Archives of physical medicine and rehabilitation · 2026
Comparative Effectiveness of Virtual Reality and Mirror Therapy on Upper Extremity Motor Recovery After Stroke: A Systematic Review and Meta-analysis.
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Chandra Kevin Axel, Jahja Felicia, Lauvita Jenny, Pebriana Regina
Аннотация
OBJECTIVE: To compare the effectiveness of virtual reality (VR) and mirror therapy (MT) on upper extremity motor recovery after stroke, focusing on motor impairment and manual function.
DATA SOURCES: A systematic search of major electronic databases was conducted to identify randomized controlled trials (RCTs) evaluating VR and MT in poststroke rehabilitation.
STUDY SELECTION: RCTs enrolling adult stroke survivors that directly compared VR and MT and reported upper extremity outcomes were included. Outcomes comprised the Fugl-Meyer Assessment for Upper Extremity, including total and subscale scores, Manual Function Test, and Box and Block Test.
DATA EXTRACTION: Data on study characteristics, participants, interventions, and outcomes were extracted using standardized forms, and effect estimates were obtained for all eligible outcomes.
DATA SYNTHESIS: Seven outcomes from RCTs were pooled. Heterogeneity was negligible across outcomes (I²=0%). No statistically significant differences were observed between VR and MT for the Fugl-Meyer Assessment for Upper Extremity total score (mean difference [MD]=1.08; 95% confidence interval [CI], -1.16 to 3.33), shoulder/elbow/forearm (MD=0.82; 95% CI, -1.64 to 3.28), wrist (MD=0.14; 95% CI, -1.00 to 1.27), hand (MD=0.28; 95% CI, -1.11 to 1.67), coordination (MD=0.31; 95% CI, -0.06 to 0.68), or Box and Block Test (MD=0.71; 95% CI, -0.37 to 1.79). A statistically significant difference favoring VR was observed for the Manual Function Test (MD=1.26; 95% CI, 0.03-2.48; P=.04). However, the absolute magnitude of this difference was small relative to the total scale range, suggesting that the clinical relevance of this finding may be limited.
CONCLUSIONS: VR and MT yield comparable improvements in upper extremity motor recovery after stroke. Although VR demonstrated a small statistical advantage in manual function, the clinical relevance appears limited. Further adequately powered RCTs are needed to clarify whether specific patient subgroups may benefit more from VR-based interventions.
DATA SOURCES: A systematic search of major electronic databases was conducted to identify randomized controlled trials (RCTs) evaluating VR and MT in poststroke rehabilitation.
STUDY SELECTION: RCTs enrolling adult stroke survivors that directly compared VR and MT and reported upper extremity outcomes were included. Outcomes comprised the Fugl-Meyer Assessment for Upper Extremity, including total and subscale scores, Manual Function Test, and Box and Block Test.
DATA EXTRACTION: Data on study characteristics, participants, interventions, and outcomes were extracted using standardized forms, and effect estimates were obtained for all eligible outcomes.
DATA SYNTHESIS: Seven outcomes from RCTs were pooled. Heterogeneity was negligible across outcomes (I²=0%). No statistically significant differences were observed between VR and MT for the Fugl-Meyer Assessment for Upper Extremity total score (mean difference [MD]=1.08; 95% confidence interval [CI], -1.16 to 3.33), shoulder/elbow/forearm (MD=0.82; 95% CI, -1.64 to 3.28), wrist (MD=0.14; 95% CI, -1.00 to 1.27), hand (MD=0.28; 95% CI, -1.11 to 1.67), coordination (MD=0.31; 95% CI, -0.06 to 0.68), or Box and Block Test (MD=0.71; 95% CI, -0.37 to 1.79). A statistically significant difference favoring VR was observed for the Manual Function Test (MD=1.26; 95% CI, 0.03-2.48; P=.04). However, the absolute magnitude of this difference was small relative to the total scale range, suggesting that the clinical relevance of this finding may be limited.
CONCLUSIONS: VR and MT yield comparable improvements in upper extremity motor recovery after stroke. Although VR demonstrated a small statistical advantage in manual function, the clinical relevance appears limited. Further adequately powered RCTs are needed to clarify whether specific patient subgroups may benefit more from VR-based interventions.