The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis

Table 3

General Characteristics of Included Trials.

Study	Mean; age; E(C)	No. of patients analyzed E(C)	Months; since; onset; E(C)	VR; Intervention	Control; Intervention	Outcome Measures
Bang; (2016); [10]	62.2; (63.2)	20; (20)	30.4; (31.6)	Wii board balance system: yoga, muscular strength exercise, aerobic exercise,; balancing exercise 40 min3 d/w8 wks	low-speed treadmills 40 min3 d/w8 wks	Lt/Rt WB; Ant/post WB; Affected side; -stance phase; -swing phase; Cadence
Calabrò; (2017); [11]	60.0; (63.0)	12; (12)	8.0; (8.0)	VR+RAGT (robotic assist gait training) 45min5d/w8	RAGT (robotic assist gait training) 45min5d/w8	RMI; POMA; MAS
Cho; (2012); [12]	65.2; (63.1)	11; (11)	12.5; (12.6)	Nintendo Wii balance training (balance Bubble, ski slalom, ski jump, soccer heading, table tilting, penguin slide 30 min + Standard training (PT, OT) 30 min 5 d/w6 wks	Standard training (PT, OT) 30 min 5 d/w6 wks	PSV-apeo; PSV-mleo; PSV-apec; PSV-mlec; BBS / TUG
Cho; (2014); [13]	65.7; (63.5)	15; (15)	13.8; (15.3)	Treadmill training based real-world video recording: 30 min3d/w, 6 wks + PT (NDT, PNF) 30 min, OT (U/E ADL) 30 min, FES 20min 5d/w6wks	Treadmill walking training: 30 min3 d/w, 6 wks + PT (NDT, PNF) 30 min, OT (U/E ADL) 30 min, FES 20 min 5 d/w6 wks	AP, ML-PSV; PSVM; BBS / TUG; Gait speed; Cadence; SLSP,(%) GC; DLSP,(%) GC; Step length; Stride length
da Silva; Ribeiro; (2015); [14]	53.7; (52,8)	15; (15)	42.1; (60.4)	Nintendo (tennis, hula hoop, soccer, boxing games) 60 min2 d/w8 wks	Conventional therapy(stretching, trunk and scapular mobilization, balance, UL diagonal movement, gripping, gait) 60 min2 d/w8 wks	FMA; SF-36
Fluet; (2015); [15]	X; (X)	10; (11)	60.0; (87.0)	Robotic/virtually simulated,; arm and finger rehabilitation activities: 180 min4 d/w2 wks	Repetitive task practice on arm and finger activities: 180 min4 d/w2 wks	WMFT; FMA-UE; RGT
In; (2016); [16]	57.0; (54.0)	13; (12)	12.5; (13.6)	(VR reflection therapy 30min + Conventional therapy: patient-specific NDT, PT, OT, ST 30 min) 5 d/w4wks	(Placebo VR 30min 5d/w4wks 30min + Conventional therapy: patient-specific NDT, PT, OT, ST 30min)5d/w4wks	BBS / FRTTUG; EO APS, MLS, TSEC APS, MLS, TS10mWV
Jang; (2005); [17]	59.8; (54.4)	5; (5)	13.8; (13.4)	VR(reaching, lifting, and grasping motor skills game); 60min5d/w 4wks	No treatment	BBT; MFT; FMA-UE
Kim; (2015); [18]	X; (X)	10; (7)	>6	Community-based virtual reality scene exposure combined with treadmill training: 30 min3d/w4wks + Conventional PT (muscle strengthening, balance training, and indoor and outdoor gait training): 60 min5d/w4wks	Over ground walking, stair walking, slope walking, and unstable surface walking for 570 m 30 min3 d/w4 wks + Conventional PT(muscle strengthening, balance training, and indoor and outdoor gait training): 60 min5 d/w4 wks	PSPL AP; PSPL ML; PSPL total; APSS
Kiper; (2014); [19]	63.1; (65.5)	23; (21)	>12	Reinforced feedback in virtual environment: grasping and reaching movement 120 min5 d/w4 wks	Exercises of various movements in a horizontal or vertical plane 120 min5 d/w4 wks	FMA-UE; FIM; Movement; -Time(sec); -Speed (cm/sec); -Peak (n)
Lee D; (2014); [20]	58.3; (65.4)	12; (12)	9.3; (8.9)	VRRE (Asymmetric training on hand): 30 min5 d/w 4 wks + Standard rehabilitation training: gait, strengthening 60 min5 d/w4 wks + FES 25 m in5 d/w4 wks	Symmetric training on hand: 30min5d/w 4wks + Standard rehabilitation training: NDT(gait, strengthening): 60 min5 d/w4 wks + FES 25 min 5 d/w4 wks	FMA-UE; BBT; Grip strength; MAS-UE
Lee H; (2015); [21]	45.9; (49.2)	12; (12)	>6	VR training(sitting posture, knee bend & other leg knee extend, tightrope walking, penguin teeter-totter seesaw, balance skiing, rolling marble board, balance Wii) 30 min3 d/w6 wks + General exercise 60 min5 d/w6 wks	Task-oriented training (sit to stand from different heights, task training in standing, balance training on an unstable surface, lifting a leg in place, kicking a ball, stair climbing and descending) 30 min3 d/w6 wks + General exercise 60 min5 d/w6 wks	EOWB COP; ECWB COP; EONB COP; ECNB COP; -Path length,; -velocity; FRT
Lee S; (2016); [22]	69.2; (73.1)	10; (8)	16.2; (17.0)	Virtual reality-based bilateral upper extremity training 30min3d/w6wks + Conventional OT 30min5d/w6wks	Watching an irrelevant video in a VR environment with bilateral upper extremity training 30 min3 d/w6 wks + Conventional OT 30 min5 d/w6 wks	JHFT; BBT; GPT; Strength; -biceps, triceps; grip strength; palmar pinch; lateral pinch; tip pinch
Llorens; (2015); [23]	58.3; (55.0)	10; (10)	13.6; (19.6)	(Audiovisual feedback; while performing a stepping task 30 min+ Conventional therapy 30 min)5 d/w4 wks	Conventional therapy (static standing exercises in different positions, task-specific reaching exercises, stepping tasks, static and dynamic balance exercises, walking exercises; under different conditions) 60 min5 d/w,4 wks	BBS; POMA-balance; POMA-gait; 10-m walking
Park; (2016 ); [24]	61.6; (62.0)	15; (15)	>6	Wii Sports & Resort: bowling, table tennis, and canoeing 30 min 5 d/w4 wks + mental practice 5 min5 d/w4 wks	Wii Sports and Sports Resort games: bowling, table tennis, and canoeing games 30 min 5 d/w4 wks	FMA-UE; BBT; MAL-QOM
Park; (2017); [25]	62.0; (65.3)	10; (10)	10.8; (14.1)	Xbox Kinect (Boxing, Table tennis, Soccer, Golf, Ski, Football) 30 min+ Conventional PT 30 min 5 d/w, 6 wks	Conventional PT(NDT, PNF) 30 min 5 d/w 6 wks	FMA-LE; BBS; TUG; 10MWT
Sin; (2013); [26]	71.8; (75.6)	18; (17)	7.2; (8.5)	(Xbox Kinect sports and adventure 30 min + standard training 30 min)3/w 6 wks	standard training: 30 min3 d/w 6 wks	ROM-UE; FMA-UE; BBT
Singh; (2013); [27]	65.4; (67.0)	15; (13)	40.5; (34.9)	(Nintendo Balance: Bubble, Xbox 360 Kinect: Rally Ball 30min + standard PT) 90 min2 d/w6 wks	Standard PT (self-stretching and strengthening exercises, coordination and balance exercises, functional exercises) 120 min2 d/w6 wks	BI; OBS; 6MWT; 30sSTS; TUG; T10mWT
Song; (2015); [28]	51.4; (50.1)	20; (20)	14.8; (14.3)	Xbox Kinect Sport, Sport Season 2, Adventure, and Kinect Gunstringer 30 min 5 d/w8 wks	ergometer training 30 min 5 d/w8 wks	Affected side WB; Forward LOS; Backward LOS; TUG; 10MWT
Viana; (2014); [29]	56.0; (55.0)	10; (10)	31.9; (35.0)	VR exercises for the UL (Wii Sports resort, Wii Play Motion, Let’s Tap) 60 min3 d/w5 wks + tDCS (primary motor cortex) 13 min3 d/w5 wks	VR exercises for the UL(Wii Sports resort, Wii Play Motion, Let’s Tap) 60 min3 d/w5 wks + sham tDCS (primary motor cortex) 13 min3 d/w5 wks	FMA-UL; WMFT-time; WMFT-FAS; MAS; Grip strength; SSQOL; SSQOL -UL%
Yom; (2015); [30]	64.6; (78.1)	10; (10)	11.1; (11.6)	Virtual reality-based ankle exercise (VRAE): exercising on the floor, balance board, cushion; ball, standing on one foot. 30 min5 d/w6 wks + Conventional PT 60 min5 d/w6 wks	Watching an environmental documentary irrelevant to ankle exercise 30 min5 d/w6 wks + Conventional PT 60 min5 d/w6 wks	MAS; Tardieu scale; TUG; Velocity; Cadence; Step length; Stride length; Stance time %; Swing time %; Double limb support

