JMIR Publications

ABSTRACT

Background:

There have been continued efforts to implement virtual reality (VR) to support the delivery of poststroke upper extremity motor rehabilitation exercises in recent years. Therefore, it is important to review and analyze existing research evidence of its effectiveness.

Objective:

Through a systematic review and meta-analysis of randomized controlled trials, this study examined the effectiveness of using VR-supported exercise therapy for upper extremity motor rehabilitation in stroke patients.

Methods:

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. CINAHL Plus, Medline, Web of Science, Embase, and Cochrane Library were searched on December 31, 2021. Changes in outcomes related to impairments in upper extremity functions and structures, activity limitations, and participation restrictions in life situations from baseline to post-intervention, from post-intervention to follow-up assessment, and from baseline to follow-up assessment were examined. Standardized mean differences (SMDs) were calculated using a random-effects model. Subgroup analyses were performed to determine whether differences in treatment outcomes depended on age, stroke recovery stage, VR program(s) type, therapy delivery format, similarities in the intervention duration between study groups, the intervention duration for VR groups, and trial length.

Results:

Forty-two publications representing 43 trials (aggregated sample size=1,893) were analyzed. Compared to control groups that used either conventional therapy or no therapy, the intervention groups using VR to support exercise therapy resulted in significant improvements in upper extremity motor function (Fugl-Meyer Assessment-Upper Extremity; SMD 0.45, 95% CI 0.21 to 0.68, P<.001), range of motion (goniometer; SMD 1.01, 95% CI 0.50 to 1.52, P<.001), muscle strength (Manual Muscle Testing; SMD 0.79, 95% CI 0.28 to 1.30, P=.002), and independence in day-to-day activities (Functional Independence Measure; SMD 0.23, 95% CI 0.06 to 0.40, P=.01 and modified Rankin Scale; SMD 0.57, 95% CI 0.01 to 1.12, P=.046). Significant subgroup differences were observed for hand dexterity (Box and Block Test), spasticity (Ashworth Scale or modified Ashworth Scale), arm and hand motor ability (Wolf Motor Function Test and Manual Function Test), hand motor ability (Jebsen Hand Function Test), and quality of life (Stroke Impact Scale). There was no evidence suggesting that the benefits of VR-supported exercise therapy were maintained after the interventions ended.

Conclusions:

VR-supported upper extremity exercise therapy can be effective in improving motor rehabilitation results. Our review showed that, of the twelve rehabilitation outcomes examined, during the course of VR-based therapy, significant improvements were detected in two (upper extremity motor function and range of motion), and both significant and non-significant improvements were observed in another two (muscle strength and independence in day-to-day activities), depending on the measurement tools/methods used.