Effects of immersive virtual reality on limb motor function, balance, gait and quality of life after stroke: A systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract; described as statistically significant for FMA-UE and selected gait parameters

• Effect Size: Not explicitly reported in abstract; described as 'small but significant' — specific standardised mean difference not available from abstract

• Primary Outcome: Upper extremity motor impairment measured by the Fugl-Meyer Assessment Upper Extremity (FMA-UE): small but statistically significant improvement favouring IVR combined with conventional rehabilitation

• Nnt Or Sensitivity: Not calculable from available abstract data; GRADE certainty rated low to very low, limiting clinical translation of effect estimates

• Confidence Interval: Not reported in abstract

Clinical Application

IVR technology is increasingly accessible but remains costly and requires technical infrastructure, trained staff, and appropriate clinical space. Cybersickness (motion-induced nausea/disorientation) is a known adverse effect that may limit tolerability in some stroke survivors, particularly those with vestibular dysfunction or cognitive impairment. The review reports IVR as 'safe,' but adverse event data are not quantified in the abstract. Implementation in community rehabilitation or home settings remains limited. IVR-based rehabilitation is not currently listed on the Pharmaceutical Benefits Scheme (PBS) and is not a TGA-regulated therapeutic device in the conventional sense, though specific VR platforms may require TGA registration as medical devices under the Therapeutic Goods Act 1989. The RACGP and Stroke Foundation Australia's Clinical Guidelines for Stroke Management (2023 update) recommend technology-assisted rehabilitation as an adjunct but do not specifically endorse IVR due to insufficient high-certainty evidence — consistent with this review's conclusions. Australian public hospital rehabilitation units may face significant cost and resource barriers to IVR implementation. Private health insurance coverage for IVR-based therapy is variable and not standardised across funds. The National Disability Insurance Scheme (NDIS) may fund assistive technology including VR for eligible participants, though IVR for stroke rehabilitation is not a defined support category. Australian clinicians should note that the included trial populations are predominantly from non-Australian settings, and generalisability to Indigenous Australians and culturally and linguistically diverse populations requires specific consideration. Adult stroke survivors across post-acute, subacute, and chronic phases of recovery who are participating in structured rehabilitation programmes. Most applicable to patients with residual upper extremity motor impairment and gait deficits. Patients must be cognitively and physically capable of tolerating IVR headset use and engaging with virtual environments.

Abstract

Immersive virtual reality (IVR) has been increasingly integrated into stroke rehabilitation albeit the effectiveness across different outcome domains remains unclear. This study aimed to review evidence from randomized controlled trials evaluating the effects of IVR, used alone or in combination with conventional rehabilitation, on motor-, functional-, and participation-related outcomes after stroke. Ovid MEDLINE, Embase, Cochrane Library and CINAHL were screened up to April 2025 to identify eligible randomized controlled trials (RCTs). A systematic literature search was conducted. Randomized controlled trials including adults with stroke and evaluating immersive virtual reality interventions were eligible. Studies using non-immersive VR, non-randomized designs, or not reporting motor, functional, or participation outcomes were excluded. Meta-analyses were performed where data were sufficiently homogeneous; otherwise, outcomes were summarized descriptively. Risk of bias was assessed using standardized appraisal tools, and certainty of evidence was evaluated using the GRADE approach. Out of 3,574, we included 34 RCTs involving post-acute, subacute and chronic stroke survivors, with a total of1200 participants. Meta-analyses showed IVR, most commonly delivered in combination with conventional rehabilitation, to be associated with improvements in upper extremity motor impairment, particularly measured by the Fugl-Meyer Assessment Upper Extremity (FMA-UE). Small but significant effects were also found for selected gait parameters. In contrast, effects on functional performance, balance, and quality of life were inconsistent and could not be robustly quantified. The overall certainty of evidence ranged from low to very low, primarily due to heterogeneity, methodological limitations, and small sample sizes. In conclusion, IVR appears to be a promising and safe supplement to conventional stroke rehabilitation, particularly for improving motor impairment. However, evidence remains limited and inconsistent across functional outcomes. More well-designed, adequately powered trials with standardized interventions and clinically meaningful outcome measures are needed to clarify the role of IVR in stroke rehabilitation. PROSPERO (Registration number: CRD420250639792).

References

1. 1.Islam, D., Marklund, I., von Euler, M., & Jaensson, M. (2026). Effects of immersive virtual reality on limb motor function, balance, gait and quality of life after stroke: A systematic review and meta-analysis. PLoS ONE. https://doi.org/10.1371/journal.pone.0351114