Complementary use of virtual reality in motor recovery after stroke: A systematic review with meta-analysis

Abstract

Introduction: Physical therapy is a cornerstone of motor rehabilitation following stroke, a leading cause of disability worldwide. Virtual reality is currently being used as a therapeutic adjunct with promising results, although its benefits have not yet been fully established. Objective: This study aims to evaluate the efficacy of virtual reality combined with conventional physical therapy for post-stroke motor rehabilitation, compared to conventional physical therapy alone. Methods: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Selected articles were required to report at least one outcome related to motor rehabilitation—specifically involving upper or lower limbs, gait, or balance. Risk of bias was assessed using the Risk of Bias (RoB 2) tool, and statistical analysis was performed using Review Manager (RevMan). Results: The results indicated a moderate-to-large clinical effect (standardized mean difference of 0.79) favoring the combination of virtual reality (VR) and physical therapy. However, the pooled result did not reach statistical significance (p = 0.16). Furthermore, very high heterogeneity was observed among the studies (I² = 87%). The presence of serious inconsistency resulted in low overall certainty of the evidence. Conclusion: Although virtual reality appears to be a promising tool for enhancing motor recovery after stroke, methodological limitations and low certainty of evidence prevent a definitive claim regarding its superiority over conventional physical therapy alone. Therefore, further randomized clinical trials with larger sample sizes and rigorous methodology are needed.