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Meta-Analysis
. 2021 Nov 6;21(21):7389.
doi: 10.3390/s21217389.

Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis

Irene Cortés-Pérez  1   2 , Marcelina Sánchez-Alcalá  2   3 , Francisco Antonio Nieto-Escámez  4   5 , Yolanda Castellote-Caballero  2 , Esteban Obrero-Gaitán  2 , María Catalina Osuna-Pérez  2
Affiliations
Meta-Analysis

Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis

Irene Cortés-Pérez et al. Sensors (Basel). .

Abstract

Patients with multiple sclerosis (PwMS) have a high level of fatigue and a reduced quality of life (QoL) due to the impact of multiple sclerosis (MS). Virtual reality-based therapy (VRBT) is being used to reduce disability in PwMS. The aim of this study was to assess the effect of VRBT on fatigue, the impact of MS, and QoL in PwMS.

Methods: A systematic review with meta-analysis was conducted through a bibliographic search on PubMed, Scopus, Web of Science, and PEDro up to April 2021. We included randomized controlled trials (RCTs) with PwMS that received VRBT in comparison to conventional therapy (CT) including physiotherapy, balance and strength exercises, and stretching or physical activity, among others; or in comparison to simple observation; in order to assess fatigue, MS-impact, and QoL. The effect size was calculated using Cohen's standardized mean difference with a 95% confidence interval (95% CI).

Results: Twelve RCTs that provided data from 606 PwMS (42.83 ± 6.86 years old and 70% women) were included. The methodological quality mean, according to the PEDro Scale, was 5.83 ± 0.83 points. Our global findings showed that VRBT is effective at reducing fatigue (SMD -0.33; 95% CI -0.61, -0.06), lowering the impact of MS (SMD -0.3; 95% CI -0.55, -0.04), and increasing overall QoL (0.5; 95% CI 0.23, 0.76). Subgroup analysis showed the following: (1) VRBT is better than CT at reducing fatigue (SMD -0.4; 95% CI -0.7, -0.11), as well as in improving the mental dimension of QoL (SMD 0.51; 95% CI 0.02, 1); (2) VRBT is better than simple observation at reducing the impact of MS (SMD -0.61; 95% CI -0.97, -0.23) and increasing overall QoL (SMD 0.79; 95% CI 0.3, 1.28); and (3) when combined with CT, VRBT is more effective than CT in improving the global (SMD 0.6, 95% CI 0.13, 1.07), physical (SMD 0.87; 95% CI 0.3, 1.43), and mental dimensions (SMD 0.6; 95% CI 0.08, 1.11) of QoL.

Conclusion: VRBT is effective at reducing fatigue and MS impact and improving QoL in PwMS.

Keywords: fatigue; meta-analysis; multiple sclerosis; quality of life; videogames; virtual reality.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow chart for study selection.
Figure 2
Figure 2
Forest Plot of the Effect of Virtual Reality on Fatigue.
Figure 3
Figure 3
Subgroup Analysis of the Effect of Virtual Reality on Fatigue According to Specific Comparisons.
Figure 4
Figure 4
Forest Plot of the Effect of Virtual Reality on the Impact of Multiple Sclerosis.
Figure 5
Figure 5
Subgroup Analysis of the Effect of Virtual Reality on the Impact of Multiple Sclerosis According to Specific Comparisons.
Figure 6
Figure 6
Forest Plot of the Effect of Virtual Reality on Overall Quality of Life.
Figure 7
Figure 7
Subgroup Analysis of the Effect of Virtual Reality on Overall Quality of Life According to Specific Comparisons.
Figure 8
Figure 8
Subgroup Analysis of the Effect of Virtual Reality on the Physical Dimension of Quality of Life, According Specific Comparisons.
Figure 9
Figure 9
Subgroup Analysis of the Effect of Virtual Reality on the Mental Dimension of Quality of Life According to Specific Comparisons.
See this image and copyright information in PMC

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