Effects of virtual reality and robot-assisted therapy on rehabilitation outcomes in cerebral palsy: a systematic review and meta-analysis.

The review protocol was registered after some screening had already been done, which can introduce selective reporting risk. All included trials were rated high risk of bias because participants and therapists could not be blinded, and some did not describe outcome assessor blinding. The balance result was very low certainty and was sensitive to one trial with baseline imbalance. Daily-activity, spasticity and range-of-motion evidence was low or very low, and several outcomes used small numbers of trials. Many subgroup analyses were exploratory and had too few studies to compare VR with robot-assisted therapy or different cerebral palsy types. The Modified Ashworth Scale is an ordinal scale but was pooled as if it were continuous. Only English trials from 2016 to 2025 were included, so broader populations and older protocols were not represented.

Do not treat the balance and daily-activity improvements as meaningful for patients. The balance gain was 2.06 points on the Pediatric Balance Scale, and the daily-activity gain was 0.51 points on a PEDI-CAT scale with a mean of 50; the paper says these changes did not reach clinically important thresholds.