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Table 3 Summary of the effectiveness of virtual reality therapy compared to active intervention by outcomes in Parkinson’s disease

From: The effectiveness of virtual reality for rehabilitation of Parkinson disease: an overview of systematic reviews with meta-analyses

Outcomes

Study

Effect estimation

(95% CI)

Studies (participants)

Certainty of the evidence

(GRADE)

Gait speed

Sarasso E (2021) [16]

MD 0.03 (−0.01, 0.07)

8 (279)

⊕〇〇〇

Very lowa,c,f

Gait speed

Triegaardt J (2020) [19]

SMD 0.08 (−0.27, 0.44)

6 (209)

⊕〇〇〇

Very lowa,c

Gait speed

Lina C (2020) [21]

MD 0.13(0.02, 0.24)

4 (174)

⊕〇〇〇

Very lowa,c

Gait speed

Wang B (2019) [23]

MD −0.00 (−0.06, 0.06)

5 (203)

⊕⊕〇〇

Lowc,d

Gait speed

Lei C (2019) [25]

SMD 0.19 (−0.03, 0.40)

7 (347)

⊕〇〇〇

Very lowa,c,f

Gait speed

Dockx K (2016) [26]

SMD 0.18 (−0.20, 0.57)

3 (106)

⊕⊕〇〇

Lowc,d

Stride/step length

Sarasso E (2021) [16]

SMD 0.64 (0.25, 1.02)

4 (110)

⊕〇〇〇

Very lowa,c,f

Stride/step length

Triegaardt J (2020) [19]

SMD 0.70 (0.32, 1.08)

4 (116)

⊕〇〇〇

Very lowa,c

Stride/step length

Wang B (2019) [23]

MD 9.65 (4.31, 14.98)

2 (79)

⊕⊕〇〇

Lowa,c,g

Stride/step length

Lei C (2019) [25]

SMD 0.72 (0.40, 1.04)

4 (166)

⊕〇〇〇

Very lowc,d,f

Stride/step length

Dockx K (2016) [26]

SMD 0.69 (0.30, 1.08)

3 (106)

⊕⊕〇〇

Lowc,d

Walking stability (DGI)

Elena P (2021) [18]

MD 1.13 (0.35, 1.92)

3 (176)

⊕⊕〇〇

Lowc,d

Walking stability (DGI)

Lei C (2019) [25]

SMD −0.15 (−0.50, 0.19)

3 (130)

⊕〇〇〇

Very lowa,c

Walking stability (DGI/FGA)

Sarasso E (2021) [16]

SMD 0.39 (−0.15, 0.93)

6 (207)

⊕〇〇〇

Very lowa,b,c.f

Walking stability (DGI/FGA)

Chen Y (2020) [22]

MD 0.31 (−0.56, 1.19)

5 (220)

⊕〇〇〇

Very lowa,b,c,f

Walking distance (6MWT)

Sarasso E (2021) [16]

MD 8.20 (−17.28, 33.69)

3 (72)

⊕⊕〇〇

Lowa,c,g

Walking distance (6MWT)

Wang B (2019) [23]

MD 8.91 (−43.43, 61.13)

2 (45)

⊕⊕〇〇

Lowa,c,g

Balance (BBS)

Sarasso E (2021) [16]

MD 2.09 (0.86, 3.33)

14 (430)

⊕⊕〇〇

Low a,b,g

Balance (BBS)

Elena P (2021) [18]

MD 2.64 (0.45, 4.83)

7 (281)

⊕〇〇〇

Very lowa,b,c,g

Balance (BBS)

Triegaardt J (2020) [19]

SMD 0.26 (−1.02, 0.62)

5 (166)

⊕〇〇〇

Very lowa,b,c

Balance (BBS)

Lina C (2020) [21]

MD 2.28 (1.39, 3.16)

9 (281)

⊕⊕〇〇

Lowa,c,g

Balance (BBS)

Chen Y (2020) [22]

MD 1.23 (0.15, 2.31)

