Game-Based Virtual Reality System for Upper Limb Rehabilitation After Stroke in a Clinical Environment: Systematic Review and Meta-Analysis

The use of virtual reality (VR) for stroke rehabilitation has been implemented during the last decade. At present, most studies still focus on the effects of VR on upper limb rehabilitation, and few studies have explored VR games, VR system designs, and rehabilitation modes for upper limb rehabilitation. This study aims to (1) evaluate the rehabilitation effect of stroke patients using a game-based VR upper limb rehabilitation system in clinical settings; (2) investigate the impact of custom and commercial VR games on patients in clinical settings; and (3) review VR upper limb rehabilitation modes. The PubMed, ScienceDirect, Scopus, Web of Science, and IEEE Xplore databases were searched, and related literature published through December 2021 was included. A total of 4700 articles were retrieved according to the search strategy. We identified 24 studies, including 793 patients. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of game-based VR upper limb rehabilitation systems. A meta-analysis was conducted to compare the effects of upper limb function, hand dexterity, daily living ability, and cognitive function between the experimental group (EG, using VR for upper limb rehabilitation) and control group (CG, receiving conventional rehabilitation, including physical therapy and occupational therapy). We also conducted an analysis of both custom and commercial games. The results of the meta-analysis proved that game-based VR upper limb rehabilitation therapy for cerebral apoplexy is an effective method of rehabilitation in clinical settings and is more effective than traditional rehabilitation in improving patients' upper limb function and hand mobility. Custom games heal better than commercial games. This study only includes nonimmersive device rehabilitation modes due to research constraints and classified them into four categories. The mode of VR games combined with rehabilitation instruments may solve the problem that patients with severe upper limb dysfunction cannot operate games. Whether the use of immersive VR devices and the fun of games will affect patients' rehabilitation motivation and effect is the direction of future research.