Effects of virtual reality technology on cognition and negative emotions in stroke patients: Meta-analysis

doi:10.3877/cma.j.issn.2095-123X.2025.03.005

Abstract

Abstract:

Objective

To systematically evaluate the efficacy of virtual reality (VR) technology in improving cognitive function and alleviating negative emotions among stroke patients.

Methods

Randomized controlled trials (RCTs) investigating VR-based 1nterventions for cognitive and mental health outcomes in stroke patients were retrieved from China Knowledge Network, WANFANG, Wipro database, PubMed, Embase, Web of Science, and Cochrane Library databases (inception to June 21, 2024). After screening 5545 records, two researchers independently performed deduplication, study selection, data extraction, and risk-of-bias assessment. The VR group used VR technology combined with conventional therapy, while the control group only used the conventional therapy. A total of 12 outcome indicators were categorized into 9 domains. Meta-analyses were conducted using RevMan 5.4 and Stata 17.0.

Results

A total of 29 RCTs were included, including 1516 patients, including 727 in the VR group and 789 in the control group. In the VR training group, the scores of overall cognitive function (SMD=0.69, 95%CI: 0.40-0.99), perceptual function (MD=2.19, 95%CI: 1.30~3.19), language function (MD=9.87, 95%CI: 7.47-12.26), memory function (MD=2.59, 95%CI: 2.00-3.18), depression [MD=-2.92, 95%CI: (-4.55)-(-1.29)] and anxiety [SMD=-0.61, 95%CI: (-1.17)-(-0.04)] of stroke patients were the difference was statistically significant (P<0.05); There was no significant difference in the scores of executive ability, attention and visuospatial ability between the two groups (P>0.05).

Conclusions

VR training effectively improves global cognition, language function, and alleviates anxiety/depression in stroke patients, while its effects on executive function, attention, and visuospatial ability require further validation.

Key words: Virtual reality, Stroke, Cognitive function, Emotions

Shanshan Wang, Wen Wang, Qiliang Yang, Wenchao Zhang, Ningning Cui, Ting Li. Effects of virtual reality technology on cognition and negative emotions in stroke patients: Meta-analysis[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2025, 15(03): 161-170.

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Figures/Tables 5

References 54

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纳入研究	国家	例数		年龄（岁）		干预措施	对照措施	疗程	结局指标	PEDro得分（分）
纳入研究	国家	T	C	T	C	干预措施	对照措施	疗程	结局指标	PEDro得分（分）
Gueye等^[13]，2021	捷克	25	25	66.56±12.26	68.12±11.97	VR训练	OT	3周	①	6
Akinci等^[14]，2024	土耳其	17	17	59.18±8.89	59.12±13.22	VR训练+OT	OT	6周	①	7
Oh等^[15]，2019	韩国	17	14	57.4±12.2	52.6±10.7	VR训练	OT	6周	①②	8
林玮佳等^[16]，2023	中国	30	30	59.64±4.80	60.23±5.10	VR认知训练+多奈哌齐	传统认知训练+多奈哌齐	3个月	①②	6
Maier等^[17]，2020	西班牙	16	14	45~75	45~75	VR认知训练	传统认知训练	18周	①②④⑦⑧⑩	8
于梅青等^[18]，2021	中国	20	18	60.75±12.54	63.17±11.12	VR训练+OT	OT	30 d	①④	7
Manuli等^[19]，2020	意大利	30/	30	48.0±12.1	40.1±10.7	VR训练+机器人辅助训练	机器人辅助训练	8周	①⑦⑧⑩	6
黄爱茹等^[20]，2022	中国	48	48	59.62±9.35	58.15±7.64	VR训练+OT	OT	4周	①⑨	6
Torrisi等^[21]，2021	意大利	24	24	53.2±12.1	55.3±8.7	VR手部训练	传统手部训练	8周	①⑩	6
许方军等^[22]，2021	中国	44	44	55.36±10.13	57.82±11.94	VR认知训练+OT	OT＋传统认知训练	4周	②③	7
付亏杰等^[23]，2019	中国	20	20	54.00±4.96	54.15±6.92	VR训练+OT	OT	4周	②③	6
李佳等^[24]，2019	中国	25	25	56.80±10.44	53.88±10.40	VR训练	OT	2周	②⑤	7
Adomavičienė等^[25]，2019	立陶宛	17	25	66（60.5~70）	62（61~69）	VR训练+OT+机器人辅助训练	OT+机器人辅助训练	2周	②⑥	7
Kim等^[26]，2011	韩国	15	13	66.5±11.0	66.5±11.0	VR认知训练	传统认知训练	4周	②⑦	6
Lee等^[27]，2020	韩国	11	11	58.18±8.22	59.09±11.65	VR训练	OT	4周	③	6
陶林花等^[28]，2015	中国	20	20	63.70±8.70	62.05±10.17	VR训练+OT	OT	8周	③	6
Park等^[29]，2015	韩国	15	15	64.7±8.9	65.2±8.0	VR训练	OT	4周	③⑫	6
王丽琴等^[30]，2022	中国	20	20	48.25±11.39	49.10±11.62	VR训练+OT	OT	6周	④	6
沈林芳等^[31]，2017	中国	40	40	56.89±10.11	57.33±9.54	VR训练+OT	OT	8周	④	6
许楠婕和何予工^[32]，2020	中国	36	36	52.33±5.37	51.67±4.61	VR训练	OT	4周	④	6
阮丽英等^[33]，2021	中国	30	30	64.6±3.02	65.1±3.11	VR训练+OT	OT	4周	④⑤	6
de Rooij等^[34]，2021	荷兰	28	24	65（57~70）	61（53~71）	VR训练	OT	6周	④⑤	6
Lin等^[35]，2020	中国	38	107	64.5±13.5	66.9±13.3	VR训练+OT	OT	6周	⑥	8
Unibaso-Markaida等^[36]，2019	西班牙	15	15	60±15	60±15	VR训练+运动锻炼	运动锻炼	8周	⑦⑧	7
陈姣姣等^[37]，2016	中国	25	25	60.68±9.19	59.56±8.38	VR训练+OT+人工记忆训练	OT+人工记忆训练	6周	⑨	8
温鸿源等^[38]，2017	中国	40	40	61.9±6.9	63.7±7.8	VR训练+OT+人工记忆训练	OT+人工记忆训练	2个月	⑨	6
Braley等^[39]，2021	美国	17	15	58.9±10	64.2±9.9	VR训练	OT	10周	⑪	6
叶维霞等^[40]，2020	中国	30	30	65.11±6.92	64.98±7.13	VR训练+言语训练	言语训练	8周	⑪	6
Choi等^[41]，2018	韩国	14	14	49.50±23.00	51.00±13.75	VR训练+OT	OT	6周	⑫	7

