Effects of self-directed game-based virtual reality program on upper-limb motor recovery in mild-to-moderate ischemic stroke: a randomized controlled trial.

BACKGROUND

Virtual reality (VR) has been demonstrated as an effective intervention for promoting motor recovery post-stroke. A self-directed game-based VR training can reduce manpower, but its safety and efficacy still need to be evaluated.

AIM: To evaluate the efficacy of a self-directed game-based VR program on upper-limb motor recovery in mild-to-moderate ischemic stroke patients.

DESIGN

Randomized controlled trial.

SETTING

Inpatient rehabilitation center.

POPULATION: A total of 84 mild-to-moderate ischemic stroke patients with unilateral upper limb motor impairment were randomly allocated to the VR group (N.=42) and the control group (N.=42).

METHODS

All participants underwent a standardized inpatient rehabilitation program. The VR group received an additional 20 minutes of user-centric VR training, while the control group engaged in an additional 20 minutes of conventional upper-limb training as a control training. The treatment plan was implemented for 6 days per week over a 4-week period.

RESULTS

Blinded assessments at baseline (T0), post-intervention (T1) and 6-week follow-up (T2) revealed significant group-time interactions favoring the VR group in the Fugl-Meyer Assessment-Upper Extremity (FMA-UE, P=0.001), elbow extension strength (MMT, P=0.038) and Barthel Index (BI, P=0.002), although no significant differences were observed in MMT scores for shoulder flexion/extension and elbow flexion (P=0.407/P=0.573, P=0.407). Notably, significantly more patients in the VR group achieved the FMA-UE MCID (≥9 points) than controls (44.7% vs. 2.6%, P<0.001), with moderate stroke patients deriving the greatest benefit. Post-intervention usability metrics demonstrated high system acceptability (SUS: 75.07±7.20), minimal simulator sickness (SSQ=3.74 [0.00, 3.74]) and positive exercise motivation (BREQ-2 RAI: 15.79±3.80).

CONCLUSIONS

The findings indicate that integrating self-directed VR games into conventional rehabilitation enhances upper-limb functional recovery and independence in mild-to-moderate ischemic stroke patients, with sustained effects at 6 weeks. This facilitated clinically meaningful improvements, particularly in patients with moderate baseline impairment. Although safe and engaging, the program may require targeted approaches for specific joint movements. Further studies should explore long-term outcomes and optimal implementation protocols.

CLINICAL REHABILITATION IMPACT: Self-directed game-based VR games with conventional therapy enhance upper-limb functional recovery and independence in mild-to-moderate stroke patients, offering a scalable solution for inpatient rehabilitation.