EFFECTS OF IMMERSION LEVEL AND INTERVENTION TIMING IN VR-BASED STROKE REHABILITATION: A META-ANALYSIS OF UPPER LIMB RECOVERY
DOI:
https://doi.org/10.20961/magnaneurologica.v4i2.3269Keywords:
immersion, stroke rehabilitation, upper limb motor recovery, virtual realityAbstract
Background: Virtual Reality (VR) has emerged as a contemporary modality in neurorehabilitation, utilizing interactive environments and multisensory feedback to support neuroplasticity and motor learning. However, the influence of stroke phase and VR immersion level on therapeutic effectiveness has not been systematically synthesized.
Objective: To systematically synthesize the effectiveness of VR-based interventions on upper limb motor function after stroke and critically evaluate the moderating effects of stroke phase and VR immersion level on rehabilitation outcomes.
Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, with searches across major scientific databases. Experimental studies, including randomized controlled trials (RCTs) and quasi-experimental studies, assessing upper limb motor function using the Fugl-Meyer Assessment–Upper Extremity (FMA-UE) were included. Risk of bias was evaluated using the Cochrane Risk of Bias tool. A random-effects model was applied to calculate pooled Mean Differences (MDs), with subgroup analyses based on stroke phase and VR immersion level.
Results: Eleven studies (10 RCTs and 1 quasi-experimental study) involving 388 participants were included. VR-based interventions demonstrated a statistically significant improvement in upper limb motor function compared with conventional therapy (MD = 8.97; 95% CI 6.11–11.82; p < 0.00001). Significant effects were consistently observed in both the chronic phase (MD = 9.96) and the subacute phase (MD = 8.36). Both non-immersive and immersive VR yielded clinically meaningful benefits, with no significant difference between immersion levels (p = 0.97).
Conclusion: Virtual Reality based neurorehabilitation significantly enhances post-stroke upper limb motor recovery, with consistent effectiveness regardless of stroke phase or device immersion level. These findings support VR as a flexible and clinically applicable adjunct to standard rehabilitation, although standardized intervention protocols and long-term outcome evaluations remain necessary.
References
1. Soleimani M, et al. The Efficacy of Virtual Reality for Upper Limb Rehabilitation in Stroke Patients: A Systematic Review and Meta-Analysis. BMC Med Inform Decis Mak; 2024. 24(1):135. DOI: 10.1186/s12911-024-02534-y
2. Cardile D, et al. A Systematic Review on the Use of Virtual Reality in Post-Stroke Patients: Exploring When Modalities Make the Difference in Executive and Motor Recovery. Front Virtual Real; 2025. 6:1653968. DOI: 10.3389/frvir.2025.1653968
3. Katan M, Luft A. Global Burden of Stroke. Semin Neurol; 2018. 38(2):208-211. DOI: 10.1055/s-0038-1649503
4. Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization: Global Stroke Fact Sheet 2025. Int J Stroke; 2025. 20(2):132-144. DOI: 10.1177/17474930241308142
5. Zhang W, Lyu S, Zhang S. Virtual Reality Technology for Upper and Lower Limb Motor Function, Daily Function, and Balance in Stroke Patients: A Meta-Analysis of Randomized Controlled Trials. PeerJ; 2025. 13:e20402. DOI: 10.7717/peerj.20402
6. Kenea CD, Abessa TG, Lamba D, Bonnechère B. Immersive Virtual Reality in Stroke Rehabilitation: A Systematic Review and Meta-Analysis of Its Efficacy in Upper Limb Recovery. J Clin Med; 2025. 14(6):1783. DOI: 10.3390/jcm14061783
7. Bargeri S, Baggio M, Guida S, Castellini G, Gianola S. Evolving Trends in Virtual Reality Rehabilitation for Stroke in Research Publications. Arch Physiother; 2024. 14(1). DOI: 10.33393/aop.2024.3155
8. Adams RJ, Ellington AL, Kuccera KA, Leaman H, Smithson C, Patrie JT. Telehealth-Guided Virtual Reality for Recovery of Upper Extremity Function Following Stroke. OTJR (Thorofare N J); 2023. 43(3):446-456. DOI: 10.1177/15394492231158375
9. Alves SS, Ocamoto GN, de Camargo PS, Santos ATS, Terra AMV. Effects of Virtual Reality and Motor Imagery Techniques Using Fugl Meyer Assessment Scale in Post-Stroke Patients. Int J Ther Rehabil; 2018. 25(11):587-601. DOI: 10.12968/ijtr.2018.25.11.587
10. Ase H, Honaga K, Tani M, et al. Effects of Home-Based Virtual Reality Upper Extremity Rehabilitation in Persons with Chronic Stroke: A Randomized Controlled Trial. J Neuroeng Rehabil; 2025. 22:20. DOI: 10.1186/s12984-025-01564-5
11. Bai Y, Liu F, Zhang H. Artificial Intelligence Limb Rehabilitation System on Account of Virtual Reality Technology on Long-Term Health Management of Stroke Patients in the Context of the Internet. Comput Math Methods Med; 2022. 2022:2688003. DOI: 10.1155/2022/2688003
12. Ogun MN, Kurul R, Yaşar MF, et al. Effect of Leap Motion-Based 3D Immersive Virtual Reality Usage on Upper Extremity Function in Ischemic Stroke Patients. Arq Neuropsiquiatr; 2019. 77(10):681-688. DOI: 10.1590/0004-282X20190129
13. Pradana MF, Gunawan H, Nauphar D. Efektivitas Virtual Reality Upper Motoric Training terhadap Pemulihan Fungsi Motorik Atas pada Pasien Stroke. Syntax Lit; 2025. 10(9):3776-3793.
