Home-based virtual reality for upper limb stroke rehabilitation: supervised vs. unsupervised approaches – a systematic review with meta-analysis of unsupervised interventions
Abstract
Purpose To evaluate the effectiveness of home-based virtual reality (VR) for upper limb recovery in stroke survivors, specifically distinguishing between supervised and unsupervised approaches.Materials and Methods We searched PubMed, Scopus, and Web of Science for randomized controlled trials (RCTs). Risk of bias was assessed using RoB 2, and certainty of evidence via GRADE. A narrative synthesis included all eligible studies (n = 7), while a meta-analysis focused on a homogeneous subgroup (n = 2) comparing unsupervised home-based VR to unsupervised active controls.Results Seven RCTs (n = 414) were reviewed. The meta-analysis of unsupervised trials (n = 291) showed no significant difference between home-based VR and active control groups (SMD = −0.06; 95% CI: −0.29 to 0.17; p = 0.62; I2 = 0%). Conversely, narrative synthesis indicated that interventions incorporating active remote supervision consistently yielded positive outcomes. The overall certainty of evidence was “Very Low.”Conclusions Unsupervised home-based VR does not appear superior to conventional home exercise. though it serves as a comparable alternative when direct supervision is limited. However, interventions involving therapist supervision show promise. The “human factor” of supervision may be more critical than the technology itself, highlighting the need for future trials to clearly define supervision levels.
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- Authors
- Karimi, M., & Aminzadeh, M.
- Affiliations
- Ahvaz Jundishapur University of Medical Sciences (IR)
- Urmia University of Medical Sciences (IR)
- Corresponding author
- Karimi, MohammadElias
- Venue
- Disability and Rehabilitation
- Publisher
- Informa UK Limited
- Published
- 2026-05-23
- Pages
- 1-14
- ISSN
- 0963-8288 (ISSN-L)
- 1464-5165
- OpenAlex
- W7162200914
- Semantic Scholar
- 52606e44b758af82bb8e2260851c8a8a81020c25
- Cited by
- 0
- References
- 43
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Disability and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Keywords
- stroke rehabilitation, upper limb recovery, distant supervision, active control, home-based exercise, stroke survivors
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