Efficacy of Robot-Assisted and Virtual Reality Interventions on Balance, Gait, and Daily Function in Patients With Stroke: A Systematic Review and Network Meta-analysis

Objective This study aimed to evaluate the comparative effectiveness and ranking of robot-assisted training, virtual reality, and robot-assisted rehabilitation combined with virtual reality in improving balance, gait, and daily function in patients with stroke. Data Sources PubMed, EMBASE, the Cochrane Library, Physiotherapy Evidence Database, CINAHL, Web of Science, and ProQuest Dissertations and Theses abstracting and indexing databases were comprehensively searched to include randomized controlled trials published through August 31, 2022. Study Selection Randomized controlled trials comparing robot-assisted training, virtual reality, robot-assisted rehabilitation combined with virtual reality, and conventional therapy to assess the effects on balance, gait, and daily function of patients with stroke. Data Extraction The risk of bias was assessed using the Cochrane Risk of Bias tool and the methodological quality of the studies was assessed using the Physiotherapy Evidence Database scale. A network meta-analysis of random effects models was performed for direct and indirect effects. Data were analyzed using Stata SE 17.0 and R 4.2.1. Data Synthesis A total of 52 randomized controlled trials involving 1,559 participants were included in this study. Based on the ranking probabilities, robot-assisted rehabilitation combined with virtual reality was most effective in improving balance (surface under the cumulative ranking curve [SUCRA]=82.0%; mean difference [MD]=4.10; 95% confidence interval [CI], 0.43 to 7.67). Virtual reality was most effective in improving velocity (SUCRA=97.8%; MD=−0.15; 95% CI, −0.24 to −0.06) and daily function (SUCRA=92.1%; MD=−7.85; 95% CI, −15.18 to −1.07). Conclusions Compared to robot-assisted training and conventional therapy, robot-assisted training combined virtual reality was most likely the best intervention for balance, and virtual reality might be the most helpful in improving daily function for patients after stroke. Further studies are needed to clarify the specific efficacy of robot-assisted training combined with virtual reality and virtual reality on gait.