Author:
Student number: Klik hier als u tekst wilt invoeren.
Data: 1-1-2024
Product: CAT
Word count: 998 words
Critically Appraised Topic “CAT”
“What is the effect of VR based rehabilitation on upper limb
recovery in stroke patients compared to conventional
methods?”
THIM Hogeschool voor Fysiotherapie, Nieuwegein
,Table of Contents
Introduction.....................................................................................................................................4
Research Question...........................................................................................................................4
Search..............................................................................................................................................5
Search results...................................................................................................................................6
Result................................................................................................................................................9
Evaluation......................................................................................................................................14
Internal Validity........................................................................................................................14
External Validity.......................................................................................................................14
Other evaluation........................................................................................................................15
Conclusion and recommendation.................................................................................................15
Bibliography..................................................................................................................................16
Appendices.....................................................................................................................................19
Appendix I: Quality assessment of the systematic review and meta-analysis.....................19
Appendix II: PEDro score for Park et al. (2021)...................................................................20
Appendix III: PEDro score for Aguilera-Rubio et al. (2024)................................................21
, Emile Jacolino
LE Grade 6,3
Date rating 10.5.24
Conditional and design requirements (all points must have been assessed satisfactorily for the substantive assessment) Rating (S/I) Feedback
1 The article contains a maximum of 1000 words. This excludes tables, figures and bibliography. s
2 The report has the standard structure and form of a CAT which corresponds to the document 'how do I write a CAT?' s
3 In terms of layout, the report meets the set requirements (font, line spacing 1.5, etc.). s
4 The subject is a topical subject from daily practice which can be answered with a quantitative research. s
5 There is no protocol or guideline available for answering the clinical question OR the student indicates that he disagrees
s
with this guideline or that it does not apply to a specific patient.
6 There is a reference to a physiotherapeutic journal from which this topic originated, or there has been consensus with one
s
of the assessors of the scientific portfolio about the chosen topic.
7 At the inclusion of literature, the following minimum is present: one systematic review / meta-analysis plus at least one
s
effect study or at least 3 effect studies are present.
8 No plagiarism has been committed: no figures / tables / diagrams copied literally + no literal text copied or copied. s
9 Correct language
- The text has been written in a contemplative way as much as possible (not from the I-he-we form)
- The sentence structure is sufficiently correct (enumeration; word order; sentence length). s
- The choice of words (including prepositions) is to-the-point
- Not too many annoying typing and spelling errors are present
10 Literature
- Statements are substantiated by a source
s
- Sufficient relevant source references are present (taking into account the pyramid of evidence)
- The APA style has been correctly implemented in text and bibliography
Sufficient
Rating Feedback
Substantive assessment
(1-4)
1 Background and research question Background and research question
- A clear reason has been described to select the topic - A clear reason has been described
- Based on the reason, a logical and clear problem definition has been formulated 3 - Based on the reason, a logical and clear problem definition has been formulated
- A well-operationalized research question (PI (C) O) has been formulated which follows logically from the problem - A well-operationalized research question (PI (C) O) has been formulated which follows logically from the
statement and reason. This provides a clear line between reason, problem and question problem statement and reason. This provides a clear line between reason, problem and question ( sufficient)
2 Search Search
- The search is valid (correct keywords, Boolean operators, MesH, databases, filters) - The search is valid (correct keywords, Boolean operators, MesH, databases, filters)
- The search is reproducible 3 - The search is reproducible
- There are clear and correct inclusion and exclusion criteria for the selection of articles in which domain and level of - There are clear and correct inclusion and exclusion criteria for the selection of articles in which domain and
evidence are specified level of evidence are specified sufficient
3 Search results Search results
- There is a clear table with the articles that you have read in full text and why they have or have not been included. - There is a clear table with the articles that you have read in full text and why they have or have not been
- There is a flowchart showing how studies were selected included.
