XR serious games for phantom limb pain, neurofunctional recovery, and prosthetic adoption: a systematic review

PURPOSE: To synthesize evidence on Extended Reality (XR) serious games for Phantom Limb Pain (PLP), neurofunctional recovery, embodiment, and adoption following amputation. MATERIALS AND METHODS: PubMed, Scopus, Web of Science, and IEEE Xplore were searched up to January 2026. Eligible studies included adults with limb amputation who received XR serious game interventions and reported rehabilitation or user-experience outcomes. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Evidence certainty was rated using GRADE across 5 outcome domains. RESULTS: 24 studies met the inclusion criteria. XR interventions showed consistent PLP reduction, with AR-based phantom motor execution systems reporting the largest effect sizes (d = 0.9-1.3) and preliminary evidence of reversal of cortical reorganization. VR exergames improved gait and balance in 2 RCTs. Immersive VR and EMG systems indicated improved object manipulation, performance time, and motor control. Neurofunctional and embodiment outcomes provided mechanistically plausible evidence regarding cortical activity, embodiment, and physiological adaptation. CONCLUSIONS: XR serious games show preliminary benefit in reducing phantom limb pain, improving functional mobility, supporting prosthesis control, and enhancing embodiment after amputation. Evidence linking XR-mediated sensorimotor feedback to cortical adaptation remains exploratory but is supported by neurofunctional findings. Usability and engagement outcomes were positive, although real-world implementation and scalability remain under-researched.