Response to reviewers commentary on ‘Virtual reality in stroke rehabilitation: Still more virtual than real’

  • Published on
    09-Mar-2017

  • View
    212

  • Download
    0

Embed Size (px)

Transcript

  • CLINICAL COMMENTARY

    Response to reviewers commentary on Virtual reality in strokerehabilitation: Still more virtual than real

    J. H. CROSBIE1, S. LENNON1, J. R. BASFORD2 & S. M. MCDONOUGH1

    1Health and Rehabilitation Sciences Research Institute, Faculty of Life and Health Sciences, University of Ulster,

    Newtownabbey, N Ireland, and 2Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN

    55902, USA

    Accepted August 2006

    We read with interest Drs Weiss and Rings

    commentary on our review, Virtual reality in stroke

    rehabilitation: still more virtue than real [1]. We

    suspect that we share more areas of agreements than

    disagreements with the authors, but it would be

    valuable to go through their points below.

    Weiss and Ring begin by noting that the introduc-

    tion of a new technology is often marked by a pattern

    in which an early phase of uncritical acceptance is

    followed a period of disappointment and rejection

    and ultimately progresses to either being discarded

    or slowly gaining credibility and utility. While not all

    of us were familiar with the development of this

    theme by Rizzo and Buckwalter [2,3], we agree with

    its existence and believe that history reveals that the

    process can be repeated time and time again [4]. We

    also concur with the commentators opinion that

    VR-based rehabilitation may have entered Slope of

    Enlightenment. Whether any of it has reached a

    Plateau of Productivity seems more arguable.

    In any event, this brings us to the issue of

    whether virtual reality, particularly its application to

    stroke rehabilitation, is ready for the rigours of a

    systematic review. The commentators aver no. We

    believe differently, but our differences may be more

    apparent than real. First of all, the commentators

    and we would both accept that the VR stroke

    literature is too heterogeneous and small to warrant

    a meta-analysis. We did not attempt to do one. We

    do, however, believe that a systematic analysis has

    its value, as it requires an objective (as possible)

    collection of all articles within the prescribed

    databases that match the search words used.

    Obviously, articles can be missed but the risk seems

    smaller than with the more subjective approach of

    the classical review.

    The issue of whether presentations and proceed-

    ings papers should be included a systematic review

    frequently arises. The benefits of limiting ones

    survey to the peer reviewed literature are that

    supposedly only the best and most rigorous papers

    are influencing the reviewers assessment. As can be

    seen from our review, even the peer-reviewed papers

    in VR stroke rehabilitation leave something to

    desired. It is not clear that the risks and efforts

    involved in the assessing of unreviewed work out-

    weigh the potential possibility of missing timely and

    exciting new research. In any event, one would hope

    that the chance of missing important material would

    decrease with time as improvements in technology

    reduce the delay from submission to publication.

    Authors, at times will include a section in a review on

    papers that do not meet the review criteria but which

    are pertinent to the topic at hand. We chose not to do

    this, due to the difficulty of obtaining a representative

    sample, but with hindsight this may have been a

    beneficial thing to have done. Recent work by Egger

    et al. [5] may provide some support for this view in

    that these authors explored the impact of wider

    versus narrower based literature searches and con-

    cluded that searches limited to the English language

    literature available in the major bibliographic data-

    bases produced findings that differed little from

    broader searches. We did note VR rehabilitations

    Correspondence: S. M. McDonough, Health and Rehabilitation Sciences Research Institute, Faculty of Life and Health Sciences, University of Ulster, Shore

    Road, Newtownabbey, Co. Antrim, BT37 0QB, N Ireland. E-mail: s.mcdonough@ulster.ac.uk

    Disability and Rehabilitation, July 2007; 29(14): 1151 1152

    ISSN 0963-8288 print/ISSN 1464-5165 online 2007 Informa UK Ltd.DOI: 10.1080/09638280600965767

    Dis

    abil

    Reh

    abil

    Dow

    nloa

    ded

    from

    info

    rmah

    ealth

    care

    .com

    by

    Uni

    vers

    ity o

    f B

    rist

    ol o

    n 11

    /04/

    14Fo

    r pe

    rson

    al u

    se o

    nly.

  • rapid rate of change and alluded to a few websites

    and international meetings. The additional detail

    provided by the commentators is appreciated.

    In conclusion, we believe that our review, which

    included rather detailed discussions of the interven-

    tions instead of a mere statistical and mathematical

    ranking, provided some value for the reader. The

    strength of systematic review is that it allows an

    objective survey of the literature. A weakness,

    particularly at the level of the abstract, is that

    findings of unclear quality or statistically significant

    cannot be addressed. This, we contend, is the role of

    more speculative papers such as editorials, expert

    discussions of health care trend, and perhaps in the

    discussion and conclusions of the traditional litera-

    ture review.

    References

    1. Crosbie JH, Lennon S, Basford JR, McDonough SM. Virtual

    reality in stroke rehabilitation: Still more virtual than real.

    Disabil Rehabil.

    2. Rizzo AA, Buckwlater JG. Introduction to the theme issue of

    virtual environments for clinical neuropsychology. Presence:

    Teleoperators and Virtual Environments 2001;10:3 5.

    3. Rizzo AA. Virtual reality and disability: Emergence and

    challenge. Disabil Rehabil 2002;24:567 569.

    4. Basford JR. A historical perspective of the popular use of

    electric and magnetic therapy. Arch Phys Med Rehabil

    2001;82:1261 1269.

    5. Egger M, Juni P, Bartlett C, Holenstein F, Sterne J. How

    important are comprehensive literature searches and the

    assessment of trial quality in systematic reviews? Empirical

    Study. Health Technol Assess 2003;7(3).

    1152 J. H. Crosbie et al.

    Dis

    abil

    Reh

    abil

    Dow

    nloa

    ded

    from

    info

    rmah

    ealth

    care

    .com

    by

    Uni

    vers

    ity o

    f B

    rist

    ol o

    n 11

    /04/

    14Fo

    r pe

    rson

    al u

    se o

    nly.

Recommended

View more >