- Clear and valid reasons are described for whether or not to select the articles 4 - There is a flowchart showing how studies were selected
- The correct studies have been selected (the assessor did not find better studies in a short search that could answer the - Clear and valid reasons are described for whether or not to select the articles
question) - The correct studies have been selected (the assessor did not find better studies in a short search that could
answer the question)
4 Results Results
- There is a clear and complete representation of the design of the included studies - There is a clear and complete representation of the design of the included studies
- The results of the articles are described as clearly, correctly and completely as possible and are aimed at the research - The results of the articles are described as clearly, correctly and completely as possible and are aimed at the
question research question
- The description of the results shows a good understanding of the results of the studies and relevant statistics 3 - The description of the results shows a good understanding of the results of the studies and relevant statistics
- The research question can be answered on the basis of the results - The research question can be answered on the basis of the results
- Both significance and clinical relevance of the results have been described where possible - Both significance and clinical relevance of the results have been described where possible. sufficient
5 Evaluation Evaluation
- The internal validity has been correctly and critically assessed. The correct measuring instrument was used and the most - The internal validity has been correctly and critically assessed. The correct measuring instrument was used and
important items were identified the most important items were identified
3
- The external validity has been correctly and critically assessed and substantiated - The external validity has been correctly and critically assessed and substantiated
- Other advantages and disadvantages of the intervention (possibly with regard to other outcome measures, etc.) are - Other advantages and disadvantages of the intervention (possibly with regard to other outcome measures,
correctly and critically described etc.) are correctly and critically described
6 Conclusion and recommendation Conclusion and recommendation
- The recommendation is in line with the reason and research question - The recommendation is in line with the reason and research question
- The conclusion and recommendation follow logically from the results and evaluation of the selected articles 2 - The conclusion and recommendation follow logically from the results and evaluation of the selected articles
- The recommendation provides real added value and enrichment of knowledge in relation to the cause - The recommendation provides real added value and enrichment of knowledge in relation to the cause
Total points: 43,0
Feedback Grade: 6,3
The final outcome of this CAT is sufficient…...... Carefully look at the feedback in the text to read the substantiation that led to this result.
,Introduction
Virtual Reality (VR) is a computer-generated simulation that puts users in an
immerse three-dimensional or non-immerse setting that they can interact with
using special equipment like headsets and gloves (Lowood, 2024). In
physiotherapy it's increasingly being used to engage patients in their
rehabilitation by providing a controlled, customizable, and interactive setting
that can replicate real-life activities safely (Keshner, 2004).
Since the publication of the 2014 edition of the KNGF Guideline on Stroke, many
new research findings have been published regarding rehabilitation after a
stroke. As a result, many of the recommendations in the 2014 Guideline are no
longer in line with the currently available evidence and insights. This report seeks
to investigate whether recent studies provide updated evidence supporting the
use of VR based rehabilitation in promoting upper limb recovery in stroke
patients.
By addressing this question, we aim to fill the gap in knowledge left by the
outdated guidelines and provide insights into optimizing rehabilitation strategies
for stroke patients.
Research Question
What is the effect of VR based rehabilitation on upper limb recovery in stroke patients
compared to conventional methods?
Table 1
PICO method
PICO format question Patient or Intervention Comparison Outcome
Problem intervention
In patients with stroke (P), Stroke Virtual reality- Conventional Upper limb
does virtual reality-based patient based methods
rehabilitation (I) compared rehabilitation
to standard rehabilitation
methods (C) result in better
outcomes in promoting
upper limb recovery (O)?
, Search
PubMed and Cochrane Library were used as the two main electronic database
sources for the medical literature. Additionally, There has been made use of the
highest quality using the levels of evidence pyramid. The exact search strategy
along with the corresponding inclusion and exclusion criteria are described in
Table 2a and Table 2b, respectively.
Table 2a
Search string databases
Database Date Search string Number of
results
PubMed 20/03/2024 Exact string: N=27
("stroke*"[Title] OR "Cerebrovascular Accident" OR CVA) AND
("Virtual Reality" [MeSH] OR "Virtual Reality Exposure Therapy" OR
"VR Rehabilitation") AND ("Upper Extremity" [MeSH] OR "Upper
Limb" OR Arm OR "Upper Limb Recovery") AND ("stroke
rehabilitation" OR "post-stroke recovery") AND ("conventional
therapy" OR "traditional rehabilitation" OR "traditional therapy"
OR "standard rehabilitation")
Applied Filters:
Meta-Analysis, Randomized Controlled Trial, Systematic Review,
from 2015 – 2024
Cochrane 21/03/2024 Exact string: N=13
Library #1 [mh "stroke"] AND [mh "virtual reality"]
#2 "upper limb" OR "arm" OR "upper extremity"
#3 "standard rehabilitation" OR "conventional therapy" OR
"traditional rehabilitation" OR "traditional therapy"
#4 #1 AND #2 AND #3
Applied Filters:
Date from 2015 - 2024
Table 2b
Inclusion/exclusion criteria
Inclusion criteria Exclusion criteria
Studies that looked at Stroke All other study designs other than those stated
patients (post-acute, subacute, or in the inclusion.
chronic stroke) studies that were unfinished. (e.g. Pilot, or
Studies in which virtual reality was protocol)
the main intervention in at least one Studies that were done before 2015
group Studies that mentioned conditions other than
The following study types: stroke
Randomized Controlled Trial (RCT) & Studies that were not written in English
Systematic review/meta-analysis No full-text assess available (Sci-hub was used)
(SR/MA)
Studies published in 2015 or after
Student number: Klik hier als u tekst wilt invoeren.
