People with Parkinson’s disease present with both motor and non-motor symptoms. Tele rehabilitation (TR) is effective to maintain and improve different functional activities in people with neurological disorders. Virtual reality (VR)-based rehabilitation involves training movement and activities in a virtual setting.
Objective
To systematically review the evidence and estimate the effect of virtual and tele-rehabilitation on motor and non-motor impairments in patients with PD.
Methods
The databases MEDLINE, PEDro, Scopus, and Web of Science were searched from inception to January 2024 for randomized controlled trials (RCTs) and quasi-experimental studies. The methodological quality of the included studies and risk of bias was assessed using the PEDro scale and Cochrane risk of bias tool respectively. Studies providing sufficient data on either of the pre-established outcome measure were included in the meta-analysis.
Results
Meta-analysis of the 18 studies showed that more improvement in balance function was seen with VR rehabilitation than with traditional exercise (TE) training. VR and TE were found to have similar effects on the (DGI) dynamic gait timed-up and go (TUG) test.
Conclusions
The available evidence suggests a positive effect of VR exercise on balance function. TR is feasible and provides similar clinical benefits to that of in-person care. VR and TR compared to TE in physiotherapy have similar effects on gait.
NijkrakeMJKeusSHKalfJG, et al.Allied health care interventions and complementary therapies in Parkinson’s disease. Parkinsonism Relat Disord2007; 13(Suppl 3): S488–S494. DOI: 10.1016/s1353-8020(08)70054-3.
5.
SchragAJahanshahiMQuinnN. What contributes to quality of life in patients with Parkinson’s disease?J Neurol Neurosurg Psychiatry2000; 69(3): 308–312. DOI: 10.1136/jnnp.69.3.308.
6.
van NimwegenMSpeelmanADHofman-van RossumEJ, et al.Physical inactivity in Parkinson’s disease. J Neurol2011; 258(12): 2214–2221. DOI: 10.1007/s00415-011-6097-7.
7.
PringsheimTJetteNFrolkisA, et al.The prevalence of Parkinson’s disease: a systematic review and meta-analysis. Mov Disord2014; 29(13): 1583–1590. DOI: 10.1002/mds.25945.
8.
NeriusMFinkADoblhammerG. Parkinson’s disease in Germany: prevalence and incidence based on health claims data. Acta Neurol Scand2017; 136(5): 386–392. DOI: 10.1111/ane.12694.
9.
TanseyMGGoldbergMS. Neuroinflammation in Parkinson’s disease: its role in neuronal death and implications for therapeutic intervention. Neurobiol Dis2010; 37(3): 510–518. DOI: 10.1016/j.nbd.2009.11.004.
10.
IruthayarajahJMcIntyreACotoiA, et al.The use of virtual reality for balance among individuals with chronic stroke: a systematic review and meta-analysis. Top Stroke Rehabil2017; 24(1): 68–79. DOI: 10.1080/10749357.2016.1192361.
11.
ZasadzkaETrzmielTPieczyńskaA, et al.Modern technologies in the rehabilitation of patients with multiple sclerosis and their potential application in times of COVID-19. Medicina (Kaunas)2021; 57(6): 549. DOI: 10.3390/medicina57060549.
12.
BrennanDMMawsonSBrownsellS. Telerehabilitation: enabling the remote delivery of healthcare, rehabilitation, and self management. Stud Health Technol Inf2009; 145: 231–248.
13.
Linares-Del ReyMVela-DesojoLCano-de la CuerdaR. Mobile phone applications in Parkinson’s disease: a systematic review. Neurologia2019; 34(1): 38–54. DOI: 10.1016/j.nrl.2017.03.006.
14.
AgostiniMMojaLBanziR, et al.Telerehabilitation and recovery of motor function: a systematic review and meta-analysis. J Telemed Telecare2015; 21(4): 202–213. DOI: 10.1177/1357633x15572201.
15.
HaileyDRoineROhinmaaA, et al.Evidence of benefit from telerehabilitation in routine care: a systematic review. J Telemed Telecare2011; 17(6): 281–287. DOI: 10.1258/jtt.2011.101208.
16.
McCueMFairmanAPramukaM. Enhancing quality of life through telerehabilitation. Phys Med Rehabil Clin N Am2010; 21(1): 195–205. DOI: 10.1016/j.pmr.2009.07.005.
17.
Peñasco-MartínBde los Reyes-GuzmánAGil-AgudoÁ, et al.[Application of virtual reality in the motor aspects of neurorehabilitation]. Rev Neurol2010; 51(8): 481–488.
18.
LiaoYYYangYRChengSJ, et al.Virtual reality-based training to improve obstacle-crossing performance and dynamic balance in patients with Parkinson’s disease. Neurorehabil Neural Repair2015; 29(7): 658–667. DOI: 10.1177/1545968314562111.
19.
