Virtual Reality Training for Upper Extremity in Subacute Stroke (VIRTUES)

Abstract

Objective: To compare the effectiveness of upper extremity virtual reality rehabilitation training<br/>(VR) to time-matched conventional training (CT) in the subacute phase after stroke.<br/>Methods: In this randomized, controlled, single-blind phase III multicenter trial, 120 participants<br/>with upper extremity motor impairment within 12 weeks after stroke were consecutively included<br/>at 5 rehabilitation institutions. Participants were randomized to either VR or CT as an adjunct to<br/>standard rehabilitation and stratified according to mild to moderate or severe hand paresis,<br/>defined as $20 degrees wrist and 10 degrees finger extension or less, respectively. The training<br/>comprised a minimum of sixteen 60-minute sessions over 4 weeks. The primary outcome measure<br/>was the Action Research Arm Test (ARAT); secondary outcome measures were the Box and<br/>Blocks Test and Functional Independence Measure. Patients were assessed at baseline, after<br/>intervention, and at the 3-month follow-up.<br/>Results: Mean time from stroke onset for the VR group was 35 (SD 21) days and for the CT group<br/>was 34 (SD 19) days. There were no between-group differences for any of the outcome measures.<br/>Improvement of upper extremity motor function assessed with ARAT was similar at the<br/>postintervention (p 5 0.714) and follow-up (p 5 0.777) assessments. Patients in VR improved<br/>12 (SD 11) points from baseline to the postintervention assessment and 17 (SD 13) points from<br/>baseline to follow-up, while patients in CT improved 13 (SD 10) and 17 (SD 13) points, respectively.<br/>Improvement was also similar for our subgroup analysis with mild to moderate and severe<br/>upper extremity paresis.<br/>Conclusions: Additional upper extremity VR training was not superior but equally as effective as<br/>additional CT in the subacute phase after stroke. VR may constitute a motivating training alternative<br/>as a supplement to standard rehabilitation.<br/>ClinicalTrials.gov identifier: NCT02079103.<br/>Classification of evidence: This study provides Class I evidence that for patients with upper<br/>extremity motor impairment after stroke, compared to conventional training, VR training did<br/>not lead to significant differences in upper extremity function improvement. Neurology®<br/>2017;89:1–9