Virtual Reality Therapy for Upper Limb Motor Impairments in Patients With Stroke: A Systematic Review and Meta-Analysis.
Rebeca Villarroel, Bárbara Rachel García-Ramos, José Luis González-Mora and 1 others
PMID 40022760WHAT IT FOUND
Non-immersive VR added to conventional therapy improved upper limb motor function and manual dexterity in stroke patients, but did not improve daily living activities.
Effects were significant in the first six months after stroke and when VR supplemented rather than replaced standard therapy.
Key findings
01VR combined with conventional therapy produced a significant improvement in upper limb motor function (the primary outcome) compared with conventional therapy alone, with a large pooled effect (SMD = 5.24, 95% CI 2.76 to 7.73, P < 0.0001) across 28 studies and 903 subjects, though heterogeneity was high (I² = 75%).
02Manual dexterity improved significantly with VR (SMD = 0.23, 95% CI 0.04 to 0.43, P = 0.02) across 27 studies and 1031 subjects, a small effect with moderate heterogeneity (I² = 55%).
03Daily living activities showed no significant improvement with VR (SMD = 0.15, 95% CI −0.03 to 0.34, P = 0.10) across 16 studies and 708 subjects, and this null result held in every subgroup tested.
STILL TO COME
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What it does not show
Heterogeneity was high for motor function (I² = 75%) and moderate for manual dexterity (I² = 55%), meaning the included studies varied widely in their VR devices, games, patient populations, and treatment durations, so the pooled number is an average across very different interventions. 31 of the 40 studies were rated as having some concerns for risk of bias, mainly around randomisation and the inability to blind therapists and patients to the VR intervention. Eleven of the 40 studies were pilot trials, and 9 were rated low certainty by GRADE. The 10-year publication window and English-only restriction excluded older and non-English work. Daily living activities were measured with self-report scales (Barthel Index, FIM), which the authors note may not capture the complex, socially embedded skills that define true independence. The wide variety of VR hardware, software, and tasks across studies means the pooled effect does not point to any specific product or protocol.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not read the motor function and dexterity gains as evidence that VR can replace conventional therapy. In the subgroup analysis, VR used alone showed no significant effect (P = 0.06 for motor function, P = 0.95 for manual dexterity), while VR added to conventional therapy did. Also, the null result for daily living activities means better scores on a motor scale did not translate into more independence in dressing or feeding.
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