Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 26, 2025
Open Peer Review Period: Feb 26, 2025 - Apr 23, 2025
Date Accepted: Aug 29, 2025
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Combination treatment of virtual reality and mirror therapy for the stroke patients: a systematic review and meta-analysis of randomized controlled trials
ABSTRACT
Background:
Stroke inevitably results in a range of disabilities. Both virtual reality (VR) and mirror therapy (MT) have shown efficacy in stroke rehabilitation. In recent years, the combination of these two approaches has emerged as a potential treatment for stroke patients.
Objective:
This systematic review and meta-analysis aim to assess the efficacy of combination treatment of VR and MT in stroke rehabilitation.
Methods:
Five electronic databases were systematically searched for relevant articles published up to Jan. 2025. Randomized controlled trials (RCTs) that investigated combination treatment of VR and MT for participants with stroke were included. The risk of bias and the certainty of the evidence were assessed using the Cochrane collaboration’s tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline, respectively.
Results:
A total of 293 participants across 10 RCTs were included, with 6 RCTs contributing to the meta-analysis. The statistical analysis indicated significant improvements in the Fugl-Meyer Assessment of Upper Extremity (FMA-UE) (MD 3.49, 95% CI 1.43 to 5.55; P=0.0009) and manual function test (MD 2.64, 95% CI 1.78 to 3.49; P<0.00001), and box and block test (MD 1.02, 95% CI 0.16 to 1.88; P=0.02). Subgroup differences were observed in FMA-UE, manual function test and box and block test.
Conclusions:
Moderate-quality evidence supports the combination treatment of VR and MT as a beneficial nonpharmacological approach to improve upper extremity motor function and hand dexterity in patients with stroke. However, the limited number of studies and small sample sizes restrict the generalizability of these findings, highlighting the need for further research. Clinical Trial: PROSPERO CRD42024572150
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Copyright
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