JMIR Publications

ABSTRACT

Background:

Stroke is a leading cause of long-term disability, often resulting in upper extremity dysfunction. Traditional rehabilitation methods often face challenges such as limited patient access to resources and lack of sustained motivation. Home-based virtual reality (VR) training is gaining traction as an innovative, sustainable and interactive alternative. However, the effectiveness of home-based VR, specifically for upper extremity recovery in patients with stroke, remains insufficiently explored.

Objective:

This systematic review aims to synthesize existing evidence to evaluate the impact of home-based VR interventions on upper extremity function recovery in patients with stroke.

Methods:

A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, and CINAHL Ultimate databases, targeting English-language randomized controlled trials (RCTs) published up to June 30, 2024. Two independent reviewers screened articles based on predefined inclusion criteria, focusing on studies involving patients with stroke with upper extremity dysfunction who received home-based VR training. Data extraction and risk of bias assessment were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results:

Eight RCTs with 392 participants were included. This review shows that home-based VR training positively affects upper extremity function recovery in patients with stroke, especially in motor control improvement. Customized VR systems were more effective than commercial VR systems in patients with moderate to severe disorders. Although studies generally showed positive results, differences in intervention protocols, small sample sizes, and the lack of long-term follow-up limited the generalizability of results. The effectiveness of VR therapy also varied based on the VR system type, intervention intensity, and the functional level of patients.

Conclusions:

Home-based VR training is a viable and effective way to enhance upper extremity rehabilitation for stroke patients, especially when using customized systems. However, heterogeneity in study design, differences in outcome measures, and limited long-term follow-up data affect the reliability of the current conclusions. Future studies should include larger, standardized RCTs with long-term follow-up to assess their continued effects. In addition, exploring the introduction of immersive VR in home-based rehabilitation and its cost-effectiveness comparison with traditional methods can help optimize its application and patient rehabilitation outcomes. Clinical Trial: PROSPERO CRD42024526650; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024526650