Virtual reality sitting training (v no intervention) on ability to sit in people with SCI | SCI Physiotherapy Clinical Practice Guidelines

	Virtual reality sitting training (v no intervention) on ability to sit in people with SCI
P	People with SCI	Evidence recommendation Weak for (95%)		Weak evidence recommendation FOR Virtual Reality sitting training may be provided to improve ability in sitting in people with SCI.
I	Virtual reality (VR) sitting training	Evidence recommendation Weak for (95%)
C	No intervention	Consensus-based opinion statement No opinion statements
O	Ability to sit	Consensus-based opinion statement No opinion statements
	SUMMARY	1 RCT (see reference)		Mean difference (95% CI): Seated reach in mm 63 (38 to 89) Favours VR sitting training
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Serious	Imprecision Serious	Indirectness Serious	Publication bias Serious

VIRTUAL REALITY SITTING TRAINING FOR FUNCTIONAL ABILITY TO SIT: GRADE Evidence to Decision
PROBLEM	No	Probably no	Probably yes	Yes		Don't know
DESIRABLE EFFECTS	Trivial	Small	Moderate	Large		Don't know
UNDESIRABLE EFFECTS	Large	Moderate	Small	Trivial		Don't know
CERTAINTY OF EVIDENCE	Very low	Low	Moderate	High		No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME	Important uncertainty or variability	Possibly important uncertainty or variability	Probably no important uncertainty or variability	No important uncertainty or variability
BALANCE OF EFFECTS	Favours the Control	Probably favours the Control	Does not favour either the intervention (I) or the comparison (C)	Probably favours the I	Favours the I	Don't know
RESOURCES REQUIRED	Large costs	Moderate costs	Negligible costs and savings	Moderate savings	Large savings	Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES	Very low	Low	Moderate	High		No included studies
COST EFFECTIVENESS	Favours the comparison	Probably favours the comparison	Does not favour either the intervention or the comparison	Probably favours the intervention	Favours the intervention	No included studies
EQUITY	Reduced	Probably reduced	Probably no impact	Probably increased	Increased	Don't know
ACCEPTABILITY	No	Probably no	Probably yes	Yes		Don't know
FEASIBILITY	No	Probably no	Probably yes	Yes		Don't know

VIRTUAL REALITY SITTING TRAINING FOR ABILITY TO SIT: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
TAK 2015	Game based virtual reality sitting training (plus usual care) V Usual care	6 weeks, 30 minutes ×3 sessions per week of Nintendo Wii- based VR balance training	AIS A or B SCI (cervical and thoracic)	13/13	Modified functional reach test (front)	Some concerns of Risk of Bias PEDro = 7/10

The Australian and NZ SCI Physiotherapy guideline committee recommends virtual reality sitting training to improve sitting in people with SCI. This is an evidence recommendation supported by the results of one randomised controlled trial. The guideline states:

Virtual Reality sitting training may be provided to improve ability in sitting in people with SCI.

This recommendation was formed by considering the results of one randomised controlled trials alongside other factors. The trial results indicate that virtual reality sitting training is better than no virtual reality sitting training to improve sitting. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.

This is an evidence-based recommendation. Evidence-based recommendations are more robust than consensus-based opinion statements. They can be strong or weak. This is a weak evidence-based recommendation which means the guideline panel is confident that they can probably recommend Virtual Reality sitting training to improve ability in sitting in people with SCI based on evidence.

To learn more about this recommendation go to the research summary.

Tak S, Choi W and Lee S. Game-based virtual reality training improves sitting balance after spinal cord injury: a single-blinded, randomized controlled trial. Medical Science Technology 2015 Jun 26;56:53-59.