The Effects of Virtual Reality Training on Post-Stroke Upper and Lower Limb Function: A Meta-Analysis

This meta-analysis presents an updated comparison between virtual reality (VR) training and conventional training (CT) in post-stroke rehabilitation by incorporating recent studies based on prior meta-analyses. We searched 3 international electronic databases (MEDLINE, Embase, and the Cochrane Library) and a Korean database (KoreaMed) to identify relevant studies. Out of 5,218 studies, 30 randomized controlled trials were selected through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Among these, 21 focused on upper limb training and 14 on lower limb training. A subgroup meta-analysis was conducted based on the VR type. The risk of bias (RoB) was assessed using Cochrane's RoB tool. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method. The outcomes were categorized into upper limb motor function, fine motor function, and activities of daily living (ADLs) for upper limb training, and lower limb motor function, balance, and gait velocity for lower limb training. A random-effects model for the meta-analysis indicated that VR training showed significant superiority over CT in improving upper limb motor function, ADL, and balance. This study provides low- to moderate-certainty evidence supporting the superiority of VR training over CT. Clinicians and therapists should consider individual rehabilitation needs, goals, patient preferences, and available resources when selecting VR for post-stroke functional recovery.