Summary of patient demographics and study details (meta-analysis).
| Study (year) | IVR with conventional therapy | Conventional therapy | Stroke onset | Inclusion criteria | VR intervention | Control | VR tools | Outcome | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Male (%) | Age (SD) | n | Male (%) | Age (SD) | |||||||
| Amin et al. (2025) [17] | 26 | 62 | 51.8 (12.9) | 26 | 69 | 49.8 (9.9) | 2 weeks–6 months | Subacute stroke; MAS < 4; FMA-UE 25–55; MoCA ≥ 21; age ≥ 18 | 48 min × 4/week × 6 weeks (24 sessions): 24 min VR hand games + 24 min conventional therapy | 48 min conventional PT + OT for upper limb | Oculus Quest 2 + Unity3D | Significant improvement in FMA-UE, ARAT, BBT (all p < 0.001) vs. control |
| Jo et al. (2024) [18] | 15 | 46.7 | 51.7 (13.6) | 15 | 53.3 | 47.1 (13.9) | < 6 months | < 6 month post-stroke; MMSE-K ≥ 21; mild-moderate motor impairment (FMA) | 60 min conventional × 5/week + 30 min 360° mirror therapy × 3/week × 4 weeks (wrist/hand/forearm/elbow tasks) | Neurodevelopmental therapy, muscle strengthening, joint mobilization | Pico G2 VR 4K head-mounted device (HMD) | 360MT group: significantly greater gains in FMA-UE, MFT, BBT vs. TMT (p < 0.05) and CG (p < 0.001); higher engagement |
| Peláez-Vélez et al. (2023) [19] | 13 | 75 | 51.9 (18.6) | 13 | 58.3 | 59.6 (16.0) | < 6 months | Stroke < 6 month (ischemic/haemorrhagic); age 18–80; active upper limb mobility; able to stand | 1 h neuro PT × 5/week × 6 weeks + 3 VR sessions/week; standing VR games (chopping, rowing, tree climbing) × 40 reps | Strengthening, resistance, kinesitherapy, aerobic, gait training on stable/unstable surfaces | Oculus Quest 2 + Kinect 360 | Significant gains in motricity index (p = 0.005), trunk control (p = 0.008), Tinetti (p = 0.004), BBS (p = 0.007), FAC (p = 0.038) |
| Hsu et al. (2022) [20] | 18 | 44 | 52.9 (11.8) | 17 | 29 | 56.9 (13.0) | < 6 months | Chronic stroke > 6 months; unilateral infarction/haemorrhage; FM-UE 23–60; MMSE ≥ 24 | 20 min task-specific training + 30 min VR-MT / 30 min OT × 2/week × 9 weeks; forearm/wrist/hand exercises × 50 reps | Sensorimotor stimulation + ADL skill training (remediated + compensatory) | Oculus Rift + Leap Motion Controller | No significant group × time effect on FM-UE (p = 0.075); significant effects on FM-UE wrist (p = 0.012) and BBT (p = 0.044) |
| Huang et al. (2022) [21] | 15 | 40 | 50.8 (12.3) | 15 | 27 | 58.3 (11.2) | < 6 months | Age 20–75; stroke > 3 months; Brunnstrom stage of stroke > 3; confirmed by CT/MRI; MMSE > 18; no other neuro comorbidities | 16 sessions × 60 min, 2–3 days/week + regular OT; 6–10 VR tasks/session (aiming, shooting, punching, ADLs) | Conventional tools: peg board, climbing ladder, stacking cones for upper limb | HTC Vive + wireless controllers | Significant time effects on IL-6, HO-1, 8‑hydroxy‑2‑deoxyguanosine, most clinical scales; group × time effects on FMA-UE shoulder/elbow/forearm (p = 0.004), total (p = 0.008), AROM-shoulder flexion (p = 0.001) |
| Kwak et al. (2024) [22] | 18 | 55.6 | 54.3 (17.7) | 18 | 61.1 | 59.2 (13.9) | > 6, < 27 months | Stroke > 6 months;; conscious; independent walking > 10 m; able to operate VR | 30 min conventional × 5/week × 5 weeks + 30 min IVR × 3/week × 5 weeks; standing balance sports games (tennis, bowling, air gun) | ROM exercises, mat training, weight-shift training | Oculus Quest 2 + touch controllers | Significant gains in BBS and TUG (p < 0.01); improved gait velocity, step/stride length, single-limb support (p < 0.01) |
| Mekbib et al. (2021) [23] | 12 | 75 | 52.2 (13.3) | 11 | 73 | 61 (7.7) | < 3 months | Moderate-severe UE impairment; first ischemic/haemorrhagic stroke < 3 months; age ≥ 18; intact hearing/vision; MMSE > 16.3 | 1 h VR + 1 h OT × 4 days/week × 2 weeks; reach/grasp/release tasks with virtual colour balls (mirror + affected limb modes) | OT: ADLs, balance, gait training, weight shift, distal/proximal UE movements | Oculus Rift + Leap Motion | Both groups improved BI (p < 0.05); VR group: significantly greater FM-UE gains (p < 0.05); increased neural activity in primary motor cortex |
| Huang et al. (2024) [24] | 20 | 65 | 51.8 (12.9) | 20 | 55 | 49.8 (9.9) | < 6 months | Age 30–85; first stroke < 1 month; subacute subcortical lesion (basal ganglia/internal capsule/corona radiata/brainstem); Brunnstrom stage of stroke II–IV | 30 min conventional + 30 min IVR × 5 days/week × 3 weeks; 6 VR programs (kitchen, shooting, playground, basketball, boxing, fencing) | PT + OT: grips, finger/gross movements, strength, stretching, ADL training | HTC Vive + wireless controllers | VR > control on FMA-UE post-intervention (MD 9.1, p = 0.019) and follow-up (MD 11.5, p = 0.020); consistent BI results; FC changes in ipsilesional pre-motor/dorsolateral prefrontal cortex and visual/middle frontal regions |
| Lee et al. (2014) [25] | 10 | 80 | 47.9 (12.0) | 11 | 54.5 | 54.0 (11.9) | < 12 months | Chronic stroke ≥ 6 months; no balance-affecting meds; MMSE < 24; sitting > 10 s unsupported; standing unsupported 1 min | 30 min general PT + 30 min VR postural control × 3/week × 4 weeks; AR training in 3 stages (lying, sitting, standing with ball/foothold) | General PT with therapist | Super Video Graphics Array (SVGA) HMD + 2 computers for display/data | Significant time effect on TUG, BBS, velocity, cadence, step/stride length; group × time effect on gait velocity and step/stride length bilaterally |
ADL: activities of daily living; ARAT: Action Research Arm Test; AROM: active range of motion; BBS: Berg Balance Scale; BBT: Box and Block Test; BI: Barthel Index; CG: control group; FMA-UE/FM-UE: Fugl-Meyer Assessment of the Upper Extremity; HMD: head-mounted device; IVR: immersive virtual reality; MMSE: Mini-Mental State Examination; MoCA: Montreal Cognitive Assessment; MRI: magnetic resonance imaging; OT: occupational therapy; PT: physiotherapy; ROM: range of motion; TUG: Timed Up and Go test; VR: virtual reality.