Title : Comparative effectiveness of virtual reality-based rehabilitation and robotic-assisted therapy for upper limb recovery after stroke: A systematic review and meta-analysis
Abstract:
Background: Technology-assisted rehabilitation may improve upper limb recovery after stroke, but the comparative effectiveness of virtual reality (VR)-based rehabilitation and robotic-assisted therapy (RAT) remains unclear.
Objective: This systematic review and meta-analysis aimed to evaluate the comparative effectiveness of virtual reality (VR)-based rehabilitation and robotic-assisted therapy (RAT) for upper limb motor recovery in post-stroke patients.
Method: We conducted a systematic review and meta-analysis of studies in adults (>18 years) with ischemic or hemorrhagic stroke and upper extremity impairment. PubMed, EMBASE, and Scopus were searched from inception to March 4, 2026. Eligible studies evaluated isolated VR or isolated RAT versus conventional therapy. Risk of bias was assessed using Cochrane Risk of Bias version 2. Random-effects meta-analyses were performed using standardized mean difference (SMD) and 95% confidence intervals (CI).
Result: Based on eight studies, technology-based rehabilitation showed a significant overall advantage for upper extremity motor function (FMA-UE) as compared to standard therapy (SMD 0.26; 95% CI 0.11 to 0.40) with low heterogeneity. The subgroup effects were constant for VR (SMD 0.34; 95% CI -0.08 to 0.75) and RAT (SMD 0.25; 95% CI 0.00 to 0.49), with no significant subgroup difference (p=0.544). When measuring quality of life/stroke impact with SIS, the pooled effect was small and borderline (SMD 0.23; 95% CI -0.00 to 0.47), with no
significant subgroup difference (p=0.906). The risk of bias was between low and moderate.
Conclusion: VR and RAT appear similarly effective as adjuncts to conventional therapy for improving post-stroke upper limb motor outcomes.
Keywords: Stroke rehabilitation; Virtual reality; Robotic-assisted therapy; Upper extremity; Fugl-Meyer Assessment; Meta-analysis
