Don’t be a technophobe – virtual reality therapy for Fatigue

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As darkness falls on the Northern Hemisphere, fatigue, depression and anxiety creep upon the population. For those with MS these symptoms can become unmanageable during this period. Fatigue on average affects 75% of individuals with MS, and affects both physical and mental quality of life.

Quality of life is an intangible barometer of well-being with a number of influences that adversely or positively impact on it on a daily basis. Lifestyle and work add another dimension of complexity by isolating the individual. My observation is that PwMS are isolated not only in their outward self that they present to others, but also in some instances within their home lives.

To break down these barriers you sometimes have to force the interaction, and this is where virtual interaction stands out. Depending on how it is designed, you find yourself interacting with MS teams in your home. The interaction provides direct access to care in a way that hospital appointments can never provide.

Virtual reality – “use of interactive simulations created with computer hardware and software to present users with opportunities to engage in environments that appear and feel similar to real world objects and events”

In a review looking at the use of virtual reality (VR) in neurorehabilitation protocols, the authors report that VR offers greater improvements in fatigue and quality of life in MS than conventional therapies (pharmacological and non-pharmacological) – see figure below.

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Figure: Plot showing that VR favours improvements in overall quality of life

It also favourably influences the physical dimension of quality of life (see Figure below) and the mental dimension of quality of life (see the second figure below).

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Figure: Plot of how VR favours improvements in the physical dimension of quality of life
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Figure: Plot of how VR favours improvement in the mental dimension of quality of life

This area of technology is relatively new to me, but a quick search on the internet provides multiple options. This physiotherapy link here discuses some of the physical components: Virtual Reality Treatment for Multiple Sclerosis – Physiopedia (physio-pedia.com). Check it out!

Abstract

Review Sensors (Basel) 2021 Nov 6;21(21):7389. doi: 10.3390/s21217389.

Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis

Irene Cortés-PérezMarcelina Sánchez-Alcalá Francisco Antonio Nieto-Escámez Yolanda Castellote-CaballeroEsteban Obrero-GaitánMaría Catalina Osuna-Pérez 

Patients with multiple sclerosis (PwMS) have a high level of fatigue and a reduced quality of life (QoL) due to the impact of multiple sclerosis (MS). Virtual reality-based therapy (VRBT) is being used to reduce disability in PwMS. The aim of this study was to assess the effect of VRBT on fatigue, the impact of MS, and QoL in PwMS.

Methods: A systematic review with meta-analysis was conducted through a bibliographic search on PubMed, Scopus, Web of Science, and PEDro up to April 2021. We included randomized controlled trials (RCTs) with PwMS that received VRBT in comparison to conventional therapy (CT) including physiotherapy, balance and strength exercises, and stretching or physical activity, among others; or in comparison to simple observation; in order to assess fatigue, MS-impact, and QoL. The effect size was calculated using Cohen’s standardized mean difference with a 95% confidence interval (95% CI).

Results: Twelve RCTs that provided data from 606 PwMS (42.83 ± 6.86 years old and 70% women) were included. The methodological quality mean, according to the PEDro Scale, was 5.83 ± 0.83 points. Our global findings showed that VRBT is effective at reducing fatigue (SMD -0.33; 95% CI -0.61, -0.06), lowering the impact of MS (SMD -0.3; 95% CI -0.55, -0.04), and increasing overall QoL (0.5; 95% CI 0.23, 0.76). Subgroup analysis showed the following: (1) VRBT is better than CT at reducing fatigue (SMD -0.4; 95% CI -0.7, -0.11), as well as in improving the mental dimension of QoL (SMD 0.51; 95% CI 0.02, 1); (2) VRBT is better than simple observation at reducing the impact of MS (SMD -0.61; 95% CI -0.97, -0.23) and increasing overall QoL (SMD 0.79; 95% CI 0.3, 1.28); and (3) when combined with CT, VRBT is more effective than CT in improving the global (SMD 0.6, 95% CI 0.13, 1.07), physical (SMD 0.87; 95% CI 0.3, 1.43), and mental dimensions (SMD 0.6; 95% CI 0.08, 1.11) of QoL.

Conclusion: VRBT is effective at reducing fatigue and MS impact and improving QoL in PwMS.

About the author

Neuro Doc Gnanapavan

8 comments

  • How interesting. Is VR quite novel here? It’s new to me but then again I may not be paying attention. How does one access it on the NHS? Or is it a pay for therapy?
    The all Spanish style names of the meta-analysts suggest it’s either a Latin-American or a Spanish research team, so we’re their participants from there or internationally recruited?
    I hope you’re doing well after your RTA Ide.

  • VR is relatively new in health and sadly not available on the NHS. These require access to the software that has been developed on Microsoft kinect , Xbox kinect etc.
    The work presented here is a review of other studies published in this area. Although, the original article is from Spain the individual studies come from different countries.

    • Back in the day, I was recommended a Wii-fit balance board by my physio. She told me it was being used by a lot of physios as a diagnostic tool, adding to the normal visual assessment of balance. (Standing on the balance board, a green spot appears on the screen marking the body’s centre of gravity). I used it for years, enjoying the ‘games’, all of which are performed while you’re upright and static, so there is no danger of a fall. There were sections on yoga, cardio and balance, all done through cartoons , personalised messages and music – daft but motivational. I think it’s out of production now, probably superseded by something fancier but for anyone keen there’s likely a product out there already.

    • Back in the day I was recommended to buy a Wii-fit balance board by my physio, who told me it was being used as a diagnostic tool for balance in clinics and care settings. (Standing on the board, a green light appears on the screen indicating the body’s centre of gravity, so it’s easy to see where problems are). There is a series of ‘games’ in sections for yoga, cardio and balance, all done via cartoons, music and personalised messages. All of them are done while you’re upright and static so no danger of a fall. Daft but effective. After many years, my board gave up the ghost and I don’t suppose it’s still in production but no doubt has been replaced by something fancier. so for anyone looking, there will be something ouit there.

      • Thanks Kay, the kinect are the newer versions of these types of programmes. If you have an Xbox at home it worth looking to see if there are programmes available.

    • I believe it is the performance rewards that are built into these types of programmes. It’s a trend with most gaming platforms.

      • It’s interesting these type of fast rewards usually cause long-term cognitive issues (focus, lazyness) but improve fatigue..

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