Galvin, J., McDonald, R., Catroppa, C. & Anderson, V. (2011). Brain Injury, 1-8, Early Online
Objective: One randomized control trial (RCT) and four case studies were found that fit the criteria of the literature search; research articles that “specifically refer to upper limb interventions and outcomes of the use of virtual reality (VR) with children who had neurological impairment.”
Process: Studies were rated for level of evidence using the Australian National Health and Medical Research Council scale (1) and for study quality using the Downs and Black Checklist (2). The Downs and Black scale assesses internal validity, generalizability, bias, confounders and power. The instruments used within the studies were the Quality of Upper Extremity Skills Test, the Melbourne Assessment, the Pediatric Motor Activity Log and the Canadian Occupational Performance Measure. Three of the studies used one item of one sub-test of the Bruininks-Oseretsky Test of Motor Proficiency.
Results: The RCT showed an evidence level of II (n = 34) and the remaining articles are all case studies (n =1-5) with an evidence level of IV. The studies scored from 9 to 22 of a possible 32 points on the Downs and Black scale, with only the RCT scoring more than 50% on each of the sub-scales. The case studies are weak in the areas of reporting and analysis which limits their external validity. Power is limited due to sample size.
Conclusion: “Small sample sizes and inconsistencies in outcome measures limit the ability to generalize findings.” There is a continuing need to establish evidence for the clinical utility of VR as a treatment medium.
Link to abstract: http://informahealthcare.com/doi/abs/10.3109/02699052.2011.558047
References: (1) NHMRC. (1999) A guide to the development, implementation and evaluation of clinical practice guidelines. In: Council NNHaMR, editor. Canberra: Australian Government. (2) Downs, S.H. & Black, N. (1998). The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. Journal of Epidemiology and Community Health, 52: 377- 384.