Virtual reality–based interventions influence self-reported levels of upper limb use after stroke: a systematic review and meta-analysis

Virtual reality (VR) technology can be incorporated as a technical platform for the application of motor learning principles to deliver personalized interventions. The effects of VR-based rehabilitation on poststroke upper limb (UL) motor improvement have primarily been assessed using motor impairment and activity limitation outcomes. Comparatively less attention has been paid to the effects of the intervention on self-perceived use of the UL in the performance of daily life activities. Information on self-perceived use (assessed using the Motor Activity Log; MAL) provides insight into real-life use of the more-affected UL in daily activities. We conducted a systematic review and meta-analyses to examine the influence of VR-based interventions on the self-perceived quantity and quality of poststroke UL use using the MAL. Using standard methodology, we conducted a literature search of databases including MEDLINE and ISI Web of Science using keywords related to stroke and VR. The PEDRo scale helped assess the quality of the retrieved studies. Meta-analyses helped assess change in Quality of Movement (QoM) and Amount of Use (AoU) scores. Effect sizes (ES) were quantified based on the Rehabilitation Treatment Specification System as follows: small (0.08–0.18), medium (0.19–0.40), and large (≥ 0.41). We retrieved a total of 14 studies. The quality of the published studies ranged from moderate to good. Use of VR-based interventions resulted in an increase in QoM scores postintervention (large ES; 0.50; 95% CI: 0.15–0.85, P < 0.005) and at retention testing (medium ES; 0.39; 95% CI: 0.08–0.71, P = 0.02). Similar positive effects were reported for AoU scores postintervention (medium ES; 0.4, 95% CI: 0.05–0.75, P = 0.03) and at retention testing (medium ES; 0.36; 95% CI: 0.02–0.7, P = 0.04). VR-based rehabilitation is beneficial in improving self-perceived quality and quantity of post-stroke UL use for the performance of daily life activities in the real-world setting.