不同虚拟现实技术对帕金森病患者运动功能疗效的网状Meta分析

doi:10.3969/j.issn.1006-9771.2025.11.006

Abstract

Abstract:

Objective To systematically compare the efficacy of different virtual reality (VR) technologies on motor dysfunction in patients with Parkinson's disease (PD) through a network meta-analysis (NMA).

Methods Following the PRISMA-NMA guidelines, randomized controlled trials (RCT) that compared the effect of at least two interventions on motor function in patients with PD were searched in PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang data and VIP. The interventions included immersive virtual reality (IVR), non-immersive virtual reality (VRT), augmented reality (AR), treatment as usual (TAU) and active control (AC). The primary outcomes included Unified Parkinson's Disease Rating Scale Part Ⅲ (UPDRS-Ⅲ), Berg Balance Scale (BBS) and Timed Up and Go Test (TUGT). A frequentist-based random-effects model was used to conduct NMA, and the surface under the cumulative ranking curve (SUCRA) was used to rank the interventions.

Results A total of 20 RCT involving 890 patients were included. IVR performed best in improving the score of UPDRS-Ⅲ (SUCRA = 97.7%) and was significantly superior to TAU (SMD = -0.82, 95%CI -1.28 to -0.37). IVR showed the highest probability of being the best option for the score of BBS (SUCRA = 85.2%) and was significantly superior to TAU (SMD = 3.94, 95%CI 1.08 to 6.80). IVR performed best in the outcome of TUGT (SUCRA = 95.1%) and was significantly superior to VRT (SMD = 1.06, 95%CI 0.40 to 1.72), AR (SMD = -1.09, 95%CI -1.98 to -0.19) and TAU (SMD = -1.38, 95%CI -1.95 to -0.82). However, subgroup analysis revealed that the efficacy advantage of IVR was mainly confirmed in short-term (four to six weeks) interventions, while the evidence for long-term efficacy was currently very limited.

Conclusion The efficacy of interventions on motor rehabilitation in patients with PD appears to be positively correlated with the technology's level of immersion. As the most immersive technology, IVR is the optimal choice for improving overall motor function, balance and mobility in patients with PD. VRT and AR serve as effective adjuvants and are superior to TAU.

Key words: Parkinson's disease, virtual reality, motor activity, network meta-analysis

CLC Number:

R473.74

ZHANG Hao, XU Chuanlei, WEI Zhenxing, MA Lihong. Comparison of different virtual reality technologies on motor function in Parkinson's disease: a network meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(11): 1290-1302.

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References 42

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人群(Population)		干预(Intervention)	比较(Comparison)	结局(Outcome)
帕金森病患者不限年龄、性别、病程	8A00.0帕金森病	干预措施	干预前后比较	整体运动功能(UPDRS-III)
帕金森病患者不限年龄、性别、病程		IVR	干预方式比较	b760 随意运动控制功能
		VRT	干预组与对照组比较	平衡功能(BBS)
		AR		d415维持身体姿势功能
		干预时间		综合移动能力(TUGT)
				d450 行走功能

纳入文献	国家	n(T/C)	年龄(T/C)/岁	干预措施	对照	干预时间	结局指标
娄峰旗等^[16](2021)	中国	30/30	(66.57±5.21)/(67.12±4.92)	IVR	TAU	4周	UPDRS-III、TUGT、BBS
刘静等^[17](2020)	中国	21/21	(62.14±7.21)/(61.86±7.53)	IVR	TAU	4周	UPDRS-III、TUGT、BBS
陈思等^[18](2017)	中国	20/20	(66.45±5.60)/(66.50±5.58)	IVR	TAU	4周	TUGT、BBS
林志诚等^[19](2016)	中国	30/30	(67.5±8.1)/(68.2±7.9)	VRT	TAU	6周	TUGT、BBS
冯浩等^[20](2019)	中国	32/32	(62.3±7.2)/(61.8±7.5)	VRT	TAU	4周	TUGT、BBS
Rosenfeldt等^[21](2025)	美国	25/22	(70.0±6.44)/(68.1±5.94)	AR	TAU	8周	TUGT
Pazzaglia等^[22] (2020)	意大利	25/26	(72.0±7.0)/(70.0±10.0)	VRT	TAU	6周	BBS、DGI
Pompeu等^[23] (2012)	巴西	16/16	—	VRT	TAU	7周	BBS
Lee等^[24](2015)	韩国	10/10	(68.4±2.9)/(70.1±3.3)	VRT	TAU	6周	BBS
Yuan等^[25](2020)	中国	12/12	(67.8±5.5)/(66.5±8.8)	IVR	TAU	6周	BBS
Kashif等^[26](2024)	巴基斯坦	20/20	(63.20±4.85)/(61.95±4.62)	VRT	TAU	12周	UPDRS-III、BBS
Goffredo等^[27](2023)	意大利	49/48	(67.8±6.6)/(68.2±5.8)	VRT	TAU	6周	UPDRS-III
Santos等^[28](2019)	巴西	13/14	(61.7±7.3)/(64.5±9.8)	VRT	TAU	8周	BBS；DGI、TUGT
Song等^[29](2018)	澳大利亚	28/25	(68±7)/(65±7)	VRT	TAU	12周	TUGT
Yang等^[30](2016)	中国	11/12	(72.5±8.4)/(75.4±6.3)	VRT	TAU	6周	UPDRS-III、BBS、TUGT
Gulcan等 ^[31](2023)	土耳其	15/15	—	AR	TAU	6周	UPDRS-III、BBS、TUGT
Mirelman等^[32] (2011)	美国	20/20	(64.9±8.4)/(68.2±6.9)	VRT	AC	6周	UPDRS-III、TUGT
Feng等^[33](2019)	中国	14/14	(67.47±4.79)/(66.93±4.64)	VRT	TAU	12周	UPDRS-III、TUGT、BBS
Gandolfi等^[34](2017)	意大利	36/36	(69.3±8.1)/(68.8±7.8)	VRT	TAU	8周	UPDRS-III、TUGT、BBS
Liao等^[35](2015)	中国	20/20	(65.6±8.4)/(68.3±7.1)	VRT	TAU	6周	UPDRS-III、TUGT、BBS

