JMIR Publications

ABSTRACT

Background:

Virtual reality (VR)-based interventions have been recognised as promising nonpharmacological therapies for improving the ability to perform daily activities, as well as for reducing depression and anxiety, among stroke survivors. However, the comparative effectiveness of different types of VR interventions remains unclear. Therefore, this study aimed to compare and rank the efficacy of various VR interventions for improving the ability to perform daily activities, as well as for treating depression and anxiety, among stroke survivors.

Objective:

A frequentist network meta-analysis was conducted to compare and rank the relative effects of various VR interventions on improving the ability to perform daily activities, as well as for treating depression and anxiety, among stroke survivors.

Methods:

We systematically searched six English-language and three Chinese-language databases from their inception to December 2025. Randomised controlled trials (RCTs) investigating the effectiveness of VR interventions in stroke survivors were included. A random-effects model was used for pairwise meta-analyses to directly assess the effects of individual VR interventions. A consistency model was employed for the network meta-analysis to evaluate the relative effects and probability of being the best model for the different VR interventions.

Results:

This analysis included 21 RCTs involving four different nonpharmacological interventions. The preliminary evidence from this study suggests that VR comprehensive cognitive gaming (VR-CCG) has the potential to be the most effective intervention for improving the ability of stroke survivors to perform daily activities. Furthermore, VR team therapy (VR-TM) and VR sport training (VR-SPT) may have positive effects in reducing depression and anxiety, respectively. However, these findings should be interpreted with caution, as they are based on a limited number of studies (with one study focusing on VR-CCG for ADL and VR-TM for depression, and two studies focusing on VR-SPT for anxiety), along with wide confidence and prediction intervals. Further meta-regression analyses revealed no significant associations between the predefined covariates (including age, country, session duration, intervention frequency, intervention period, and level of VR immersion) and any of the outcomes.

Conclusions:

This study provides evidence supporting the effectiveness of VR-based interventions in improving the ability to perform daily activities, as well as treating depression and anxiety, in poststroke patients. However, given the limitations of this study and the small number of included studies, these findings should be interpreted with caution. Further high-quality research is needed to validate the optimal application scenarios and mechanisms of action for different VR interventions. This will provide more robust, direct evidence regarding their comparative effectiveness.