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      Efficacy of Virtual Reality Rehabilitation after Spinal Cord Injury: A Systematic Review

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          Abstract

          Background

          Spinal cord injury (SCI) is often associated with long-term impairments related to functional limitations in the sensorimotor system. The use of virtual reality (VR) technology may lead to increased motivation and engagement, besides allowing a wide range of possible tasks/exercises to be implemented in rehabilitation programs. The present review aims to investigate the possible benefits and efficacy of VR-based rehabilitation in individuals with SCI.

          Methods

          An electronically systematic search was performed in multiple databases (PubMed, BVS, Web of Science, Cochrane Central, and Scielo) up to May 2019. MESH terms and keywords were combined in a search strategy. Two reviewers independently selected the studies in accordance with eligibility criteria. The PEDro scale was used to score the methodological quality and risk of bias of the selected studies.

          Results

          Twenty-five studies (including 482 participants, 47.6 ± 9.5 years, 73% male) were selected and discussed. Overall, the studies used VR devices in different rehabilitation protocols to improve motor function, driving skills, balance, aerobic function, and pain level, as well as psychological and motivational aspects. A large amount of heterogeneity was observed as to the study design, VR protocols, and outcome measures used. Only seven studies (28%) had an excellent/good quality of evidence. However, substantial evidence for significant positive effects associated with VR therapy was found in most of the studies (88%), with no adverse events (88%) being reported.

          Conclusion

          Although the current evidence is limited, the findings suggest that VR-based rehabilitation in subjects with SCI may lead to positive effects on aerobic function, balance, pain level, and motor function recovery besides improving psychological/motivational aspects. Further high-quality studies are needed to provide a guideline to clinical practice and to draw robust conclusions about the potential benefits of VR therapy for SCI patients. Protocol details are registered on PROSPERO (registration number: CRD42016052629).

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          Most cited references53

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          The effectiveness of virtual reality distraction for pain reduction: a systematic review.

          Virtual reality technology enables people to become immersed in a computer-simulated, three-dimensional environment. This article provides a comprehensive review of controlled research on the effectiveness of virtual reality (VR) distraction for reducing pain. To be included in the review, studies were required to use a between-subjects or mixed model design in which VR distraction was compared with a control condition or an alternative intervention in relieving pain. An exhaustive search identified 11 studies satisfying these criteria. VR distraction was shown to be effective for reducing experimental pain, as well as the discomfort associated with burn injury care. Studies of needle-related pain provided less consistent findings. Use of more sophisticated virtual reality technology capable of fully immersing the individual in a virtual environment was associated with greater relief. Overall, controlled research suggests that VR distraction may be a useful tool for clinicians who work with a variety of pain problems. Copyright © 2010 Elsevier Ltd. All rights reserved.
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            PRISMA harms checklist: improving harms reporting in systematic reviews

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              Incidence of Spinal Cord Injury Worldwide: A Systematic Review

              Background: Incidence studies of spinal cord injury (SCI) are important for health-care planning and epidemiological research. This review gives a quantitative update on SCI epidemiology worldwide through a statistical evaluation of incidence rates. Methods: A systematic review was conducted. For each study, the crude rate ratio was calculated and, when possible, age- and gender-adjusted incidence rate ratios with 95% CI were determined by direct adjustment or using Poisson regression. Results: Thirteen studies were included. Annual crude incidence rates in traumatic SCI varied from 12.1 per million in The Netherlands to 57.8 per million in Portugal. Compared to the Portuguese reference study, incidence rates showed a 3-fold variation, with the highest rates in Canada and Portugal. Most traumatic SCI studies showed a bimodal age distribution. The first peak was found in young adults between 15 and 29 years and a second peak in older adults (mostly ≧65 years). Motor vehicle accidents and falls were the most prevalent causes of injury accounting for nearly equal percentages. In contrast, another age pattern in non-traumatic SCI reflected steadily increasing incidence with advancing age. Conclusions: The results show significant variation in SCI incidence with changing epidemiological patterns. A trend towards increased incidence in the elderly was observed, likely due to falls and non-traumatic injury.
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                Author and article information

                Contributors
                Journal
                Biomed Res Int
                Biomed Res Int
                BMRI
                BioMed Research International
                Hindawi
                2314-6133
                2314-6141
                2019
                13 November 2019
                : 2019
                : 7106951
                Affiliations
                1University of São Paulo, School of Arts, Sciences and Humanities–EACH–USP, São Paulo, Brazil
                2University of São Paulo, School of Physical Education and Sport–EEFE–USP, São Paulo, Brazil
                3University of São Paulo, Faculty of Medicine, Post-graduate Program in Rehabilitation Sciences–FMUSP–USP, São Paulo, Brazil
                Author notes

                Academic Editor: Germán Vicente-Rodriguez

                Author information
                https://orcid.org/0000-0002-2661-775X
                https://orcid.org/0000-0003-0783-6102
                Article
                10.1155/2019/7106951
                6885151
                31828120
                c42a016e-ca76-48bd-ad3a-516e23f52ec5
                Copyright © 2019 Amanda Vitória Lacerda de Araújo et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 May 2019
                : 19 August 2019
                : 31 August 2019
                Funding
                Funded by: Fundação de Amparo à Pesquisa do Estado de São Paulo
                Award ID: #2015/13096-1
                Award ID: #2012/16970-6
                Funded by: Conselho Nacional de Desenvolvimento Científico e Tecnológico
                Award ID: 304898/2016-3
                Funded by: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
                Categories
                Review Article

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