Effects of Immersive Virtual Reality on Upper-Extremity Stroke Rehabilitation: A Systematic Review with Meta-Analysis

Abstract

Virtual reality (VR) is an innovative rehabilitation tool increasingly used in stroke rehabilitation. Fully immersive VR is a type of VR that closely simulates real-life scenarios, providing a high level of immersion, and has shown promising results in improving rehabilitation functions. This study aimed to assess the effect of immersive VR-based therapy for stroke patients on the upper extremities, activities of daily living (ADLs), and pain reduction and its acceptability and side effects. For this review, we gathered all suitable randomized controlled trials from PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science. Out of 1532, 10 articles were included, with 324 participants. The results show that immersive VR offers greater benefits in comparison with conventional rehabilitation, with significant improvements observed in ADLs (SMD 0.58, 95% CI 0.25 to 0.91, I2 = 0%, p = 0.0005), overall function as measured by the Fugl-Meyer Assessment (MD 6.33, 95% CI 4.15 to 8.50, I2 = 25%, p = 0.00001), and subscales for the shoulder (MD 4.96, 95% CI—1.90–8.03, I2 = 25%, p = 0.002), wrist (MD 2.41, 95% CI—0.56–4.26, I2 = 0%, p = 0.01), and hand (MD 2.60, 95% CI—0.70–4.5°, I2 = 0%, p = 0.007). These findings highlight the potential of immersive VR as a valuable therapeutic option for stroke survivors, enhancing their ADL performance and upper-limb function. The immersive nature of VR provides an engaging and immersive environment for rehabilitation.

The Use of Head-Mounted Display Systems for Upper Limb Kinematic Analysis in Post-Stroke Patients: A Perspective Review on Benefits, Challenges and Other Solutions

“…Fostering patients’ intrinsic motivation to actively participate in the therapeutic process is especially important, particularly when conventional methods may lead to boredom or lack of interest [ 85 ]. The available studies [ 22 , 85 , 86 ] on neurorehabilitation indicate that HMD-VR exhibits the potential to enhance tailored assessment and intervention methods by engaging patients within an immersive virtual environment. According to different authors [ 22 , 36 , 86 , 87 ], HMD-VR can be an effective tool to improve upper limb motor outcomes and kinematic factors, as well as ADLs, in post-stroke patients.…”

“…The available studies [ 22 , 85 , 86 ] on neurorehabilitation indicate that HMD-VR exhibits the potential to enhance tailored assessment and intervention methods by engaging patients within an immersive virtual environment. According to different authors [ 22 , 36 , 86 , 87 ], HMD-VR can be an effective tool to improve upper limb motor outcomes and kinematic factors, as well as ADLs, in post-stroke patients. In particular, De Giorgi et al [ 88 ] used HMD-VR to perform virtual art therapy, which remarkably promotes the autonomy of post-stroke patients in their ADLs and upper limb functioning, in terms of muscle strength and pinching.…”

“…In the neurorehabilitation context, the HMD-VR platforms were mostly used to train upper limb functions in post-stroke patients. According to recent studies [ 22 , 23 ], these systems are promising tools used to improve upper limb functional outcomes and daily living activities in chronic post-stroke patients. HMD-VR platforms offer the possibility of performing task-oriented movements with high degrees of realism, which could enhance gesture relevance [ 21 , 24 ].…”