementia.

          Methods

          Electronic databases were searched to identify studies that used an experimental design to investigate VR intervention outcomes for patients with MCI or dementia. Studies were excluded if the intervention did not focus on VR, if relevant quantitative outcomes were not reported, or if the intended study purpose was assessment or diagnosis. Data were extracted and analyzed from studies that met criteria. To synthesize the intervention effect sizes (ES), we used random effects models to accommodate heterogeneity in the main effect and sub-group analyses. To identify the potential reason for heterogeneity and compare ES according to the moderator variables, subgroup analyses were conducted based on study characteristics and intervention outcomes.

          Results

          Data from eleven studies that met eligibility criteria were analyzed. VR intervention delivered to participants with MCI or dementia produced small to medium effects (ES = 0.29, CI = 0.16, 0.42). The ES for studies using semi-immersive technology (ES = 0.37, CI = 0.25, 0.49) was greater than the studies using full-immersive VR (ES = 0.03, CI = -0.14, 0.21). The results showed small-to-medium effects for VR interventions affecting key outcome variables such as cognition (ES = 0.42, CI = 0.24, 0.60) and physical fitness (ES = 0.41, CI = 0.16, 0.65).

          Conclusion

          VR interventions, particularly of the semi-immersive type, are useful for people with MCI or dementia. These results should contribute to the establishment of practical guidelines for VR interventions for patients with cognitive decline.

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          Most cited references37

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          Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity.

          To develop and validate a new risk-of-bias tool for nonrandomized studies (NRSs). We developed the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). A validation process with 39 NRSs examined the reliability (interrater agreement), validity (the degree of correlation between the overall assessments of RoBANS and Methodological Index for Nonrandomized Studies [MINORS], obtained by plotting the overall risk of bias relative to effect size and funding source), face validity with eight experts, and completion time for the RoBANS approach. RoBANS contains six domains: the selection of participants, confounding variables, the measurement of exposure, the blinding of the outcome assessments, incomplete outcome data, and selective outcome reporting. The interrater agreement of the RoBANS tool except the measurement of exposure and selective outcome reporting domains ranged from fair to substantial. There was a moderate correlation between the overall risks of bias determined using RoBANS and MINORS. The observed differences in effect sizes and funding sources among the assessed studies were not correlated with the overall risk of bias in these studies. The mean time required to complete RoBANS was approximately 10 min. The external experts who were interviewed evaluated RoBANS as a "fair" assessment tool. RoBANS shows moderate reliability, promising feasibility, and validity. The further refinement of this tool and larger validation studies are required. Copyright © 2013 Elsevier Inc. All rights reserved.
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            Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments.

            In virtual reality exposure therapy (VRET), patients are exposed to virtual environments that resemble feared real-life situations. The aim of the current study was to assess the extent to which VRET gains can be observed in real-life situations. We conducted a meta-analysis of clinical trials applying VRET to specific phobias and measuring treatment outcome by means of behavioral laboratory tests or recordings of behavioral activities in real-life. Data sources were searches of databases (Medline, PsycInfo, and Cochrane). We included in total 14 clinical trials on specific phobias. Results revealed that patients undergoing VRET did significantly better on behavioral assessments following treatment than before treatment, with an aggregated uncontrolled effect size of g = 1.23. Furthermore, patients undergoing VRET performed better on behavioral assessments at post-treatment than patients on wait-list (g = 1.41). Additionally, results of behavioral assessment at post-treatment and at follow-up revealed no significant differences between VRET and exposure in vivo (g = -0.09 and 0.53, respectively). Finally, behavioral measurement effect sizes were similar to those calculated from self-report measures. The findings demonstrate that VRET can produce significant behavior change in real-life situations and support its application in treating specific phobias.
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              Virtual reality in stroke rehabilitation: a systematic review of its effectiveness for upper limb motor recovery.

              It is estimated that 50% to 75% of individuals who experience a stroke have persistent impairment of the affected upper limb (UL). There is a need to identify the best training strategies for retraining motor function of the UL. One intervention showing promise is virtual reality (VR), using either immersive or nonimmersive technology. Before recommending VR for use in clinical practice, it is important to understand the evidence regarding its effectiveness. Two questions about the effectiveness of VR for UL rehabilitation in stroke were posed: (1) Is the use of immersive VR more effective than conventional therapy or no therapy in the rehabilitation of the UL in patients with hemiplegia? (2) Is the use of nonimmersive VR more effective than conventional therapy or no therapy in the rehabilitation of the UL in patients with hemiplegia? There is level 1b evidence suggesting an advantage to training in immersive VR environments versus no therapy in UL rehabilitation, and level 5 evidence for training in immersive VR versus conventional therapy. There is level 4 evidence showing conflicting results for training in nonimmersive VR versus no therapy, and level 2b evidence for training in nonimmersive VR versus conventional therapy. The current evidence on the effectiveness of using VR in the rehabilitation of the UL in patients with stroke is limited but sufficiently encouraging to justify additional clinical trials in this population.
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                Author and article information

                Contributors
                82-2-2258-7816 , jhee90@catholic.ac.kr
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                12 July 2019
                12 July 2019
                2019
                : 19
                : 219
                Affiliations
                [1 ]ISNI 0000 0001 2171 7754, GRID grid.255649.9, College of Nursing, , Ewha Womans University, ; 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760 South Korea
                [2 ]ISNI 0000 0004 0470 4224, GRID grid.411947.e, Associate Professor, Department of Clinical Nursing, College of Nursing, , The Catholic University of Korea, ; 222 Banpo-daero, Seocho-gu, Seoul, 06591 South Korea
                Author information
                http://orcid.org/0000-0003-0341-7007
                Article
                2180
                10.1186/s12888-019-2180-x
                6626425
                31299921
                39791729-baef-410d-9da0-e6f65933a429
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 4 March 2019
                : 12 June 2019
                Funding
                Funded by: This work was supported by a Korea Research Foundation grant funded by the Korean Government [(MOEHRD, Basic Research Promotion Fund)
                Award ID: 2017R1E1A1A01075188
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Clinical Psychology & Psychiatry
                mild cognitive impairment,dementia,meta-analysis,virtual reality

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