Concurrent validity of an immersive virtual reality version of the Box and Block Test to assess manual dexterity among patients with stroke.
Gauthier Everard, Yasmine Otmane-Tolba, Zélie Rosselli and 7 others
PMID 35065678WHAT IT FOUND
A virtual reality version of the Box and Block Test correlates strongly with the physical test for stroke patients.
Scores are lower in VR, so do not mix the two. It offers objective movement data and high usability for home monitoring.
Key findings
01Correlations between the classical Box and Block Test and the virtual reality version were large and significant for patients with stroke in both the paretic and less-affected hands.
02Participants moved between 30 and 40% fewer blocks in virtual reality than in the classical physical test.
03The virtual reality test showed strong short-term reliability and good to excellent usability scores for patients with stroke.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study only assessed short-term test-retest reliability within a single session; reliability over weeks or months is unknown. The virtual grasp (pressing buttons) is not identical to natural hand opening and closing, which may affect ecological validity. The system cannot track arm, shoulder, or trunk compensations, limiting its use for full upper-limb kinematic analysis. One patient was excluded due to difficulty understanding the VR interface, suggesting it may not be suitable for patients with significant cognitive or communication impairments. The sample size was small (22 patients), and the study did not include patients with severe upper-limb impairment (most had moderate recovery, mean FMA 76.3%).
Declared interests
The study was funded by Région Wallone. No commercial conflicts of interest were declared by the authors.
The easy way to misread this
Do not assume a patient's virtual reality score is directly comparable to their physical Box and Block Test score. Scores in the virtual test are consistently 30-40% lower, so switching between tests mid-rehabilitation will falsely suggest a decline in dexterity.