Innovations In Clinical Neuroscience

JAN-FEB 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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[ V O L U M E 1 4 , N U M B E R 1 – 2 , J A N U A R Y – F E B R U A R Y 2 0 1 7 ] Innovations in CLINICAL NEUROSCIENCE 15 projectors, and/or gloves fitted with s ensors or touch-sensitive motors. Sensors may allow researchers to monitor and record a patient's level of interactivity (known as "immersion" or "presence") in a way that is reliable, s afe, and replicable. 3 VR's immersive, entertaining effects are useful for redirecting the patient's attention away from painful treatment experiences and reducing anxiety, discomfort, or unpleasantness. 12 VR has been utilized in many studies to distract (often pediatric) patients during wound redressing in burn care, and in exposure therapy for phobias or posttraumatic stress disorder (PTSD) as a substitute for imagination of a feared environment. 7 VR has been used to treat eating disorders and obesity, allowing patients to improve body image perceptions and promote healthier eating habits by inhabiting realistic avatars in stress- inducing virtual situations, such as food shopping. 7 VR is also used for patient motor rehabilitation, aiding patients to reacquire specific skills and improve body movement in virtual environments that are less dull or discouraging than standard gym exercises. 7 METHODS Literature search strategy. We reviewed all controlled trials of VR in inpatient medical settings published over the last 10 years. We used PsycINFO, PubMed, and Medline electronic databases to identify studies from 2005 to 2015, based on the following keywords: virtual reality, VR therapy, treatment, and inpatient. We also reviewed reference lists of previous reviews and meta-analyses to identify titles not captured in our initial search. We excluded trials with no control or comparison group, case studies, outpatient studies, theses or dissertations, and articles not published in the English language. As displayed in Figure 1, our initial search yielded 2,024 citations of journal articles written in English over the last decade. We discarded 1,966 citations not involving inpatient populations and reviewed the remaining 58 studies in more detail. We excluded 42 of these studies because they did not meet all inclusion criteria, were duplicates, or because the full text was not available. We grouped the final 11 eligible studies based on their application of VR to three broad medical conditions: pain distraction, eating disorders/obesity, and cognitive/motor rehabilitation. These studies are described in Table 1. Evaluation of study quality. To evaluate the strength of scientific evidence reported in these studies, we utilized a measure developed by Reisch, Tyson, and Mize, chosen among several measures reviewed and approved by the Agency for Healthcare Research and Quality (AHRQ). 13,14 We selected the Reisch measure because it can be used for both observational studies and randomized, controlled trials (RCTs) and thoroughly assesses many important domains, including the following: study purpose, experimental design, sample size determination, description and suitability of subjects, randomization and stratification, usage of control/comparison group, treatment procedures, blinding, attrition, subject and treatment evaluation metrics, data analysis and presentation, and treatment recommendations. The measure aggregates data on 34 attributes within these 12 domains to produce a quality ratio (0–1), and can be adjusted to exclude attributes that do not apply to a given study. For example, blinding to the usage of VR is impossible by design, so this domain was not included in our evaluation of study quality. Two raters (study authors JR and MR) scored each VR trial, utilizing a subset of applicable questions that totaled 27 points. After each rater completed a review of one of the VR trials, the raters conferred and discussed differences in scoring. Then, each rater reviewed the complete set of articles presented herein. 15 We assessed inter- rater reliability by computing Cohen's FIGURE 1. Flowchart of search strategy and study selection process

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