8 (266)

⊕〇〇〇

Very lowa,b,c

Balance (BBS)

Wang B (2019) [23]

MD 2.69 (1.37, 4.02)

9 (299)

⊕〇〇〇

Very lowa,b,c,g

Balance (BBS)

Santos P (2019) [24]

MD 1.24 (0.24, 2.25)

3 (72)

⊕〇〇〇

Very lowa,c

Balance (BBS)

Lei C (2019) [25]

SMD 0.22 (0.01, 0.42)

11 (360)

⊕〇〇〇

Very lowa,c

Balance (BBS)

Dockx K (2016) [26]

MD 0.55 (−0.48, 1.58)

3 (86)

⊕⊕〇〇

Lowc,d

Balance (BBS)

Harris DM (2015) [27]

SMD 0.12 (−0.58, 0.83)

1 (32)

⊕〇〇〇

Very lowa,c

Balance (TUG)

Sarasso E (2021) [28]

MD −1.55 (−3.06, −0.04)

8 (236)

⊕〇〇〇

Very lowc,d,e

Balance (TUG)

Elena P (2021) [18]

MD −0.98 (−2.21, 0.26)

6 (205)

⊕⊕〇〇

Lowc,d

Balance (TUG)

Lina C (2020) [21]

MD −1.66 (−2.74, −0.58)

7 (190)

⊕⊕〇〇

Lowc,d

Balance (TUG)

Chen Y (2020) [22]

MD −0.18 (−1.37, 1.00)

4 (120)

⊕〇〇〇

Very lowb,c,d

Balance (TUG)

Wang B (2019) [23]

MD −2.86 (−5.60, −0.12)

5 (144)

⊕⊕〇〇

Lowb,c,d,g

Balance (TUG)

Lei C (2019) [25]

MD −1.95 (−2.81, −1.08)

7 (237)

⊕〇〇〇

Very lowb,c,d

Balance (BBS/TUG/SLS)

Dockx K (2016) [26]

SMD 0.34 (−0.04, 0.71)

5 (155)

⊕〇〇〇

Very lowc,d,f

Balance confidence (ABC)

Elena P (2021) [18]

MD 7.03 (0.36, 13.69)

2 (115)

⊕⊕〇〇

Lowa,c,g

Balance confidence (ABC)

Chen Y (2020) [22]

MD 1.69 (−2.62, 6.01)

2 (115)

⊕〇〇〇

Very lowa,c

Balance confidence (ABC/FES/FES-I)

Sarasso E (2021) [28]

SMD 0.08 (−0.15, 0.32)

7 (334)

⊕〇〇〇

Very lowa,c,f

Balance confidence (ABC/FES)

Lei C (2019) [25]

SMD −0.73 (−1.43, −0.02)

3 (104)

⊕〇〇〇

Very lowb,c,d,f

Motor function (UPDRS-III)

Sarasso E (2021) [28]

MD −0.25 (−2.28, 1.79)

5 (164)

⊕〇〇〇

Very lowb,c,d

Motor function (UPDRS-III)

Triegaardt J (2020) [19]

SMD −0.38 (−1.45, 0.69)

3 (75)

⊕〇〇〇

Very lowb,c,d

Motor function (UPDRS-III)

Lei C (2019) [25]

SMD −0.50 (−1.48, 0.48)

5 (164)

⊕〇〇〇

Very lowa,b,c

Quality of life (PDQ-39)

Elena P (2021) [18]

MD −1.21 (−1.68, −0.73)

7 (207)

⊕〇〇

Lowc,d

Quality of life (PDQ-39)

Santos P (2019) [24]

MD −8.90 (−15.22, −2.58)

2 (56)

⊕⊕⊕〇

Moderatec,d,g

Quality of life (PDQ-39)

Dockx K (2016) [26]

MD 3.73 (−2.16, 9.61)

6 (106)

⊕〇〇〇

Very lowa,b,c,g

Quality of life (PDQ-39/PDQ-8)

