Virtual Reality Exergaming in Outpatient Stroke Rehabilitation: A Scoping Review and Clinician Roadmap

Background/Objectives: Outpatient stroke rehabilitation is expanding as inpatient episodes shorten. Virtual reality (VR) exergaming can extend practice and standardize progression, but setting-specific effectiveness and implementation factors remain unclear. This scoping review mapped VR exergaming in outpatient stroke care and identified technology typologies and functional outcomes. Methods: Guided by the JBI Manual and PRISMA-ScR, searches of MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were conducted in April 2025. The study included adults post-stroke undergoing VR exergaming programs with movement tracking delivered in clinic-based outpatient or home-based outpatient settings. Interventions focused on functional rehabilitation using interactive VR. Results: Sixty-six studies met the criteria, forty-four clinic-based and twenty-two home-based. Serious games accounted for 65% of interventions and commercial exergames for 35%. Superiority on a prespecified functional endpoint was reported in 41% of trials, 29% showed within-group improvement only, and 30% found no between-group difference; effects were more consistent in supervised clinic programs than in home-based implementations. Signals were most consistent for commercial off-the-shelf and camera-based systems. Gloves or haptics and locomotor platforms were promising but less studied. Head-mounted display interventions showed mixed findings. Adherence was generally high, and adverse events were infrequent and mild. Conclusions: VR exergaming appears clinically viable for outpatient stroke rehabilitation, with the most consistent gains in supervised clinic-based programs; home-based effects are more variable and sensitive to dose and supervision. Future work should compare platform types by therapeutic goal; embed mechanistic measures; strengthen home delivery with dose control and remote supervision; and standardize the reporting of fidelity, adherence, and cost.