Review Article (Meta-Analysis)| Volume 103, ISSUE 6, P1131-1143.e7, June 2022

Effect of Time-Dose-Matched Virtual Reality Therapy on Upper Limb Dysfunction in Patients Poststroke: A Meta-Analysis of Randomized Controlled Trials

Published:October 04, 2021DOI:



      To investigate the efficacy and acceptability of virtual reality (VR) with time-dose-matched conventional therapy (CT) in patients poststroke with upper limb dysfunction.

      Data Sources

      Cochrane, PubMed, Web of Science, Embase, and ProQuest were systematically searched up to May 24, 2021.

      Study Selection

      Randomized controlled trials comparing VR with time-dose-matched CT in patients poststroke with upper limb dysfunction were included.

      Data Extraction

      The extracted data included efficacy (mean change in structure/function, activity, and participation scores), acceptability (dropouts for all reasons), adverse events, and characteristics of the included studies. The Cochrane risk of bias assessment tool was used to assess the risk of bias.

      Data Synthesis

      Thirty-one randomized controlled trails were included. VR was superior to time-dose-matched CT in terms of the World Health Organization's International Classification of Functioning, Disability and Health structure/function, with a standardized mean difference (SMD) of 0.35, but not activity and participation. Subgroup analyses demonstrated that virtual environment was superior to CT in structure/function (SMD=0.38) and activity (SMD=0.27), whereas there were no significant differences between commercial gaming and CT in any World Health Organization International Classification of Functioning, Disability and Health domain. VR mixed with CT was more effective than time-dose-matched CT in structure/function (SMD=0.56), whereas VR only was not significantly different from CT. There were no significant differences in the incidence of adverse events and dropout rates between VR and CT.


      The results suggest that VR is superior to time-dose-matched CT in terms of recovery of upper extremity motor function, especially when a virtual environment is used or VR is mixed with CT. However, VR (VR only or mixed with CT) does not improve patients’ daily activity performance and participation compared with CT. Overall, VR appears to be safe and acceptable as CT. Large-scale definitive trials are needed to verify or refute these findings.


      List of abbreviations:

      ARAT (Action Research Arm Test), BBT (Box and Block Test), BI (Barthel Index), CG (commercial gaming), CI (confidence interval), CT (conventional therapy), FMU (Upper Extremity Fugl-Meyer), GS (grip strength), JHFT (Jebsen Hand Function Test), ICF (International Classification of Functioning, Disability and Health), MAL-QOM (Motor Activity Log-Quality of Movement), MBI (Modified Barthel Index), MI (Motricity Index), OR (odds ratio), RCT (randomized controlled trial), SIS Strength (Stroke Impact Scale Strength), SMD (standardized mean difference), VE (virtual environment), VR (virtual reality), WMFT (Wolf Motor Function Test)
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