Review question

We wanted to compare the effects of virtual reality versus an alternative treatment or no treatment on recovery after stroke using arm function and other outcomes such as walking speed and independence in managing daily activities after stroke.

Background

Many people after having a stroke have difficulty moving, thinking, and sensing. This often results in problems with everyday activities such as writing, walking, and driving. Virtual reality and interactive video gaming are types of therapy being provided to people after having a stroke. The therapy involves using computer-based programs designed to simulate real life objects and events. Virtual reality and interactive video gaming may have some advantages over traditional therapy approaches as they can give people an opportunity to practise everyday activities that are not or cannot be practised within the hospital environment. Furthermore, there are several features of virtual reality programs that might mean that patients spend more time in therapy: for example, the activity might be more motivating.

Study characteristics

We identified 72 studies involving 2470 people after stroke. A wide range of virtual reality programs were used, with most aimed to improve either arm function or walking ability. The evidence is current to April 2017.

Key results

Twenty-two trials tested whether the use of virtual reality compared with conventional therapy resulted in an improved ability to use one’s arm and found that the use of virtual reality did not result in better function (low-quality evidence). When virtual reality was used in addition to usual care or rehabilitation to increase the amount of time the person spent in therapy there were improvements in the functioning of the arm (low-quality evidence). Six trials tested whether the use of virtual reality compared with conventional therapy resulted in improved walking speed. There was no evidence that virtual reality was more effective in this case (low-quality evidence). Ten trials found that there was some evidence that virtual reality resulted in a slightly better ability to manage everyday activities such as showering and dressing (moderate-quality evidence). However, these positive effects were found soon after the end of the treatment and it is not clear whether the effects are long lasting. Results should be interpreted with caution as, while there are a large number of studies, the studies are generally small and not of high quality. A small number of people using virtual reality reported pain, headaches, or dizziness. No serious adverse events were reported.

Quality of the evidence

The quality of the evidence was generally of low or moderate quality. The quality of the evidence for each outcome was limited due to small numbers of study participants, inconsistent results across studies, and poor reporting of study details.