Subramanian 2013

Methods	RCT
Participants	Study took place in Canada 32 participants: 16 intervention, 16 control Inclusion criteria: between 40 and 80 years, sustained single ischaemic or haemorrhagic stroke 6 to 60 months previously, scored 3 to 6 on the Chedoke McMaster Stroke Assessment arm subscale and had no other neurologic or neuromuscular/orthopaedic problems affecting the upper limb and trunk Exclusion criteria: brainstem or cerebellar lesions, comprehension difficulties and marked apraxia, attention or visual field deficits Mean (SD) age: intervention group 62 (9.7), control group 60 (11) years 72% male Stroke details: 47% right hemiparesis Timing post stroke: intervention group mean (SD) 3.7 (2.2) years, control group 3.0 (1.9) years
Interventions	Virtual reality intervention: a 3D virtual environment (CAREN system) simulated a supermarket scene. Participants had to reach for objects in the virtual environment. Training was high in intensity with 72 trials of reaching in each session Control intervention: pointing at targets in a physical environment Sessions were 45 minutes for 12 days spaced over 4 weeks
Outcomes	Outcomes were recorded at baseline, post‐intervention and 3 months following intervention Upper limb outcomes: Fugl Meyer, Reaching Performance Scale for Stroke, Wolf Motor Function Test Other outcomes: Motor Activity Log‐AS Other outcomes: Motivation Task Evaluation Questionnaire Other outcomes: kinematic data
Notes	—
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated
Allocation concealment (selection bias)	Low risk	Managed by external personnel
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Blinded to allocation
Incomplete outcome data (attrition bias) All outcomes	Low risk	All completed the assessments. Small number of intervention drop outs and balanced across groups
Selective reporting (reporting bias)	Low risk	All outcomes reported as per entry on clinical trial registry