Effect of virtual reality-based upper limb training on activity of daily living and quality of life among stroke survivors: a systematic review and meta-analysis

Abstract

Background Stroke is a leading cause of disability worldwide, significantly impairing upper limb (UL) function and reducing patients' ability to perform activities of daily living (ADL) and quality of life (QoL). Virtual reality (VR) has emerged as a promising tool; for UL rehabilitation, offering immersive and engaging environments for motor recovery. However, the effectiveness of VR, its integration with conventional therapy, and their efficacy across different stroke recovery stages remain unclear. Therefore, this systematic review and meta-analysis aimed to evaluate the effectiveness of VR-based UL interventions in improving ADL and QoL among stroke survivors. Method This study adhered to PRISMA guidelines and was registered on PROSPERO (CRD42023426256). A systematic search of PubMed, Scopus, and Web of Science identified randomized controlled trials (RCTs) published in English. Inclusion criteria focused on studies using immersive VR (IVR) and non-immersive VR (NIVR) interventions to assess ADL and QoL in stroke survivors. Data extraction and quality assessment were performed independently by two reviewers using the PEDro scale to assess quality. Meta-analyses were conducted to determine the efficacy. Subgroup analyses were performed to compare IVR and NIVR, VR combined with conventional therapy versus standalone VR, and potential differences between stroke recovery stages. Result Thirty RCTs, representing 1,661 participants, were included. Overall, VR interventions significantly improved ADL (SMD = 0.27, 95% CI [0.11; 0.43], p < 0.001) and QoL (SMD = 0.94 [0.09; 1.79], p = 0.035) compared to conventional therapy. IVR demonstrated superior outcomes for ADL compared to NIVR (SMD = 0.54 [0.13; 0.95] Vs. 0.17 [0.02; 0.36], p = 0.03). Subacute stroke survivors exhibited the most significant gains in ADL (SMD = 0.52 [0.16; 0.88], p = 0.004), compared to chronic (SMD = 0.05 [-0.36; 0.46]) or acute patients (SMD = 0.08 [-0.11; 0.27]). Conclusion VR interventions, particularly IVR and VR combined with conventional therapy, significantly enhance ADL and QoL in stroke survivors with moderate certainty of evidence. These findings underscore the value of VR in rehabilitation, especially during the subacute phase, but highlight the need for further research into long-term effects and implementation in low-resource settings.