More Than Just Gaming: Evaluating The True Benefit Of Virtual Reality in Post-Stroke Upper Limb Recovery: An Overview of Systematic Reviews and Meta-Analyses

Abstract

Background: Upper limb impairment affects the majority of stroke survivors and is slow and often incomplete to recover. Virtual reality (VR) has emerged as a technology-assisted adjunct to conventional physiotherapy, but the magnitude of its added benefit remains debated.

Objective: To systematically synthesise randomised controlled trial (RCT) evidence and existing meta-analyses comparing VR with conventional physiotherapy for upper-limb motor recovery after stroke, using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) as the primary outcome.

Methods: A rapid, PRISMA-2020-informed overview-of-reviews was conducted (August 2026) across PubMed, Scopus, Web of Science, MDPI and ScienceDirect. Thirteen candidate sources (systematic reviews, meta-analyses and landmark RCTs) were screened; four meta-analyses reporting an extractable mean difference (MD) and 95% confidence interval (CI) for FMA-UE were pooled using a DerSimonian–Laird random-effects model.

Results: The pooled random-effects estimate across four meta-analyses (collectively synthesising data from 58 primary RCTs) was MD = 4.44 FMA-UE points in favour of VR (95% CI 2.37 to 6.51), with substantial between-review heterogeneity (I² = 74.9%). Individual reviews ranged from MD 3.04 (95% CI 1.46–4.62) to MD 7.47 (95% CI 5.38–9.57). Standardised mean difference (SMD)-based reviews showed smaller, and in the most recent (2026) review, non-significant effects (SMD 0.56, 95% CI −0.02 to 1.15). None of the pooled point estimates reached the accepted minimal clinically important difference of 7 FMA-UE points.

Conclusion: VR produces a statistically detectable but clinically modest improvement in upper-limb motor function compared with conventional physiotherapy when therapy dose is not matched. Benefit appears driven substantially by increased repetition and engagement rather than the technology itself. VR is best positioned as an adjunct that increases practice intensity, not a replacement for therapist-led, task-specific training.