BrachmanAMarszałekWKamieniarzA, et al.Biomechanical measures of balance after balance-based exergaming training dedicated for patients with Parkinson’s disease. Gait Posture2021; 87: 170–176. DOI: 10.1016/j.gaitpost.2021.04.036.
20.
SchaefferEBuschJHRoebenB, et al.Effects of exergaming on attentional deficits and dual-tasking in Parkinson’s disease. Front Neurol2019; 10: 646. DOI: 10.3389/fneur.2019.00646.
21.
DockxKBekkersEMVan den BerghV, et al.Virtual reality for rehabilitation in Parkinson’s disease. Cochrane Database Syst Rev2016; 12(12): Cd010760. DOI: 10.1002/14651858.CD010760.pub2.
22.
TriegaardtJHanTSSadaC, et al.The role of virtual reality on outcomes in rehabilitation of Parkinson’s disease: meta-analysis and systematic review in 1031 participants. Neurol Sci2020; 41(3): 529–536. DOI: 10.1007/s10072-019-04144-3.
23.
LinaCGuoenCHuidanW, et al.The effect of virtual reality on the ability to perform activities of daily living, balance during gait, and motor function in Parkinson disease patients: a systematic review and meta-analysis. Am J Phys Med Rehabil2020; 99(10): 917–924. DOI: 10.1097/phm.0000000000001447.
24.
MoherDLiberatiATetzlaffJ, et al.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med2009; 6(7): e1000097. DOI: 10.1371/journal.pmed.1000097.
25.
HigginsJPThompsonSGDeeksJJ, et al.Measuring inconsistency in meta-analyses. BMJ2003; 327(7414): 557–560. DOI: 10.1136/bmj.327.7414.557.
26.
VerhagenAPdeVHCde BieRA, et al.The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol1998; 51(12): 1235–1241. DOI: 10.1016/s0895-4356(98)00131-0.
27.
BridleCSpanjersKPatelS, et al.Effect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry2012; 201(3): 180–185. DOI: 10.1192/bjp.bp.111.095174.
28.
de MortonNA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother2009; 55(2): 129–133. DOI: 10.1016/s0004-9514(09)70043-1.
29.
MirelmanARochesterLMaidanI, et al.Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): a randomised controlled trial. Lancet2016; 388(10050): 1170–1182. DOI: 10.1016/s0140-6736(16)31325-3.
30.
LiaoY-YYangY-RWuY-R, et al.Virtual reality-based Wii fit training in improving muscle strength, sensory integration ability, and walking abilities in patients with Parkinson’s disease: a randomized control trial. Int J Gerontol2015; 9: 190–195. DOI: 10.1016/j.ijge.2014.06.007.
31.
YangWCWangHKWuRM, et al.Home-based virtual reality balance training and conventional balance training in Parkinson;s disease: a randomized controlled trial. J Formos Med Assoc2016; 115(9): 734–743. DOI: 10.1016/j.jfma.2015.07.012.
32.
GandolfiMGeroinCDimitrovaE, et al.Virtual reality telerehabilitation for postural instability in Parkinson’s disease: a multicenter, single-blind, randomized, controlled trial. BioMed Res Int2017; 2017: 7962826. DOI: 10.1155/2017/7962826.
33.
SantosPMachadoTSantosL, et al.Efficacy of the Nintendo Wii combination with Conventional Exercises in the rehabilitation of individuals with Parkinson’s disease: a randomized clinical trial. NeuroRehabilitation2019; 45(2): 255–263. DOI: 10.3233/nre-192771.
34.
PazzagliaCImbimboITranchitaE, et al.Comparison of virtual reality rehabilitation and conventional rehabilitation in Parkinson’s disease: a randomised controlled trial. Physiotherapy2020; 106: 36–42. DOI: 10.1016/j.physio.2019.12.007.
35.
ShihMCWangRYChengSJ, et al.Effects of a balance-based exergaming intervention using the Kinect sensor on posture stability in individuals with Parkinson’s disease: a single-blinded randomized controlled trial. J NeuroEng Rehabil2016; 13(1): 78. DOI: 10.1186/s12984-016-0185-y.
36.
AlvesMLMMesquitaBSMoraisWS, et al.Nintendo Wii™ versus Xbox Kinect™ for assisting people with Parkinson’s disease. Percept Mot Skills2018; 125(3): 546–565. DOI: 10.1177/0031512518769204.
37.
FengHLiCLiuJ, et al.Virtual reality rehabilitation versus conventional physical therapy for improving balance and gait in Parkinson's disease patients: a randomized controlled trial. Med Sci Monit2019; 25: 4186–4192. DOI: 10.12659/msm.916455.
38.
CikajloIPeterlin PotiskK. Advantages of using 3D virtual reality based training in persons with Parkinson’s disease: a parallel study. J NeuroEng Rehabil2019; 16(1): 119. DOI: 10.1186/s12984-019-0601-1.
