The Effectiveness of Therapeutic Exercise Interventions With Virtual Reality on Balance and Walking Among Persons With Chronic Stroke: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials.

After a stroke, balance and walking problems often persist well beyond the initial rehabilitation period, and finding ways to keep supporting recovery without adding pressure to healthcare staff is an ongoing challenge. This review pooled 43 randomized controlled trials to ask whether adding virtual reality, whether through headsets or interactive games, to therapeutic exercise helps balance and walking in people who are at least six months past their stroke, compared with usual therapy, no treatment, or similar exercise without virtual reality. Across the pooled studies, virtual reality training showed a large effect on balance and a moderate effect on walking compared with control groups. Interestingly, the specific content of the virtual reality programs, the type of control comparison, and how immersive the technology was did not appear to change these results.

The certainty of evidence was rated moderate for balance and low for walking, and findings apply mainly to working-age stroke survivors who can already walk without assistance, so the picture for walking benefit in particular remains less settled.

If you or someone you know is living with the long-term effects of a stroke, balance and walking difficulties can persist for years, and this research looked at whether adding virtual reality, such as VR headsets or interactive games, to exercise therapy might help. Researchers combined results from 43 separate trials involving over a thousand people who were at least six months out from their stroke. Overall, people who did exercise therapy that included virtual reality showed a larger improvement in balance than those in comparison groups, and a smaller but still noticeable improvement in walking.

Interestingly, it didn't seem to matter much what kind of virtual reality was used or how immersive it was, the benefit showed up across different approaches. That said, the confidence in these findings differs by outcome: it's rated moderate for balance and low for walking, meaning the walking result is less certain and could change with more research. The findings mainly reflect working-age adults who can already walk on their own, so they may not apply to everyone recovering from stroke.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis pooled 43 randomized controlled trials (n=1136) examining virtual reality-based therapeutic exercise for balance and walking in chronic stroke (at least six months post-stroke), against pooled controls including no treatment, conventional therapy, specific training, or identical training without virtual reality. The primary balance analysis showed a large standardized mean difference of 0.51 (95% CI 0.29-0.72, P<.001), while walking outcomes showed a moderate standardized mean difference of 0.31 (95% CI 0.09-0.53, P=.006). Meta-regression found no significant relationship between outcomes and intervention content (P=.52), control group type (P=.79), or immersion level (P=.82), suggesting the effect is not clearly attributable to any specific virtual reality feature, though this analysis has limited power to detect true moderators.

GRADE certainty was moderate for balance and low for walking, reflecting heterogeneity typical of this literature and limiting confidence particularly in the walking result. The authors note the population studied is largely working-age, ambulatory stroke survivors, and outcomes were assessed at the activity/capacity level rather than real-world participation, which the abstract flags as an area needing further defined methodology and outcome measures.