Comparative Effectiveness of Virtual Reality and Mirror Therapy on Upper Extremity Motor Recovery After Stroke: A Systematic Review and Meta-analysis.

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.