Cochrane Database Syst Rev

Virtual reality yields modest gains in stroke rehabilitation

June 26, 2025

Virtual reality (VR) is a safe adjunct to conventional stroke rehabilitation, offering small but meaningful improvements in upper limb function, balance, and activity limitation, particularly when used to increase overall therapy time. However, effects on gait, participation, and quality of life remain uncertain, and most evidence is of low to moderate certainty.

Details: This 2025 Cochrane review included 190 randomized trials (N = 7,188) comparing VR interventions with alternative therapy or usual care in adults post-stroke. The primary outcome was upper limb function and activity; secondary outcomes included gait, balance, global motor and cognitive function, activity limitation, participation, quality of life, and adverse events. Most studies were small and at unclear risk of bias, with evidence rated as low to moderate certainty.

Results:

VR vs. alternative therapy

• Upper limb function and activity: slight improvement (standardized mean difference [SMD], 0.20; 95% confidence interval [CI], 0.12–0.28; low certainty)
• Balance: slight improvement (SMD, 0.26; 95% CI, 0.12–0.40; low certainty)
• Activity limitation: slight improvement (SMD, 0.21; 95% CI, 0.11–0.32; moderate certainty)
• No meaningful effect on: gait speed, participation restriction, quality of life

VR added to usual care (resulting in increased therapy time)

• Upper limb function and activity: moderate improvement (SMD 0.42; 95% CI, 0.26–0.58; moderate certainty)
• Balance: May be beneficial (SMD, 0.68; 95% CI, 0.46–0.91; low certainty)
• Activity limitation: Probably beneficial (SMD, 0.22; 95% CI, 0.04–0.41; moderate certainty)

Safety

• Adverse events: few and mild

Source:

Laver KE, et al. (2025, June 20). Cochrane Database Syst Rev. Virtual reality for stroke rehabilitation. https://pubmed.ncbi.nlm.nih.gov/40537150/