In people who have had a stroke, virtual reality interventions improve overall arm function and activities of daily living

Jin M, Pei J, Bai Z, et al. Effects of virtual reality in improving upper extremity function after stroke: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2021:2692155211066534.

Review question

In people who have had a stroke, do interventions using virtual reality improve arm recovery, reduce activity limitations, and reduce participation restrictions?

Background

A stroke happens when blood flow to the brain is interrupted or blocked and brain cells are damaged or die. Most people who have had a stroke have some arm dysfunction, which can affect a person’s ability to participate in various activities.

Virtual reality uses computer technology to make people feel like they are in an artificial environment. They can perform physical actions that they may not be able to do as easily in the real world. There are different types of virtual reality systems ranging from game systems, like Nintendo Wii, to programs developed specifically for rehabilitation. Some are fully immersive, with head-mounted video displays, whereas others are less immersive (e.g., single tabletop screen). It is unclear whether interventions using virtual reality improve arm function and reduce limitations in people who have had a stroke.

How the review was done

The researchers did a systematic review, searching for studies that were published to October, 2021. They found 40 randomized controlled trials, with a total of 2,018 people.

The key features of the trials were:

• the average age was 53 to 76 years and 62% were men;
• people had an ischemic stroke (blood clot blocking a blood vessel in the brain) or a hemorrhagic stroke (bleeding into the brain) and had mild to severe arm weakness;
• virtual reality interventions varied by type, intensity, and session length; some were more fully immersive because they involved a head-mounted display, whereas others were non-immersive (e.g., standard televisions or computer monitors);
• virtual reality therapy lasted for 2 to 12 weeks; and
• virtual reality interventions were compared with non–virtual reality physical activities (including physical therapy) or no intervention.

What the researchers found

Compared with control, virtual reality interventions:

• improved overall arm function, motor impairment level, and activities of daily living by a small amount; and
• did not improve specific task-related activities or participation in activities.

Conclusion

In people who have had a stroke, interventions using virtual reality improve overall arm function, motor impairment level, and activities of daily living.

Effect of virtual reality interventions vs control in people who have had a stroke

*Amount of improvement with virtual reality interventions compared with control is based on standardized mean differences (SMDs), where SMD < 0.50 = small improvement; SMD 0.50 to 0.79 = moderate improvement; SMD ≥ 0.80 = large improvement.