Reliability and validity of virtual reality box & block test in healthy adults and patients with stroke: a prospective, multi-center, exploratory, cross-sectional study.

The study was exploratory and did not calculate a sample size in advance. The stroke sample was modest, and affected-hand analyses used 22 participants. Two stroke patients could not complete the VR test with the affected hand, so the tool may not work for people with severe proprioceptive or sensory problems. Reliability and validity were measured in one session only, so longer-term consistency was not tested. The VR task uses a controller and head-mounted display, which changes the physical and visual demands compared with moving real blocks. VR scores were lower than standard Box and Block Test scores and agreement limits were wide, so the two tests should not be treated as interchangeable. The study was a cross-sectional assessment validation, not a treatment trial. The authors note possible usability problems for older adults or people unfamiliar with virtual environments.

Do not use the VR-BBT block count as a direct substitute for the Box and Block Test. In this study, VR scores were lower than standard-test scores in both groups, and the agreement limits were wide. Also, this was an assessment validation study, not a treatment trial, so it does not show that the VR task improves rehabilitation.