Methodological Confidence And Reported Certainty Of Evidence For Virtual Rehabilitation And Mirror Therapy In Post-Stroke Upper-Extremity Function: An Umbrella-Review Audit Using AMSTAR 2 And GRADE

Abstract

Background. Systematic reviews of virtual rehabilitation and mirror therapy for post-stroke upper-extremity function have expanded rapidly, but the methodological confidence and reporting practices of these reviews remain unclear.

Objective. To audit the methodological confidence and reporting practices of systematic reviews examining virtual rehabilitation and mirror therapy for post-stroke upper-extremity function using AMSTAR 2.

Methods. An umbrella-review audit of review methods was conducted. PubMed, Europe PMC, and Crossref were searched on 17 August 2026. Systematic reviews and meta-analyses were eligible if they evaluated virtual rehabilitation, virtual reality, mirror therapy, or combined interventions relevant to post-stroke upper-extremity function. Methodological confidence was appraised using AMSTAR 2. No pooled effectiveness estimate or de novo GRADE certainty rating was produced.

Results. A total of 515 records were identified. After deduplication, 321 unique records were screened, and 179 were assessed for eligibility. The descriptive mapping set included 132 records (72 full-text reports and 60 abstracts or limited-metadata records). Of the 132 records, 63 could be appraised using AMSTAR 2: 1 was rated high confidence, 4 moderate, 13 low, and 45 critically low. The remaining 69 records were not assessable.

Conclusion. The evidence base for virtual rehabilitation and mirror therapy in post-stroke upper-extremity function is substantial but methodologically fragile. The findings primarily describe methodological confidence and reporting practices, highlighting a need for more rigorous evidence synthesis in this field.