Dropout rate in randomised controlled trials of balance and gait rehabilitation in multiple sclerosis: is it expected to be different for virtual reality-based interventions? A systematic review with meta-analysis and meta-regression

Abstract

To assess and meta-analyse the pooled dropout rate from the randomised control trilas that use virtual reality for balance or gait rehabilitation in people with multiple sclerosis. A systematic review of randomised control trials with meta-analysis and meta-regressions was performed. A search was conducted in PubMed, Scopus, Web of Science, the Physiotherapy Evidence Database, the Cochrane Database, CINHAL, LILACS, ScienceDirect, and ProQuest. It was last updated in July 2022. After the selection of studies, a quality appraisal was carried out using the PEDro Scale and the Revised Cochrane risk-of-bias tool for randomised trials. A descriptive analysis of main characteristics and dropout information was performed. An overall proportion meta-analysis calculated the pooled dropout rate. Odds ratio meta-analysis compared the dropout likelihood between interventions. The meta-regression evaluated the influence of moderators related to dropout. Sixteen studies with 656 participants were included. The overall pooled dropout rate was 6.6% and 5.7% for virtual reality and 9.7% in control groups. The odds ratio (0.89, p = 0.46) indicated no differences in the probability of dropouts between the interventions. The number, duration, frequency, and weeks of sessions, intervention, sex, multiple sclerosis phenotype, Expanded Disability Status Scale score, and PEDro score were not moderators ( p > 0.05). Adverse events were not reported and could not be analysed as moderators. Dropouts across the virtual reality and control comparators were similar without significant differences. Nonetheless, there is a slight trend that could favour virtual reality. Standardisation in reporting dropouts and adverse events is recommended for future trials. PROSPERO database, registration number ID CRD42021284989. Supplementary Information The online version contains supplementary material available at 10.1007/s10055-022-00733-4.

Non-Immersive Virtual Reality Telerehabilitation System Improves Postural Balance in People with Chronic Neurological Diseases

“…Therefore, the future research agenda should analyze the efficacy of telerehabilitation in more severely affected patients and increase the panel typology of treatments delivered remotely for complete physical and cognitive telerehabilitation in patients with chronic neurological diseases. Furthermore, the observed dropout rate (slightly more than 10%) was higher than the estimated a priori dropout rate (about 5%), approximately expected in these two neurological populations after virtual reality clinical trials as reported from recent metanalyses [86,87]. In these metanalyses, the typical reasons for dropout were difficulties in reaching the research center, refusal to participate, personal or familial issues, loss of data due to administrative problems, exacerbation of symptoms or other medical complications [86].…”

Fatigue: Physiology and Pathology

“…Not only apps measuring fatigue through questionnaires but also wearable devices have proved to be useful in the continuous monitoring of fatigued MS patients (Sparaco et al, 2018;Tong et al, 2019;Block et al, 2022). These "health technologies" usually have an internet or smartphone connection and therefore allow non-stop collection of data about physiological parameters (e.g., heart rate, sleep levels) and track any kind 2019;Maggio et al, 2019a,b;Cuesta-Gómez et al, 2020;Manuli et al, 2020;Ozkul et al, 2020;Yazgan et al, 2020;Cortés-Pérez et al, 2021;Leonardi et al, 2021;Nascimento et al, 2021;Pagliari et al, 2021;Altunkaya et al, 2022;Casuso-Holgado et al, 2022;Hollywood et al, 2022;Kalron et al, 2022;Moeinzadeh et al, 2022;Dogan et al, 2023;Hsu et al, 2023) Computer of physical activities through accelerometers and sensors (Sparaco et al, 2018).…”

“…Some studies have hinted at the fact that a longer duration of the rehabilitation program could cause fatigued patients with MS to lose motivation and thus adherence. Consensus about the right duration of a VR therapy session is one more time difficult to find in the literature, but it is strategic to keep in mind the potential obstacles of VR, which can hinder efficacy and cost-effectiveness (Bevens et al, 2022;Casuso-Holgado et al, 2022). Manuli et al viewed a possible solution to this gap by adding the patients' reported opinions and outcomes to the concept of feasibility.…”

Management of multiple sclerosis fatigue in the digital age: from assessment to treatment

“…Some studies have hinted at the fact that a longer duration of the rehabilitation program could cause fatigued patients with MS to lose motivation and thus adherence. Consensus about the right duration of a VR therapy session is one more time difficult to find in the literature, but it is strategic to keep in mind the potential obstacles of VR, which can hinder efficacy and cost-effectiveness (Bevens et al, 2022 ; Casuso-Holgado et al, 2022 ). Manuli et al viewed a possible solution to this gap by adding the patients' reported opinions and outcomes to the concept of feasibility.…”

“…Not only apps measuring fatigue through questionnaires but also wearable devices have proved to be useful in the continuous monitoring of fatigued MS patients (Sparaco et al, 2018;Tong et al, 2019;Block et al, 2022). These "health technologies" usually have an internet or smartphone connection and therefore allow non-stop collection of data about physiological parameters (e.g., heart rate, sleep levels) and track any kind Manuli et al, 2020;Ozkul et al, 2020;Yazgan et al, 2020;Cortés-Pérez et al, 2021;Leonardi et al, 2021;Nascimento et al, 2021;Pagliari et al, 2021;Altunkaya et al, 2022;Casuso-Holgado et al, 2022;Hollywood et al, 2022;Kalron et al, 2022;Moeinzadeh et al, 2022;Dogan et al, 2023;Hsu et al, 2023) Computer of physical activities through accelerometers and sensors (Sparaco et al, 2018).…”