HOME-BASED IMMERSIVE VIRTUAL REALITY FOR UPPER LIMB REHABILITATION IN CHRONIC STROKE: A SYSTEMATIC REVIEW

Abstract

Background: Stroke is the second leading cause of death worldwide, with upper limb motor dysfunction affecting over 55% of chronic survivors (>6 months post-onset) (GBD 2021 Stroke Collaborators, 2024). Home-based immersive virtual reality (IVR) via head-mounted displays (HMDs) directly targets the rehabilitation intensity gap in this phase. Existing systematic reviews have not isolated IVR with home delivery in the chronic stroke population.

Objective: To systematically evaluate the effectiveness, feasibility, and safety of home-based IVR for upper limb rehabilitation in adults with chronic stroke.

Methods: PRISMA 2020-compliant search of PubMed, Scopus, Web of Science, CINAHL, and Cochrane (2015-2026) (Page et al., 2021). Included studies were RCTs and feasibility trials of HMD-based IVR at home in chronic stroke with standardized upper limb outcomes. Quality was assessed using Cochrane RoB 2 and PEDro scale, with random-effects meta-analysis applied where feasible.

Results: Twelve studies (n = 487) met inclusion criteria. IVR significantly improved the Fugl-Meyer Assessment-Upper Extremity (FMA-UE; MD = 3.04, 95% CI 1.46-4.62; p < 0.001; I² = 41%) and Box and Block Test (BBT; MD = 2.85; p = 0.009). Mean adherence was 82.4%. No serious adverse events were recorded; cybersickness occurred in 8-15% of participants. Effect sizes did not consistently exceed the minimal clinically important difference (MCID) of 5-7 FMA-UE points (Page et al., 2012).

Conclusions: Home-based IVR is feasible, safe, and produces statistically significant but clinically modest upper limb gains in chronic stroke. Degree of immersion independently moderates outcome (Zhang et al., 2025). Adequately powered RCTs (n ≥200/arm) with ≥6-month follow-up are needed before standard-of-care deployment.