39.
Del DinSGalnaBLordS, et al.Falls risk in relation to activity exposure in high-risk older adults. J Gerontol A Biol Sci Med Sci2020; 75(6): 1198–1205. DOI: 10.1093/gerona/glaa007.
40.
PelosinECerulliCOgliastroC, et al.A multimodal training modulates short afferent inhibition and improves complex walking in a cohort of faller older adults with an increased prevalence of Parkinson’s disease. J Gerontol A Biol Sci Med Sci2020; 75(4): 722–728. DOI: 10.1093/gerona/glz072.
41.
BekkersEMJMirelmanAAlcockL, et al.Do patients with Parkinson’s disease with freezing of gait respond differently than those without to treadmill training augmented by virtual reality?Neurorehabil Neural Repair2020; 34(5): 440–449. DOI: 10.1177/1545968320912756.
42.
PompeuJEMendesFASilvaKG, et al.Effect of Nintendo Wii™-based motor and cognitive training on activities of daily living in patients with Parkinson’s disease: a randomised clinical trial. Physiotherapy2012; 98(3): 196–204. DOI: 10.1016/j.physio.2012.06.004.
43.
MaidanINieuwhofFBernad-ElazariH, et al.Evidence for differential effects of 2 forms of exercise on prefrontal plasticity during walking in Parkinson’s disease. Neurorehabil Neural Repair2018; 32(3): 200–208. DOI: 10.1177/1545968318763750.
44.
LeeNYLeeDKSongHS. Effect of virtual reality dance exercise on the balance, activities of daily living, and depressive disorder status of Parkinson’s disease patients. J Phys Ther Sci2015; 27(1): 145–147. DOI: 10.1589/jpts.27.145.
45.
dos Santos MendesFAPompeuJEModenesi LoboA, et al.Motor learning, retention and transfer after virtual-reality-based training in Parkinson’s disease--effect of motor and cognitive demands of games: a longitudinal, controlled clinical study. Physiotherapy2012; 98(3): 217–223. DOI: 10.1016/j.physio.2012.06.001.
46.
IserniaSDi TellaSPagliariC, et al.Effects of an innovative telerehabilitation intervention for people with Parkinson’s disease on quality of life, motor, and non-motor abilities. Front Neurol2020; 11: 846. DOI: 10.3389/fneur.2020.00846.
47.
YuanRYChenSCPengCW, et al.Effects of interactive video-game-based exercise on balance in older adults with mild-to-moderate Parkinson’s disease. J NeuroEng Rehabil2020; 17(1): 91. DOI: 10.1186/s12984-020-00725-y.
48.
TheodorosDGHillAJRussellTG. Clinical and quality of life outcomes of speech treatment for Parkinson’s disease delivered to the home via telerehabilitation: a noninferiority randomized controlled trial. Am J Speech Lang Pathol2016; 25(2): 214–232. DOI: 10.1044/2015_ajslp-15-0005.
49.
van der KolkNMde VriesNMKesselsRPC, et al.Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson’s disease: a double-blind, randomised controlled trial. Lancet Neurol2019; 18(11): 998–1008. DOI: 10.1016/s1474-4422(19)30285-6.
50.
YenCYLinKHHuMH, et al.Effects of virtual reality-augmented balance training on sensory organization and attentional demand for postural control in people with Parkinson disease: a randomized controlled trial. Phys Ther2011; 91(6): 862–874. DOI: 10.2522/ptj.20100050.
51.
DorseyERAcheyMABeckCA, et al.National randomized controlled trial of virtual house calls for people with Parkinson’s disease: interest and barriers. Telemed J e Health2016; 22(7): 590–598. DOI: 10.1089/tmj.2015.0191.
52.
VasconcellosLSSilvaRSPachêcoTB, et al.Telerehabilitation-based trunk exercise training for motor symptoms of individuals with Parkinson’s disease: a randomized controlled clinical trial. J Telemed Telecare2021; 29: 1357633x211021740. DOI: 10.1177/1357633x211021740.
53.
de MeloGELKleinerAFRLopesJBP, et al.Effect of virtual reality training on walking distance and physical fitness in individuals with Parkinson’s disease. NeuroRehabilitation2018; 42(4): 473–480. DOI: 10.3233/nre-172355.
54.
DorseyERVenkataramanVGranaMJ, et al.Randomized controlled clinical trial of “virtual house calls” for Parkinson disease. JAMA Neurol2013; 70(5): 565–570. DOI: 10.1001/jamaneurol.2013.123.
55.
DrobyAMaidanIJacobY, et al.Distinct effects of motor training on resting-state functional networks of the brain in Parkinson’s disease. Neurorehabil Neural Repair2020; 34(9): 795–803. DOI: 10.1177/1545968320940985.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
