Table II. —Characteristics of intervention and control groups, outcome measures, follow-up and main findings of the included studies.13, 14, 16, 21-23, 30, 37-47.
| Meta-analysis | Intervention group | Control group | Frequency of intervention group | Time-match intervention with control group | Outcomes | Follow-up | Main findings |
|---|---|---|---|---|---|---|---|
| Ahn et al. (2019)37 | VR VR+ CT Commercial VR rTMS+VR training |
CT Sham rTMS+VR training |
- | 8 studies out of 9 | Activity: BI and FIM | - | VR improves UL function and activities. |
| Aminov et al. (2018)38 | VE interventions+CT CG: Wii, Xavix, EyeToy, IREX system, Xbox Kinect, or a combination of systems+CT |
CT: PT, OT | Duration: M=18 sessions (range 4-36) Intensity: M=153.9 min/week (range 60-180) Frequency: mean 3 sessions/week (range 1-5) |
21 studies out of 33 (=active control group) | Body function: FMA-UE Activity: BBT, FIM, BI Participation: MAL |
6 studies: 4-6 weeks follow-up 6 studies: 8-26 follow-up |
VR intervention as an adjunct improves UL body structure and activity. |
| Chien et al. (2020)21 | RAT+CT RAT alone (of the UL) Devices: SMART Arm, Armeo Spring, REAplan robot, NeReBot training, MIT-MANUS, Gloreha, Hand Mentor Pro |
CT=PT, OT, task-training program, daily rehabilitation treatment, intermittent cutaneous electric stimulation, and home exercise program | Duration: M=5.6 weeks and 25 sessions (range 2-12 weeks and 9-40 sessions) Intensity: M=75min (range 30-120) Frequency: 5 sessions/week |
8 studies out of 11 | Body function: FMA-UE, MAS Activity: FIM, BI, Activlim questionnaire, ARAT, WMFT, QuickDASH, SIS |
- | RAT=CT for function and disability |
| Coupar et al. (2012)39 | Home therapy program: functional exercises, assistive/resistive exercises with proprioceptive neuromuscular facilitation and resistive exercises VR intervention with telerehabilitation |
Usual care VR intervention with a therapist present |
- | Not mentioned | Body function: FMA-UE Activity: BI, JTHF, WMFT |
1 study: 1 month follow-up 1 study: 6 months follow-up |
Insufficient evidence to determine if home therapy program is more or less effective than CT in hospital. |
| Doumas et al. (2021)46 | -Serious games alone -Serious games+CT Devices: end-effectors, motion capture gloves, exoskeletons, immersive VR, smartphones, tablets, EMG-controlled sensor, arm support system |
CT: OT, PT | Duration: M=5 weeks (range 2-12 weeks) Intensity: M range=30-225 min |
44 studies out of 51 | -Body function: FMA-UE -Activity: ARAT, WFMT, BBT -Participation: SIS scale |
50% of trials M=2.3 months (range 1-6) |
Serious games (displayed with RAT, VR or TR devices) showed superior results to CT for UL motor function, activity and participation |
| Ferreira et al. (2018)22 | RAT alone RAT added to CT, standard therapy, motor learning, repetitive task-specific practice, an arm-hand training program and functional task practice Devices: MIT-MANUS, Haptic Knob, ARMinIII, MIME, UL-EXO7, InMotion2, Bi-Manu Track, ARM Guide |
MI: sham RAT, no intervention, placebo intervention OI=CT=usual care, repetitive task practice, intensive conventional arm exercise program, physical therapy, electrical stimulation |
Duration: M=8 weeks (range 2-20) Intensity: 0.2-2 hours/session Frequency: M=3 sessions/week (range 2-6) |
22 studies RAT alone vs OI | Body function: FMA-UE, CMSA, MAS, MRC, hand-held dynamometer, MPS, MMT | Short term:<3 months Medium term:>3 months and<12 months Long term:>12 months |
RAT has small effects on motor control and medium effects on strength. |
| Karamians et al. (2020)14 | VR/gaming | CT=Bobath, NDT, stretching, strengthening, and ADL training | - | Not mentioned | Body function: FMA-UE Activity: ARAT, WMFT |
