da Silva Cameirao 2011

Methods	RCT
Participants	Recruited from a subacute rehabilitation unit in Spain 19 participants: 13 intervention, 6 control Inclusion criteria: recruited within 3 weeks of first stroke, severe to moderate upper limb impairment, no moderate to severe aphasia, not other cognitive deficits as assessed by the Mini Mental State Examination and aged ≤ 80 years Exclusion criteria: none specified Mean (SD) age: intervention group 63.7 (11.83), control group 59.4 (10.62), control group (Wii) 58 (14) 47% male Stroke details: 37% right hemiparesis Timing post stroke: intervention group mean (SD) 11.5 (5.1) days, control group 16.8 (5.0) days, control group (Wii) 13 (4.7) days
Interventions	Virtual reality intervention: Rehabilitation Gaming System (RGS). The main elements of the system are the vision based analysis and tracking system that capture upper limb movements through colour detection, data gloves to capture finger flexion and a virtual environment where an avatar mimics the movements of the user Control intervention (occupational therapy): occupational therapy with emphasis on motor tasks similar to those in the RGS (i.e. object displacement, grasp and release) Control intervention (Wii): used the Wii gaming system. This intervention involved the gaming features but not the neuro‐scientific hypothesis regarding recovery Sessions were 20 minutes, 3 times a week for 12 weeks (approximately 12 hours total). This was provided in addition to standard rehabilitation
Outcomes	Outcomes recorded at baseline, weeks 5, 12 and 24 Upper limb outcomes: Fugl Meyer, Chedoke Arm and Hand Activity Inventory Activity outcomes: Barthel Index Other outcomes: participant satisfaction
Notes	—
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated program
Allocation concealment (selection bias)	Low risk	Managed externally
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Blinded to allocation
Incomplete outcome data (attrition bias) All outcomes	High risk	Outliers excluded from the data analysis
Selective reporting (reporting bias)	Low risk	All outcomes reported