14. Sip P, Kozłowska M, Czysz D, Daroszewski P, Lisiński P. Perspectives of Motor Functional Upper Extremity Recovery with the Use of Immersive Virtual Reality in Stroke Patients. Sensors; 2023. 23(2):712. DOI: 10.3390/s23020712
15. Hsu HY, Kuo LC, Lin YC, Su FC, Yang TH, Lin CW. Effects of a Virtual Reality-Based Mirror Therapy Program on Improving Sensorimotor Function of Hands in Chronic Stroke Patients: A Randomized Controlled Trial. Neurorehabil Neural Repair; 2022. 36(6):335-345. DOI: 10.1177/15459683221081430
16. Huang CY, Chiang WC, Yeh YC, et al. Effects of Virtual Reality-Based Motor Control Training on Inflammation, Oxidative Stress, Neuroplasticity and Upper Limb Motor Function in Patients with Chronic Stroke: A Randomized Controlled Trial. BMC Neurol; 2022. 22:21. DOI: 10.1186/s12883-021-02547-4
17. Leng Y, Lo WLA, Mao YR, et al. The Impact of Cognitive Function on Virtual Reality Intervention for Upper Extremity Rehabilitation of Patients with Subacute Stroke: Prospective Randomized Controlled Trial with 6-Month Follow-Up. JMIR Serious Games; 2022. 10(3):e33755. DOI: 10.2196/33755
18. Amin F, Waris A, Khan MJ, et al. Evaluating the Effectiveness of Immersive Virtual Reality Rehabilitation Games with Enhanced Visual Training for Hand Motor Function Improvement Using Electromyography: Randomized Controlled Trial. JMIR Serious Games; 2025. 13(1):e74314. DOI: 10.2196/74314
19. Aderinto N, Olatunji G, Abdulbasit MO, Edun M, Aboderin G, Egbunu E. Exploring the Efficacy of Virtual Reality-Based Rehabilitation in Stroke: A Narrative Review of Current Evidence. Ann Med; 2023. 55(2):2285907. DOI: 10.1080/07853890.2023.2285907
20. Shen J, Gu X, Fu J, et al. Virtual Reality-Induced Motor Function of the Upper Extremity and Brain Activation in Stroke: Study Protocol for a Randomized Controlled Trial. Front Neurol; 2023. 14:1094617. DOI: 10.3389/fneur.2023.1094617
21. Musick S, Yalcin N. Virtual Reality for Neurorehabilitation: Mechanisms, Modalities, and Clinical Applications. Neurocritical Care Society; 2025. Retrieved on January 10, 2026. Available from: https://www.neurocriticalcare.org
22. Gangemi A, De Luca R, Fabio RA, et al. Effects of Virtual Reality Cognitive Training on Neuroplasticity: A Quasi-Randomized Clinical Trial in Patients with Stroke. Biomedicines; 2023. 11(12):3225. DOI: 10.3390/biomedicines11123225
23. Virtual Conventional Therapy for Motor Rehabilitation in Stroke Patients: A Systematic Review. Magna Neurologica; 2025. 3(2):150-159. Retrieved on January 10, 2026. Available from: https://journal.uns.ac.id/index.php/magna-neurologica/article/view/1680
24. Prajjwal P, Chandrasekar KK, Battula P, et al. The Efficacy of Virtual Reality-Based Rehabilitation in Improving Motor Function in Patients with Stroke: A Systematic Review and Meta-Analysis. Ann Med Surg (Lond); 2024. 86(9):5425-5438. DOI: 10.1097/MS9.0000000000002403
25. Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual Reality for Stroke Rehabilitation. Cochrane Database Syst Rev; 2017. 11(11):CD008349. DOI: 10.1002/14651858.CD008349.pub4
26. Al-Whaibi RM, Al-Jadid MS, ElSerougy HR, Badawy WM. Effectiveness of Virtual Reality-Based Rehabilitation Versus Conventional Therapy on Upper Limb Motor Function of Chronic Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Physiother Theory Pract; 2022. 38(13):2402-2416. DOI: 10.1080/09593985.2021.1941458
27. Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Chapman M, Crotty M. Virtual Reality for Stroke Rehabilitation. Cochrane Database Syst Rev; 2025. 6:CD008349. DOI: 10.1002/14651858.CD008349.pub5
28. Okamura R, Nakashima A, Moriuchi T, et al. Effects of a Virtual Reality-Based Mirror Therapy System on Upper Extremity Rehabilitation After Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Neurol; 2024. 14:1298291. DOI: 10.3389/fneur.2023.1298291
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Zafira Zahra Aulia Rahma, Naufal Dzulhijar, Syakira Zahra Maulida
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
