Effects of self-directed game-based virtual reality program on upper-limb motor recovery in mild-to-moderate ischemic stroke: a randomized controlled trial

Q: What are the key findings of this study?

Self-directed game-based VR training increased FMA-UE upper-limb motor scores by 4.16 points at 4 weeks and 8.63 points at 6 weeks versus control.

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Mild-to-moderate ischemic stroke with upper-limb motor impairment (n=76). Intervention: Self-directed game-based virtual reality (VR) program plus conventional rehabilitation vs. Conventional rehabilitation plus comparable intensity/complexity independent upper-limb training. Primary outcome: Change in Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score at 6 weeks (MD 8.63 points, 95% CI 5.89 to 11.37, p=<0.001).

Q: What question did this study set out to answer?

To assess the therapeutic effects of a self-directed game-based virtual reality program combined with conventional therapy on upper-limb motor function and daily independence in patients with mild-to-moderate ischemic stroke.

Yalu SUN; Shiguang SHAO; Feixiang Huo; Hongrui ZHANG; Qingjie Ji; Renlong ZHOU; Huijie SONG; Anqin Dong; Guidi ZOU; Bin SU; Yunfeng ZHANG; Hewei Wang; xiang li

doi:10.23736/s1973-9087.25.09129-4

February 1, 2026European Journal of Physical and Rehabilitation MedicineOpen Access

Effects of self-directed game-based virtual reality program on upper-limb motor recovery in mild-to-moderate ischemic stroke: a randomized controlled trial

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Key result

Self-directed game-based VR training improves upper-limb motor scores by ~9 points over control at 6 weeks.

MD +8.63 points
95% CI 5.89 to 11.37
P<0.001
n=76

Key Points

To assess the therapeutic effects of a self-directed game-based virtual reality program combined with conventional therapy on upper-limb motor function and daily independence in patients with mild-to-moderate ischemic stroke.
Randomized controlled trial evaluating participants assessed by two blinded physiotherapists at baseline (T0), 4 weeks post-treatment (T1), and 6 weeks post-treatment (T2) using an intention-to-treat approach (N=84).
Participants were stratified by baseline functional impairment into mild (FMA-UE >46) and moderate (20≤ FMA-UE ≤46) cohorts.
Primary outcome was the change in Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score; secondary outcomes included Manual Muscle Testing (MMT), Barthel Index (BI), and usability/safety assessments.
FMA-UE scores improved significantly more in the VR group than the control group at 4 weeks (difference: 4.16 points, 95% CI: 1.02 to 7.29, P=0.003) and 6 weeks (difference: 8.63 points, 95% CI: 5.89 to 11.37, P<0.001), with 44.7% (17/38) achieving the ≥9-point MCID threshold versus 2.6% (1/38) in controls (P<0.001).
Barthel Index scores showed markedly greater increases in the VR group at 4 weeks (difference: 5.53 points, 95% CI: 0.90 to 10.16, P=0.01) and 6 weeks (difference: 8.82 points, 95% CI: 4.49 to 13.14, P<0.001).
VR training resulted in greater shoulder flexion MMT gains at 4 weeks (difference: 0.45 points, P=0.007) and 6 weeks (difference: 0.53 points, P<0.001), elbow flexion (difference: 0.37 points, P=0.014) and extension (difference: 0.44 points, P=0.001) at 6 weeks, with no participant reporting an SSQ score exceeding 15.

Study Design

Type

RCT (n=76)

Blinding

Assessor- and statistician-blinded

Randomization

1:1 computer-generated randomization

Multicenter

No

PICO

P

Population

76 adults (mean age 56.4 years, 22.4% female; 84 randomized in ITT) with subacute first-ever mild-to-moderate ischemic stroke (FMA-UE ≥20, Brunnstrom III-V, MoCA >23), treated for 4 weeks and followed up at 6 weeks.

I

Intervention / Comparator

Self-directed game-based virtual reality (VR) program plus conventional rehabilitation vs Conventional rehabilitation plus comparable intensity/complexity independent upper-limb training (20 minutes/day of VR plus 110 minutes/day of conventional rehabilitation, 6 days/week)

O

Primary Outcome

Change in Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score at 6 weeks — MD 8.63 points (5.89 to 11.37), p=<0.001

Main Result

Mean Difference: 8.63 (95% CI 5.89–11.37)

Absolute Event Rate: 59.47% vs 53.74%

p-value: p=<0.001

Limitations

Only included patients with mild and moderate upper limb motor dysfunction, limiting generalizability to severe stroke populations
Did not conduct long-term follow-up assessments beyond 6 weeks
Underlying neurophysiological and functional imaging mechanisms were not explored
Did not include a standard therapist-mediated VR group as a control comparator

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Implication

Randomized controlled trial shows enhanced upper-limb motor recovery in mild-to-moderate stroke, suggesting a viable rehabilitation method.

Abstract

Self-directed game-based VR games with conventional therapy enhance upper-limb functional recovery and independence in mild-to-moderate stroke patients, offering a scalable solution for inpatient rehabilitation.

Discussion

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Cite This Study

SUN et al. (2026) conducted an RCT in Mild-to-moderate ischemic stroke with upper-limb motor impairment (n=76). Self-directed game-based virtual reality (VR) program plus conventional rehabilitation vs. Conventional rehabilitation plus comparable intensity/complexity independent upper-limb training was evaluated on Change in Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score at 6 weeks (MD 8.63 points, 95% CI 5.89 to 11.37, p=<0.001). Self-directed game-based VR training increased FMA-UE upper-limb motor scores by 4.16 points at 4 weeks and 8.63 points at 6 weeks versus control.

synapsesocial.com/papers/69843422f1d9ada3c1fb1e77 https://doi.org/10.23736/s1973-9087.25.09129-4

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Effects of self-directed game-based virtual reality program on upper-limb motor recovery in mild-to-moderate ischemic stroke: a randomized controlled trial

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Effects of self-directed game-based virtual reality program on upper-limb motor recovery in mild-to-moderate ischemic stroke: a randomized controlled trial

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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