To investigate the efficacy of virtual reality (VR)- and gaming-based interventions for improving upper extremity function post-stroke, and to examine demographic and treatment-related factors that may moderate treatment response.
A comprehensive search was conducted within the PubMed, CINAHL/EBSCO, SCOPUS, Ovid MEDLINE and EMBASE databases for articles published between 2005 and 2019 (PROSPERO Registration number 95052).
Articles investigating gaming and VR methods of treatment for upper extremity weakness were collected with the following study inclusion criteria: 1) participants aged 18 or older with upper extremity deficits, 2) randomized controlled trials or prospective study design, 3) Downs-Black rating score of >= 18, and 4) outcome measure was the Wolf Motor Functioning Test (WMFT), the Fugl-Meyer (FM) or the Action Research Arm Test (ARAT).
Thirty-eight articles met inclusion criteria. The primary outcome was proportional improvement on the WMFT, FM, or ARAT. The following individual or treatment factors were extracted: VR/gaming dose, total treatment dose, chronicity (> or < 6 months), severity of motor impairment, and presence of a gaming component.
Random effects meta-analysis models were utilized to quantify 1) the proportional recovery that occurs following VR/gaming, 2) the comparative treatment effect of VR/gaming versus conventional physiotherapy, and 3) whether the benefit of virtual reality differed based on participant characteristics or elements of the treatment.
On average, VR/gaming interventions produced an improvement of 28.5% of the maximal possible improvement. Dose and severity of motor impairment did not significantly influence rehabilitation outcomes. Treatment gains were significantly larger overall (10.8%) when the computerized training involved a gaming component versus just visual feedback. VR/gaming interventions showed a significant treatment advantage (10.4%) over active control treatments.
Overall, VR/gaming-based upper extremity rehabilitation post-stroke appears to be more effective than conventional methods. Further in-depth study of variables impacting improvement, such as individual motor presentation, treatment dose, and the relationship between the two, are needed.