Use of Virtual Reality in Upper Extremity Rehabilitation of Adults After Stroke and Its Effect on Functionality: Systematic Review and Meta-Analysis

Virtual reality (VR) is increasingly used in patients after stroke upper limb rehabilitation, but the comparative effectiveness of VR-Only versus hybrid VR combined with conventional therapy (CT) remains unclear. The objective of this review was to systematically review and meta-analyze the effectiveness of 2 distinct VR intervention approaches for patients undergoing hemiparetic upper limb rehabilitation after stroke: VR-Only versus CT, and hybrid interventions combining VR with CT versus CT alone. A PROSPERO protocol (CRD 42022349259) for a comprehensive search was conducted across 7 databases, focusing on studies published in English and Spanish. Randomized controlled trials (RCTs) comparing VR-Only or hybrid VR interventions to CT were included. Study characteristics, participant demographics, intervention specifics, and outcome measures were extracted. The risk of bias was assessed using the RoB2 tool. Meta-analyses used a random-effects model to estimate standardized mean differences (SMD) with 95% confidence intervals. Primary outcomes included motor function, motor capacity, hand dexterity, functional capacity, measured by validated instruments such as the Fugl Meyer Assessment and Box and Block Test. Twenty-seven RCTs (1156 participants) were included. Hybrid VR + CT interventions significantly improved motor function (SMD = 0.44,) and manual dexterity (SMD = 0.33,) compared to CT alone. VR-Only interventions showed positive trends but were not statistically significant. Hybrid interventions maintained benefits at follow-up (SMD = 0.63, 95% CI = 0.11 to 1.15). Optimal improvements were observed with hybrid sessions of 31 to 59 minutes daily. Hybrid VR + CT interventions are more effective than CT alone improving motor function and manual dexterity after stroke, with sustained benefits over time. VR-Only interventions showed less consistent effects. These results suggest that integrating VR into conventional therapy enhances rehabilitation outcomes of stroke survivors. Future research should focus on optimizing hybrid protocols and exploring long-term outcomes.