Data: 1-1-2024
Product: CAT
Word count: 998 words
Critically Appraised Topic “CAT”
“What is the effect of VR based rehabilitation on upper limb
recovery in stroke patients compared to conventional
methods?”
THIM Hogeschool voor Fysiotherapie, Nieuwegein
,Table of Contents
Introduction.....................................................................................................................................4
Research Question...........................................................................................................................4
Search..............................................................................................................................................5
Search results...................................................................................................................................6
Result................................................................................................................................................9
Evaluation......................................................................................................................................14
Internal Validity........................................................................................................................14
External Validity.......................................................................................................................14
Other evaluation........................................................................................................................15
Conclusion and recommendation.................................................................................................15
Bibliography..................................................................................................................................16
Appendices.....................................................................................................................................19
Appendix I: Quality assessment of the systematic review and meta-analysis.....................19
Appendix II: PEDro score for Park et al. (2021)...................................................................20
Appendix III: PEDro score for Aguilera-Rubio et al. (2024)................................................21
, Emile Jacolino
LE Grade 6,3
Date rating 10.5.24
Conditional and design requirements (all points must have been assessed satisfactorily for the substantive assessment) Rating (S/I) Feedback
1 The article contains a maximum of 1000 words. This excludes tables, figures and bibliography. s
2 The report has the standard structure and form of a CAT which corresponds to the document 'how do I write a CAT?' s
3 In terms of layout, the report meets the set requirements (font, line spacing 1.5, etc.). s
4 The subject is a topical subject from daily practice which can be answered with a quantitative research. s
5 There is no protocol or guideline available for answering the clinical question OR the student indicates that he disagrees
s
with this guideline or that it does not apply to a specific patient.
6 There is a reference to a physiotherapeutic journal from which this topic originated, or there has been consensus with one
s
of the assessors of the scientific portfolio about the chosen topic.
7 At the inclusion of literature, the following minimum is present: one systematic review / meta-analysis plus at least one
s
effect study or at least 3 effect studies are present.
8 No plagiarism has been committed: no figures / tables / diagrams copied literally + no literal text copied or copied. s
9 Correct language
- The text has been written in a contemplative way as much as possible (not from the I-he-we form)
- The sentence structure is sufficiently correct (enumeration; word order; sentence length). s
- The choice of words (including prepositions) is to-the-point
- Not too many annoying typing and spelling errors are present
10 Literature
- Statements are substantiated by a source
s
- Sufficient relevant source references are present (taking into account the pyramid of evidence)
- The APA style has been correctly implemented in text and bibliography
Sufficient
Rating Feedback
Substantive assessment
(1-4)
1 Background and research question Background and research question
- A clear reason has been described to select the topic - A clear reason has been described
- Based on the reason, a logical and clear problem definition has been formulated 3 - Based on the reason, a logical and clear problem definition has been formulated
- A well-operationalized research question (PI (C) O) has been formulated which follows logically from the problem - A well-operationalized research question (PI (C) O) has been formulated which follows logically from the
statement and reason. This provides a clear line between reason, problem and question problem statement and reason. This provides a clear line between reason, problem and question ( sufficient)
2 Search Search
- The search is valid (correct keywords, Boolean operators, MesH, databases, filters) - The search is valid (correct keywords, Boolean operators, MesH, databases, filters)
- The search is reproducible 3 - The search is reproducible
- There are clear and correct inclusion and exclusion criteria for the selection of articles in which domain and level of - There are clear and correct inclusion and exclusion criteria for the selection of articles in which domain and
evidence are specified level of evidence are specified sufficient
3 Search results Search results
- There is a clear table with the articles that you have read in full text and why they have or have not been included. - There is a clear table with the articles that you have read in full text and why they have or have not been
- There is a flowchart showing how studies were selected included.
