Comparative efficacy of virtual reality interventions with varying immersion levels on upper limb motor function, hand dexterity, and independence in the daily life of stroke survivors: a systematic review and network meta-analysis

Abstract

Upper limb motor function impairment is a highly prevalent sequela following stroke, significantly compromising patients’ independence in daily life and decreasing their quality of life. Virtual reality represents a promising therapeutic intervention for this condition; however, the comparative efficacy of virtual reality interventions with different levels of immersion remains unclear. A comprehensive electronic literature search was performed in PubMed, Embase, the Cochrane Library, Web of Science, and CINAHL up to July 2025. Randomized controlled trials (RCTs) evaluating the use of different levels of immersion virtual reality intervention (such as immersive virtual reality, semi-immersive virtual reality and nonimmersive virtual reality) compared with routine rehabilitation for stroke with upper limb motor function impairment were included. A random-effects model was used for the network meta-analysis. Efficacy was assessed via standardized mean differences (SMDs) with 95% confidence intervals (CIs), and interventions were ranked via surface under the cumulative ranking curve (SUCRA) probabilities. Twenty-nine RCTs involving 1,524 participants were included from 6,830 records. Compared with the control interventions, the virtual reality intervention improved upper limb motor function, enhanced hand dexterity, and enhanced independence in the daily life of stroke patients. With respect to upper limb motor function, immersive virtual reality was ranked the highest (SUCRA = 86.10%; SMD = 1.20; 95% CI: 0.33, 2.07), followed by semi-immersive virtual reality (SUCRA = 57.80%; SMD = 0.75; 95% CI: −0.35, 1.86) and nonimmersive virtual reality (SUCRA = 50.90%; SMD = 0.61; 95% CI: −0.15, 1.37). Compared with nonimmersive virtual reality (SUCRA = 50.50%; SMD = 0.42; 95% CI: −0.03, 0.87) and semi-immersive virtual reality (SUCRA = 49.30%; SMD = 0.43; 95% CI: −0.21, 1.07), immersive virtual reality (SUCRA = 95.60%; SMD = 1.11; 95% CI: 0.40, 1.82) was the most effective intervention for hand dexterity. With respect to independence in daily life, immersive virtual reality was the most effective technology (SUCRA = 94.90%; SMD = 1.32; 95% CI: 0.46, 2.18), followed by nonimmersive virtual reality (SUCRA = 43.10%; SMD = 0.28; 95% CI: −0.91, 1.47) and semi-immersive virtual reality (SUCRA = 39.50%; SMD = 0.23; 95% CI: −1.00, 1.46). Immersive virtual reality is the most effective treatment method for improving upper limb motor function, enhancing hand dexterity, and enhancing independence in the daily life of stroke patients. In the future, clinicians should consider prioritizing immersive virtual reality as a primary modality for stroke rehabilitation exercises. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251114167 , Identifier: CRD420251114167.