纳入研究	国家	例数		年龄（岁）		干预措施	对照措施	疗程	结局指标	PEDro得分（分）
纳入研究	国家	T	C	T	C	干预措施	对照措施	疗程	结局指标	PEDro得分（分）
Gueye等^[13]，2021	捷克	25	25	66.56±12.26	68.12±11.97	VR训练	OT	3周	①	6
Akinci等^[14]，2024	土耳其	17	17	59.18±8.89	59.12±13.22	VR训练+OT	OT	6周	①	7
Oh等^[15]，2019	韩国	17	14	57.4±12.2	52.6±10.7	VR训练	OT	6周	①②	8
林玮佳等^[16]，2023	中国	30	30	59.64±4.80	60.23±5.10	VR认知训练+多奈哌齐	传统认知训练+多奈哌齐	3个月	①②	6
Maier等^[17]，2020	西班牙	16	14	45~75	45~75	VR认知训练	传统认知训练	18周	①②④⑦⑧⑩	8
于梅青等^[18]，2021	中国	20	18	60.75±12.54	63.17±11.12	VR训练+OT	OT	30 d	①④	7
Manuli等^[19]，2020	意大利	30/	30	48.0±12.1	40.1±10.7	VR训练+机器人辅助训练	机器人辅助训练	8周	①⑦⑧⑩	6
黄爱茹等^[20]，2022	中国	48	48	59.62±9.35	58.15±7.64	VR训练+OT	OT	4周	①⑨	6
Torrisi等^[21]，2021	意大利	24	24	53.2±12.1	55.3±8.7	VR手部训练	传统手部训练	8周	①⑩	6
许方军等^[22]，2021	中国	44	44	55.36±10.13	57.82±11.94	VR认知训练+OT	OT＋传统认知训练	4周	②③	7
付亏杰等^[23]，2019	中国	20	20	54.00±4.96	54.15±6.92	VR训练+OT	OT	4周	②③	6
李佳等^[24]，2019	中国	25	25	56.80±10.44	53.88±10.40	VR训练	OT	2周	②⑤	7
Adomavičienė等^[25]，2019	立陶宛	17	25	66（60.5~70）	62（61~69）	VR训练+OT+机器人辅助训练	OT+机器人辅助训练	2周	②⑥	7
Kim等^[26]，2011	韩国	15	13	66.5±11.0	66.5±11.0	VR认知训练	传统认知训练	4周	②⑦	6
Lee等^[27]，2020	韩国	11	11	58.18±8.22	59.09±11.65	VR训练	OT	4周	③	6
陶林花等^[28]，2015	中国	20	20	63.70±8.70	62.05±10.17	VR训练+OT	OT	8周	③	6
Park等^[29]，2015	韩国	15	15	64.7±8.9	65.2±8.0	VR训练	OT	4周	③⑫	6
王丽琴等^[30]，2022	中国	20	20	48.25±11.39	49.10±11.62	VR训练+OT	OT	6周	④	6
沈林芳等^[31]，2017	中国	40	40	56.89±10.11	57.33±9.54	VR训练+OT	OT	8周	④	6
许楠婕和何予工^[32]，2020	中国	36	36	52.33±5.37	51.67±4.61	VR训练	OT	4周	④	6
阮丽英等^[33]，2021	中国	30	30	64.6±3.02	65.1±3.11	VR训练+OT	OT	4周	④⑤	6
de Rooij等^[34]，2021	荷兰	28	24	65（57~70）	61（53~71）	VR训练	OT	6周	④⑤	6
Lin等^[35]，2020	中国	38	107	64.5±13.5	66.9±13.3	VR训练+OT	OT	6周	⑥	8
Unibaso-Markaida等^[36]，2019	西班牙	15	15	60±15	60±15	VR训练+运动锻炼	运动锻炼	8周	⑦⑧	7
陈姣姣等^[37]，2016	中国	25	25	60.68±9.19	59.56±8.38	VR训练+OT+人工记忆训练	OT+人工记忆训练	6周	⑨	8
温鸿源等^[38]，2017	中国	40	40	61.9±6.9	63.7±7.8	VR训练+OT+人工记忆训练	OT+人工记忆训练	2个月	⑨	6
Braley等^[39]，2021	美国	17	15	58.9±10	64.2±9.9	VR训练	OT	10周	⑪	6
叶维霞等^[40]，2020	中国	30	30	65.11±6.92	64.98±7.13	VR训练+言语训练	言语训练	8周	⑪	6
Choi等^[41]，2018	韩国	14	14	49.50±23.00	51.00±13.75	VR训练+OT	OT	6周	⑫	7

