虚拟现实干预对儿童注意缺陷多动障碍的影响：一项系统综述、荟萃分析及探索性机器学习分析。
完整摘要 · 中文译文
目的：综合虚拟现实（VR）干预在儿童和青少年注意缺陷多动障碍（ADHD）相关临床不同结局领域中的效果，比较这些领域间的效应模式，并检验其稳健性、确定性及研究间异质性的潜在来源。方法：检索PubMed、Embase、Web of Science核心合集、IEEE Xplore、CENTRAL、ScienceDirect和CNKI，纳入针对ADHD儿童和青少年VR干预的随机对照试验和对照准实验研究。结局分为四个临床领域：ADHD/行为症状、执行/认知功能、社会/情绪功能以及运动/视觉知觉功能。这些领域内的随机效应荟萃分析作为主要疗效分析，而全领域研究水平的复合指标保留作为次要描述性综合。安全性、依从性/保留率和晕动症在研究水平进行总结。采用荟萃回归和探索性机器学习分析研究异质性，并与荟萃分析合并分别进行。结果：共纳入13项研究，涉及928名参与者，其中11项研究纳入定量综合。在主要结局领域分析中，合并Hedges' g值分别为：ADHD/行为症状0.49（95% CI -0.59至1.57），执行/认知功能1.15（95% CI 0.38至1.92），社会/情绪功能0.51（95% CI 0.08至0.93），运动/视觉知觉功能0.88（95% CI 0.02至1.74）。该去 依赖性校正比较未发现各域间差异（p = 0.624），在Hartung-Knapp推断下仅执行/认知置信区间仍高于零。次要的全域合成结果为 g = 0.98（95% CI 0.47至1.50），异质性显著（I² = 91.7%），预测区间跨越无效线（-0.69至2.65）。探索性亚组分析、meta回归和机器学习分析未发现异质性的可靠解释。安全性和依从性报告存在异质性；在报告安全性的研究中未报告严重的干预相关不良事件，但事件发生率无法估计。四个结局域的GRADE证据质量均为极低。 结论：域特异性合成在执行/认知、社会/情绪和运动/视觉感知结局方面发现了积极信号，其中对执行/认知功能的支持最为明确，而ADHD/行为估计仍不确定。这些发现支持进一步评估VR作为辅助干预手段，尽管当前证据不支持域优越性或跨环境的一致效应。证据基础小且异质、偏倚风险高以及GRADE证据质量极低，限制了对所观察效应量级和可重复性的信心。 系统评价注册：https://www.crd.york.ac.uk/PROSPERO/，标识符CRD420261405127。
完整摘要 · 英文原文
OBJECTIVE: To synthesize the effects of virtual reality (VR) interventions across clinically distinct ADHD-related outcome domains in children and adolescents, compare the pattern of effects across these domains, and examine the robustness, certainty, and potential sources of between-study heterogeneity. METHODS: PubMed, Embase, Web of Science Core Collection, IEEE Xplore, CENTRAL, ScienceDirect, and CNKI were searched for randomized controlled trials and controlled quasi-experimental studies of VR interventions in children and adolescents with ADHD. Outcomes were grouped into four clinical domains: ADHD/behavioral symptoms, executive/cognitive function, social/emotional function, and motor/visual-perceptual function. Random-effects meta-analyses within these domains were treated as the primary efficacy analyses, while an all-domain study-level composite was retained as a secondary descriptive synthesis. Safety, adherence/retention, and cybersickness were summarized at study level. Meta-regression and exploratory machine-learning analyses were used to investigate heterogeneity and were conducted separately from the meta-analytic pooling. RESULTS: Thirteen studies involving 928 participants were included, of which 11 contributed to the quantitative syntheses. In the primary outcome-domain analyses, pooled Hedges' g values were 0.49 (95% CI -0.59 to 1.57) for ADHD/behavioral symptoms, 1.15 (95% CI 0.38 to 1.92) for executive/cognitive function, 0.51 (95% CI 0.08 to 0.93) for social/emotional function, and 0.88 (95% CI 0.02 to 1.74) for motor/visual-perceptual function. The dependence-adjusted comparison did not identify differences among domains (p = 0.624), and under Hartung-Knapp inference only the executive/cognitive confidence interval remained above zero. The secondary all-domain synthesis yielded g = 0.98 (95% CI 0.47 to 1.50), with substantial heterogeneity (I² = 91.7%) and a prediction interval spanning the null (-0.69 to 2.65). Exploratory subgroup, meta-regression, and machine-learning analyses did not identify reliable explanations for heterogeneity. Safety and adherence reporting was heterogeneous; no serious intervention-related adverse event was reported among studies reporting safety, but event incidence could not be estimated. GRADE certainty was very low across all four outcome domains. CONCLUSION: Domain-specific syntheses identified positive signals for executive/cognitive, social/emotional, and motor/visual-perceptual outcomes, with the clearest support for executive/cognitive function, whereas the ADHD/behavioral estimate remained uncertain. These findings support further evaluation of VR as an adjunctive intervention, although the current evidence does not support domain superiority or consistent effects across settings. The small and heterogeneous evidence base, substantial risk of bias, and very low GRADE certainty limit confidence in the magnitude and reproducibility of the observed effects. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261405127.