Disability and rehabilitation · 2026
Home-based virtual reality for upper limb stroke rehabilitation: supervised vs. unsupervised approaches - a systematic review with meta-analysis of unsupervised interventions.
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Karimi MohammadElias, Aminzadeh Milad
Аннотация
PURPOSE: To evaluate the effectiveness of home-based virtual reality (VR) for upper limb recovery in stroke survivors, specifically distinguishing between supervised and unsupervised approaches.
MATERIALS AND METHODS: We searched PubMed, Scopus, and Web of Science for randomized controlled trials (RCTs). Risk of bias was assessed using RoB 2, and certainty of evidence via GRADE. A narrative synthesis included all eligible studies (n = 7), while a meta-analysis focused on a homogeneous subgroup (n = 2) comparing unsupervised home-based VR to unsupervised active controls.
RESULTS: Seven RCTs (n = 414) were reviewed. The meta-analysis of unsupervised trials (n = 291) showed no significant difference between home-based VR and active control groups (SMD = -0.06; 95% CI: -0.29 to 0.17; p = 0.62; I2 = 0%). Conversely, narrative synthesis indicated that interventions incorporating active remote supervision consistently yielded positive outcomes. The overall certainty of evidence was "Very Low."
CONCLUSIONS: Unsupervised home-based VR does not appear superior to conventional home exercise. though it serves as a comparable alternative when direct supervision is limited. However, interventions involving therapist supervision show promise. The "human factor" of supervision may be more critical than the technology itself, highlighting the need for future trials to clearly define supervision levels.
MATERIALS AND METHODS: We searched PubMed, Scopus, and Web of Science for randomized controlled trials (RCTs). Risk of bias was assessed using RoB 2, and certainty of evidence via GRADE. A narrative synthesis included all eligible studies (n = 7), while a meta-analysis focused on a homogeneous subgroup (n = 2) comparing unsupervised home-based VR to unsupervised active controls.
RESULTS: Seven RCTs (n = 414) were reviewed. The meta-analysis of unsupervised trials (n = 291) showed no significant difference between home-based VR and active control groups (SMD = -0.06; 95% CI: -0.29 to 0.17; p = 0.62; I2 = 0%). Conversely, narrative synthesis indicated that interventions incorporating active remote supervision consistently yielded positive outcomes. The overall certainty of evidence was "Very Low."
CONCLUSIONS: Unsupervised home-based VR does not appear superior to conventional home exercise. though it serves as a comparable alternative when direct supervision is limited. However, interventions involving therapist supervision show promise. The "human factor" of supervision may be more critical than the technology itself, highlighting the need for future trials to clearly define supervision levels.