研究	对照组类型	干预内容	频率与时长
娄峰旗等^[16](2021)	TAU	常规康复训练	—
刘静等^[17](2020)	TAU	常规平衡训练	—
陈思等^[18](2017)	TAU	常规平衡训练	—
林志诚等^[19](2016)	TAU	常规平衡训练	—
冯浩等^[20](2019)	TAU	常规康复训练	—
Rosenfeldt等^[21](2025)	TAU	标准物理治疗，包括平衡、步态和功能性任务训练	—
Pazzaglia等^[22](2020)	TAU	传统康复计划，包括平衡练习、步态训练和上肢功能活动	每次40 min，每周3次，共6周
Pompeu等^[23](2012)	TAU	平衡锻炼疗法，不使用外部提示或认知刺激	每次30 min，每周2次，共7周
Lee等^[24](2015)	TAU	常规物理治疗，包括关节活动度、伸展、平衡和步态训练	—
Yuan等^[25](2020)	TAU	常规平衡训练	—
Kashif等^[26](2024)	TAU	常规物理治疗	—
Goffredo等^[27](2023)	TAU	在家自行进行的结构化常规运动活动，包括平衡和下肢运动	每周3~5次，共6~10周，共30次
Santos等^[28](2019)	TAU	常规锻炼	—
Song等^[29](2018)	TAU	常规护理	—
Yang等^[30](2016)	TAU	常规平衡训练	—
Gulcan等^[31](2023)	TAU	常规物理治疗，包括平衡和步态训练	—
Mirelman等^[32](2011)	AC	在跑步机上行走，无VR内容	每次 45 min，每周3次，共6周
Feng等^[33](2019)	TAU	常规物理治疗，包括重心转移训练、平衡训练、步态训练等	每次45 min，每周5次，共12周
Gandolfi等^[34](2017)	TAU	在诊所进行的“感觉整合平衡训练”	每次50 min，每周3次，共7周
Liao等^[35](2015)	TAU	常规物理治疗	—

项目	VRT	IVR	TAU
IVR	0.61 (0.09~1.13)^a
TAU	-0.21 (-0.46~0.04)	-0.82 (-1.28~-0.37)^a
AR	-0.12 (-0.93~0.69)	-0.73 (-1.63~0.16)	0.09 (-0.68~0.86)

项目	VRT	IVR	TAU
IVR	-2.56 (-5.90~0.77)
TAU	1.38 (-0.37~3.13)	3.94 (1.08~6.80)^a
AR	2.35 (-5.12~9.83)	4.92 (-2.89~12.73)	0.97 (-6.29~8.24)

Comparison of different virtual reality technologies on motor function in Parkinson's disease: a network meta-analysis

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项目	VRT	IVR	TAU	AR
IVR	1.06 (0.40~1.72)^a
TAU	-0.33 (-0.67~0.01)	-1.38 (-1.95~-0.82)^a
AR	-0.03 (-0.80~0.74)	-1.09 (-1.98~-0.19)^a	0.30 (-0.40~0.99)
AC	-0.39 (-1.35~0.58)	-1.45 (-2.62~-0.28)^a	-0.06 (-1.09~0.96)	-0.36 (-1.59~0.88)

干预措施	UPDRS-III		BBS		TUGT
干预措施	SUCRA值	排名	SUCRA值	排名	SUCRA值	排名
IVR	97.7%	1	85.2%	1	95.1%	1
VRT	52.3%	2	63.5%	2	61.3%	2
AR	34.7%	3	24.2%	3	40.5%	3
TAU	15.2%	4	27.1%	4	28.2%	4
AC	—		—		24.8%	5

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