Sarasso E (2021) [28]

SMD 0.12 (−0.10, 0.35)

9 (303)

⊕〇〇〇

Very lowa,c,f

Quality of life (PDQ-39/PDQ-8)

Triegaardt J (2020) [19]

SMD 0.20 (−0.16, 0.57)

5 (176)

⊕〇〇

Lowc,d

Quality of life (PDQ-39/WHOQOL-OLD)

Lei C (2019) [25]

SMD −0.47 (−0.73, −0.22)

6 (248)

⊕〇〇〇

Very lowc,d,f

Activities of daily living (UPDRS-II)

Elena P (2021) [18]

MD −2.37 (−5.97, 1.23)

3 (101)

⊕〇〇〇

Very lowa,b,c,g

Activities of daily living (UPDRS-II)

Triegaardt J (2020) [19]

SMD −0.13 (−0.82, 0.57)

1 (32)

⊕〇〇〇

Very lowa,c

Activities of daily living (UPDRS-II)

Lei C (2019) [25]

SMD 0.25 (−0.14, 0.64)

4 (103)

⊕〇〇〇

Very lowa,c

Activities of daily living (MBI)

Lina C (2020) [21]

MD 2.93 (0.80, 5.06)

2 (51)

⊕⊕〇〇

Lowa,c,g

Cognitive function (MoCA)

Triegaardt J (2020) [19]

SMD 0.08 (−0.61, 0.78)

1 (32)

⊕〇〇〇

Very lowa,c

Cognitive function (DSF/MoCA)

Lei C (2019) [25]

SMD 0.21 (−0.28, 0.69)

2 (68)

⊕〇〇〇

Very lowa,c,f

Neuropsychiatric symptoms (BAI/BDI/HAMD)

Lei C (2019) [25]

SMD −0.96 (−1.27, −0.65)

4 (184)

⊕〇〇〇

Very lowc,d,f

  1. CI confidence intervals, GRADE Grading of Recommendations Assessment, Development and Evaluation, MD mean difference, SMD standard mean difference, DGI Dynamic Gait Index, FGA Functional Gait Assessment, 6-WMT 6-Minute Walking Test, BBS Berg balance scale, TUG Timed Up and Go test, SLS Single-Leg Stance Test, ABC Activities-Specific Balance Confidence scale, FES Falls Efficacy Scale, FES-I FES-international, UPDRS-III Unified Parkinson Disease Rating Scale part III, PDQ-39 39-item Parkinson Disease Questionnaire, WHOQOL-OLD World Health Organization Quality of Life-Old, MBI modified Barthel index, MoCA Montreal Cognitive Assessment, DSF Digit Span forward, BAI Beck Anxiety Inventory, BDI Beck Depression Inventory, HAMD Hamilton Depression scale
  2. GRADE Working Group grades of evidence—high certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
  3. aHigh risk of bias in at least a half of studies included within the analysis, hence bias is highly likely. Therefore, the certainty of evidence was downgraded by two levels due to the methodological limitations (risk of bias)
  4. bSubstantial heterogeneity among trials (I2 equal or more than 50%, equal or less than 90%). Therefore, the certainty of evidence was downgraded by one level (inconsistency)
  5. cThe total population size was small (<400). Therefore, the certainty of evidence was downgraded by one level (imprecision)
  6. dHigh risk of bias in less than a half of studies included within the analysis, hence bias is highly likely. Therefore, the certainty of evidence was downgraded by one level due to the methodological limitations (risk of bias)
  7. eConsiderable heterogeneity among trials (I2>90%). Therefore, the certainty of evidence was downgraded by two levels (inconsistency)
  8. fDifferent ways of assessment were used across studies. Therefore, the certainty of evidence was downgraded by one level (indirectness)
  9. gThe estimated effect was large reaching a plausible clinically relevant magnitude. Therefore, the certainty of evidence was upgraded by one level (other consideration, large effect)
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Systematic Reviews

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