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Effectiveness of Early Rehabilitation Combined With Virtual Reality Training on Muscle Strength, Mood State, and Functional Status in Patients With Acute Stroke: A Randomized Controlled Trial
Author(s) -
Lin RueiChing,
Chiang ShangLin,
Heitkemper Margaret McLean,
Weng ShuMin,
Lin ChiFeng,
Yang FuChi,
Lin ChiaHuei
Publication year - 2020
Publication title -
worldviews on evidence‐based nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.052
H-Index - 49
eISSN - 1741-6787
pISSN - 1545-102X
DOI - 10.1111/wvn.12429
Subject(s) - mood , rehabilitation , randomized controlled trial , stroke (engine) , anxiety , medicine , physical therapy , functional training , randomization , depression (economics) , strength training , physical medicine and rehabilitation , clinical psychology , psychiatry , mechanical engineering , engineering , economics , macroeconomics
Background Early rehabilitation has been shown to enhance functional outcomes. Whether the addition of virtual reality (VR) training could further improve muscle strength, mood state, and functional status for patients with acute stroke is unknown. Aims To investigate the effectiveness of VR training on muscle strength, mood state (depression, anxiety), and functional status in patients following acute stroke. Methods A randomized controlled trial was conducted. Patients with acute ischemic stroke ( N = 152) were selected and randomly assigned with a 1:3 randomization ratio to either experimental group (EG) or comparison group (CG). Both groups received early rehabilitation. The EG received an extra 5 days of VR training (15 min of time, two times a day), started 24 hr to 3 days poststroke. Muscle strength, mood state, and functional status were collected at admission and at the day of discharge. Generalized estimating equations were applied to examine the intervention effects. Results A total of 143 participants (94%) completed the study, and 145 were included in the intention‐to‐treat analysis. Participants in the EG reported increased muscle strength of upper and lower limbs in both affected and unaffected sides, decreased depression and anxiety, and increased functional status at discharge. When the group–time interaction was examined, the EG had greater increased upper limb muscle strength of the unaffected side (ß = 0.34, p < .001) and decreased depression and anxiety scores (ß = −2.31, p = .011; ß = −1.63, p = .047) at discharge compared with the CG. However, there was no difference in the functional status change scores from baseline between EG and CG. Linking Evidence to Action A poststroke program that includes both early rehabilitation and VR training has greater benefit in relation to mood state and muscle strength at discharge than early rehabilitation alone. Therefore, an early physical rehabilitation program that includes VR training for acute stroke inpatients should be considered for implementation in clinical settings.