Isolated effects of virtual reality training on upper limb motor function in patients with stroke: systematic review and meta-analysis

To synthesize evidence on the effects of virtual reality (VR) as monotherapy on upper motor function in stroke patients. PubMed, PEDro, CINAHL, and WOS were searched from inception to December 2024. Nineteen studies were included (637 stroke patients, mean age 59.93 ± 6.52 years). The meta-analysis showed large effects sizes in VR interventions for upper extremity motor function and joint pain assessed with the Fugl-Meyer test (Cohen’s <i>d</i> = 1.03, <i>p</i> &lt; 0.001; Cohen’s <i>d</i> = 1.49), being also superior when compared to a control group (Cohen’s <i>d</i> = 0.68, <i>p</i> &lt; 0.05, Cohen’s <i>d</i> = 1.07). In contrast, these are not statistically significant when the analyses for motor function are done considering immersive or non-immersive VR. Non-immersive RV showed a large effect size on the Motor Activity Log Amount of Use (Cohen’s <i>d</i> = 1.20) and Motor Activity Log Quality of Movement (Cohen’s <i>d</i> = 1.35). RV also showed a medium effect size on the Action Research Arm Test (Cohen’s <i>d</i> = 0.61). These results were not significant when compared to a control group. VR as monotherapy improves upper limb motor function, being superior to other therapies in those functions assessed with the Fugl-Meyer scale. It is inconclusive if one VR modality is superior to another for improvements on upper limb motor function. Virtual reality (VR) as monotherapy shows superior results compared to other therapies when upper limb motor function is assessed using the Fugl-Meyer scale.Rehabilitation professionals should interpret the choice of VR modality with caution, as current evidence does not conclusively support the superiority of one type over another for improving upper limb motor function.It is recommended to individualize VR protocols due to the variability in patient characteristics. Virtual reality (VR) as monotherapy shows superior results compared to other therapies when upper limb motor function is assessed using the Fugl-Meyer scale. Rehabilitation professionals should interpret the choice of VR modality with caution, as current evidence does not conclusively support the superiority of one type over another for improving upper limb motor function. It is recommended to individualize VR protocols due to the variability in patient characteristics.