Olana Diriba Dereje, Abessa Teklu Gemechu, Lamba Dheeraj, Triccas Lisa Tedesco, Bonnechere Bruno
Department of Biomedical Sciences, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
J Neuroeng Rehabil. 2025 Apr 24;22(1):92. doi: 10.1186/s12984-025-01603-1.
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.
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.
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]).
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.
中风是全球致残的主要原因，严重损害上肢（UL）功能，降低患者进行日常生活活动（ADL）的能力和生活质量（QoL）。虚拟现实（VR）已成为上肢康复的一种有前景的工具，为运动恢复提供沉浸式和引人入胜的环境。然而，VR的有效性、其与传统疗法的结合以及它们在不同中风恢复阶段的疗效仍不明确。因此，本系统评价和荟萃分析旨在评估基于VR的上肢干预措施对改善中风幸存者ADL和QoL的有效性。
本研究遵循PRISMA指南，并在PROSPERO（CRD42023426256）上注册。对PubMed、Scopus和Web of Science进行系统检索，以识别英文发表的随机对照试验（RCT）。纳入标准侧重于使用沉浸式VR（IVR）和非沉浸式VR（NIVR）干预措施评估中风幸存者ADL和QoL的研究。由两名评审员独立进行数据提取和质量评估，使用PEDro量表评估质量。进行荟萃分析以确定疗效。进行亚组分析以比较IVR和NIVR、VR与传统疗法联合使用与单独使用VR，以及中风恢复阶段之间的潜在差异。
纳入了30项RCT，共1661名参与者。总体而言，与传统疗法相比，VR干预显著改善了ADL（标准化均数差[SMD]=0.27，95%置信区间[0.11；0.43]，p<0.001）和QoL（SMD=0.94[0.09；1.79]，p=0.035）。与NIVR相比，IVR在ADL方面显示出更好的结果（SMD=0.54[0.13；0.95]对0.17[0.02；0.36]，p=0.03）。与慢性（SMD=0.05[-0.36；0.46]）或急性患者（SMD=0.08[-0.11；0.27]）相比，亚急性中风幸存者在ADL方面的改善最为显著（SMD=0.52[0.16；0.88]，p=0.004）。
VR干预措施，特别是IVR以及VR与传统疗法联合使用，在有中等证据确定性的情况下，能显著提高中风幸存者的ADL和QoL。这些发现强调了VR在康复中的价值，特别是在亚急性期，但也突出了对长期影响以及在资源匮乏环境中的实施进行进一步研究的必要性。