RMI (Rivermead mobility index), MAS (modified Ashworth scale), PSV-apeo (postural sway velocity-AP eye open), PSV-mlec (postural sway velocity-ML eye close), BBS (Berg Balance Scale), TUG (Timed up and go test), AP-PSV (anteroposterior postural sway velocity), ML-PSV (mediolateral postural sway velocity), PSVM (postural sway velocity moment), SLSP (single limb support period), GC (gait cycle), DLSP (double limb support period), FMA (Fugl Myer Assessment), SF-36 (Short Form 36 Health Survey), WMFT (Wolf Motor Function Test), RGT (Reach to Grasp Test), FRT (functional reach test), EO-APS (eyes open anterior-posterior sway distance), EO-MLS (eyes open medial-lateral sway distance), EO-TS (eyes open total sway distance), EC-APS (eyes closed anterior-posterior sway distance), EC-MLS (eyes closed medial-lateral sway distance), EC-TS (eyes closed total sway distance), 10-m WV (10-m walking velocity), 10-m WV (10-m walking velocity), BBT (Box and Block Test), MFT (manual function test), PSP L (postural sway path length), PSPL (postural sway path length), PSPL (postural sway path length), APSS (average postural sway speed), FIM (functional independence measure), ECWB COP (eyes-closed wide base), EONB COP (eyes-open narrow base), FRT (functional reach test), JHFT (Jebsen-Taylor hand function test), GPT (grooved pegboard test), MAL-QOM (motor activity log-quality of movement), BI (Barthel index), OBS (Overall balance score), 6MWT (six-minute walk test), 30-s STS (thirty-second sit to stand test), T10-m WT (timed ten-meter walk test), LOS (limit of stability), WMFT (wolf motor function test), WMFT-FAS (functional ability), SSQOL-UL (stroke specific quality of life-upper limb).