- Clear and valid reasons are described for whether or not to select the articles 4 - There is a flowchart showing how studies were selected
- The correct studies have been selected (the assessor did not find better studies in a short search that could answer the - Clear and valid reasons are described for whether or not to select the articles
question) - The correct studies have been selected (the assessor did not find better studies in a short search that could
answer the question)
4 Results Results
- There is a clear and complete representation of the design of the included studies - There is a clear and complete representation of the design of the included studies
- The results of the articles are described as clearly, correctly and completely as possible and are aimed at the research - The results of the articles are described as clearly, correctly and completely as possible and are aimed at the
question research question
- The description of the results shows a good understanding of the results of the studies and relevant statistics 3 - The description of the results shows a good understanding of the results of the studies and relevant statistics
- The research question can be answered on the basis of the results - The research question can be answered on the basis of the results
- Both significance and clinical relevance of the results have been described where possible - Both significance and clinical relevance of the results have been described where possible. sufficient
5 Evaluation Evaluation
- The internal validity has been correctly and critically assessed. The correct measuring instrument was used and the most - The internal validity has been correctly and critically assessed. The correct measuring instrument was used and
important items were identified the most important items were identified
3
- The external validity has been correctly and critically assessed and substantiated - The external validity has been correctly and critically assessed and substantiated
- Other advantages and disadvantages of the intervention (possibly with regard to other outcome measures, etc.) are - Other advantages and disadvantages of the intervention (possibly with regard to other outcome measures,
correctly and critically described etc.) are correctly and critically described
6 Conclusion and recommendation Conclusion and recommendation
- The recommendation is in line with the reason and research question - The recommendation is in line with the reason and research question
- The conclusion and recommendation follow logically from the results and evaluation of the selected articles 2 - The conclusion and recommendation follow logically from the results and evaluation of the selected articles
- The recommendation provides real added value and enrichment of knowledge in relation to the cause - The recommendation provides real added value and enrichment of knowledge in relation to the cause
Total points: 43,0
Feedback Grade: 6,3
The final outcome of this CAT is sufficient…...... Carefully look at the feedback in the text to read the substantiation that led to this result.
,Introduction
Virtual Reality (VR) is a computer-generated simulation that puts users in an
immerse three-dimensional or non-immerse setting that they can interact with
using special equipment like headsets and gloves (Lowood, 2024). In
physiotherapy it's increasingly being used to engage patients in their
rehabilitation by providing a controlled, customizable, and interactive setting
that can replicate real-life activities safely (Keshner, 2004).
Since the publication of the 2014 edition of the KNGF Guideline on Stroke, many
new research findings have been published regarding rehabilitation after a
stroke. As a result, many of the recommendations in the 2014 Guideline are no
longer in line with the currently available evidence and insights. This report seeks
to investigate whether recent studies provide updated evidence supporting the
use of VR based rehabilitation in promoting upper limb recovery in stroke
patients.
By addressing this question, we aim to fill the gap in knowledge left by the
outdated guidelines and provide insights into optimizing rehabilitation strategies
for stroke patients.
Research Question
What is the effect of VR based rehabilitation on upper limb recovery in stroke patients
compared to conventional methods?
Table 1
PICO method
PICO format question Patient or Intervention Comparison Outcome
Problem intervention
In patients with stroke (P), Stroke Virtual reality- Conventional Upper limb
does virtual reality-based patient based methods
rehabilitation (I) compared rehabilitation
to standard rehabilitation
methods (C) result in better
outcomes in promoting
upper limb recovery (O)?
, Search
PubMed and Cochrane Library were used as the two main electronic database
sources for the medical literature. Additionally, There has been made use of the
highest quality using the levels of evidence pyramid. The exact search strategy
along with the corresponding inclusion and exclusion criteria are described in
Table 2a and Table 2b, respectively.
Table 2a
Search string databases
Database Date Search string Number of
results
PubMed 20/03/2024 Exact string: N=27
("stroke*"[Title] OR "Cerebrovascular Accident" OR CVA) AND
("Virtual Reality" [MeSH] OR "Virtual Reality Exposure Therapy" OR
"VR Rehabilitation") AND ("Upper Extremity" [MeSH] OR "Upper
Limb" OR Arm OR "Upper Limb Recovery") AND ("stroke
rehabilitation" OR "post-stroke recovery") AND ("conventional
therapy" OR "traditional rehabilitation" OR "traditional therapy"
OR "standard rehabilitation")
Applied Filters:
Meta-Analysis, Randomized Controlled Trial, Systematic Review,
from 2015 – 2024
Cochrane 21/03/2024 Exact string: N=13
Library #1 [mh "stroke"] AND [mh "virtual reality"]
#2 "upper limb" OR "arm" OR "upper extremity"
#3 "standard rehabilitation" OR "conventional therapy" OR
"traditional rehabilitation" OR "traditional therapy"
#4 #1 AND #2 AND #3
Applied Filters:
Date from 2015 - 2024
Table 2b
Inclusion/exclusion criteria
Inclusion criteria Exclusion criteria
Studies that looked at Stroke All other study designs other than those stated
patients (post-acute, subacute, or in the inclusion.
chronic stroke) studies that were unfinished. (e.g. Pilot, or
Studies in which virtual reality was protocol)
the main intervention in at least one Studies that were done before 2015
group Studies that mentioned conditions other than
The following study types: stroke
Randomized Controlled Trial (RCT) & Studies that were not written in English
Systematic review/meta-analysis No full-text assess available (Sci-hub was used)
(SR/MA)
Studies published in 2015 or after