结局指标	纳入研究数（篇）	异质性检验结果		效应模型	Meta分析结果
结局指标	纳入研究数（篇）	P值	I²值（%）	效应模型	SMD/MD（95%CI）	P值
认知功能
整体认知	16^{[13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,29]}	<0.001	79.47	随机	0.69（0.40~0.99）	<0.001
MoCA	9^{[13,14,15,16,17,18,19,20,21]}	0.003	74.14	随机	1.61（0.55~2.67）	<0.001
MMSE	8^{[15,16,17,22,23,24,25,26]}	<0.001	85.29	随机	1.66（0.25~3.07）	0.021
LOTCA	3^[22,27,29]	0.042	67.11	随机	7.55（4.15~10.94）	<0.001
记忆功能	3^[20,37,38]	0.739	0	固定	2.59（2.00~3.18）	<0.001
注意力
TMT-A	4^{[17,19,26,36]}	0.023	73.36	随机	-7.35（-33.25~18.56）	0.578
TMT-B	3^[17,19,36]	0.166	44.31	固定	-32.46（-52.62~-12.31）	0.002
语言功能	2^[39,40]	0.340	0	固定	9.87（7.47~12.26）	<0.001
命名功能	2^[39,40]	0.258	21.61	固定	14.96（12.08~17.85）	<0.001
执行功能	3^[17,19,21]	<0.001	87.53	随机	1.11（-0.34~2.55）	0.134
感知功能	4^{[22,23,27,28]}	0.084	53.40	随机	2.19（1.30~3.19）	<0.001
视空间功能	2^[29,41]	0.531	0	固定	2.42（-2.66~7.49）	0.351
负性情绪
焦虑	5^{[24,25,33,34,35]}	<0.001	82.20	随机	-0.61（-1.17~-0.04）	0.042
抑郁	7^{[17,18,30,31,32,33,34]}	<0.001	86.61	随机	-2.92（-4.55~-1.29）	<0.001

结局指标	纳入研究数（篇）	异质性检验结果		效应模型	Meta分析结果
结局指标	纳入研究数（篇）	P值	I²值（%）	效应模型	SMD/MD（95%CI）	P值
认知功能
整体认知	16^{[13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,29]}	<0.001	79.47	随机	0.69（0.40~0.99）	<0.001
MoCA	9^{[13,14,15,16,17,18,19,20,21]}	0.003	74.14	随机	1.61（0.55~2.67）	<0.001
MMSE	8^{[15,16,17,22,23,24,25,26]}	<0.001	85.29	随机	1.66（0.25~3.07）	0.021
LOTCA	3^[22,27,29]	0.042	67.11	随机	7.55（4.15~10.94）	<0.001
记忆功能	3^[20,37,38]	0.739	0	固定	2.59（2.00~3.18）	<0.001
注意力
TMT-A	4^{[17,19,26,36]}	0.023	73.36	随机	-7.35（-33.25~18.56）	0.578
TMT-B	3^[17,19,36]	0.166	44.31	固定	-32.46（-52.62~-12.31）	0.002
语言功能	2^[39,40]	0.340	0	固定	9.87（7.47~12.26）	<0.001
命名功能	2^[39,40]	0.258	21.61	固定	14.96（12.08~17.85）	<0.001
执行功能	3^[17,19,21]	<0.001	87.53	随机	1.11（-0.34~2.55）	0.134
感知功能	4^{[22,23,27,28]}	0.084	53.40	随机	2.19（1.30~3.19）	<0.001
视空间功能	2^[29,41]	0.531	0	固定	2.42（-2.66~7.49）	0.351
负性情绪
焦虑	5^{[24,25,33,34,35]}	<0.001	82.20	随机	-0.61（-1.17~-0.04）	0.042
抑郁	7^{[17,18,30,31,32,33,34]}	<0.001	86.61	随机	-2.92（-4.55~-1.29）	<0.001

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