Virtual Reality-Assisted Rehabilitation for Upper-Limb Function in Stroke Survivors: A Systematic Review

Background: Upper-limb impairment is a major contributor to chronic disability after stroke. Conventional recovery protocols frequently suffer from poor adherence, limited accessibility, and insufficient intensity for prolonged rehabilitation. Methods: We performed a systematic analysis of randomized controlled trials (RCTs) and non-randomized designs published between 2019 and 2024, assessing virtual reality (VR) interventions for upper-limb stroke rehabilitation. Participant characteristics, VR intervention details, primary and secondary outcomes, and adherence rates were analyzed in accordance with PRISMA guidelines. The review is registered in PROSPERO (CRD420251150877). We searched PubMed, Embase, Wiley, Scopus, and Cochrane databases. Study quality was assessed using the RoB 2 and ROBINS-I tools. This review received no funding. Results: Forty-one trials met the inclusion criteria. High variability in study methodology, VR devices, intervention protocols, and outcome measures limited direct comparability. Dropout rates were low and were frequently attributed to factors unrelated to the VR intervention. Adverse events were uncommon, supporting the feasibility and safety of VR-based rehabilitation. Conclusions: While VR is a safe and feasible modality, large-scale, multicenter clinical trials with standardized protocols and long-term follow-up are essential to define the role of VR in routine stroke care.