- | VR is more effective than CT. |
| Kwakkel et al. (2008)40 | RAT Devices: MIT-MANUS, MIME, ARM Guide, Bi-Manu-Track, InMotion Shoulder-Elbow Robot |
NDT CT Electrical stimulation |
Frequency: M=48.3 min/day | No | Body function: FMA-UE, CMSA Activity: FIM |
- | RAT=CT RAT improves motor function |
| Laver et al. (2017)41 | 5 intervention approaches including VR in UL training (35 studies) Devices: commercially available gaming consoles, CAREN system, Customised VR programs |
Recreational therapy CIMT No intervention Usual care CT |
Duration: 5 ->21 hours | Not mentioned | Body function: FMA-UE Activity: WMFT, MAL, ARAT, BI |
Short term follow-up:<3 months | VR and video gaming=CT but VR used as an adjunct to CT may be effective in UL function and ADL. |
| Laver et al. (2020)30 | Telerehabilitation at home, in a long-term care facility or a separated local healthcare centre goal-setting, education, family therapy, and case management UL physical function OT+PT Devices: telephone, videoconferencing hardware and software, desktop videophones |
In-person rehabilitation No rehabilitation Usual care |
- | Not mentioned | Body function: FMA-UE, ARAT, NHPT Activity: BI |
- | Telerehabilitation=usual care and in person therapy. |
| Lee et al. (2019)42 | VR unilateral UL: Nintendo VR bilateral UL: Wii sport, Xbox Kinect Robotic/virtually stimulated Some studies add CT |
CT No treatment (1 study) |
- | All studies except for one (no treatment) | Body function: FMA-UE, BBT | - | VR improves motor function in chronic stroke patients. |
| Lo et al. (2017)43 | RAT (TR=0) RAT+CT (TR=0.2-0.6) Devices: unilateral and bilateral arm robotics |
CT | Duration: total hours=4-300 | TR=0 | Body function: FMA-UE, CMSA, WMFT-FAS Activity: FIM, BI, SIS, CAFE40, MAL-QOM, AMAT-F |
20 studies:<3 months 16 studies:>3 months |
RAT=CT for UL movement and ADL. |
| Maier et al. (2019)13 | SVR: alone or with CT Devices: Microsoft Kinect, data gloves, computer vision, sensors, video camera, webcam, light-emitting diodes, hand-held sensors NSVR Devices: Nintendo Wii, Microsoft Xbox kinect, Sony PlayStation EyeToy Some studies add CT |
CT OT PT Recreational therapy |
Duration: M=4.3-4.4 weeks (range 2-12) with M=23.9 and 21.9 of total hours Intensity: range 20-158.3 minutes/session |
Not for all studies | Body function: FMA-UE, MI, SIS (hand), Brunnstrom Motor Recovery Stage Activity: BBT, FIM, BI, ARAT, WMFT |
- | SVR is more beneficial than CT in UL recovery. NSVR is not more beneficial than CT. |
| Mehrholz et al. (2020)16 | RAT: UDFHT, EPAHT, UPAHT, EXAHT, DGFHT, EBAHT Devices: MIT Manus/InMotion, Bi-Manu-Track, Amadeo |
CT | - | Yes | Body function: FMA-UE, SIS (hand function), Activity: WMFT, BI, FIM |
- | RAT=CT in UL function and ADL. Any device is better or worse than another one. |
| Norouzi-Gheidari et al. (2012)23 | RAT Devices: REHAROB, T-WREX, ARM-Guide, MIME, NeReBot, and MIT-Manus. |
CT | - | Yes, statistical analysis separated time-match and additional RT | Body function: FMA-UE, MSS, MPS Activity: FIM |
7 studies follow-up (3; 6; 8 months and 3 years) | Intensive CT=RAT for motor recovery, ADL, strength and motor control. |
| Prange et al. (2006)44 | RAT=repetitive, goal-directed forward-reaching movements (active movement) RAT+CT Devices: MIT-Manus, MIME, ARM-Guide |
CT | - | Not mentioned | Body function: FMA-UE | - | RAT improve motor control more than CT. |
| Rintala et al. (2019)45 | Home based training non-supervised or tele-supervised for UL motor function Devices: Video, audiovidual DVD Online web-based telerehabilitation program VR with game play (Nintendo Wii) |
- UL exercises in VE at home non-supervised - Telephone Calls - Usual care |
Frequency: 3-5 sessions/week | Not mentioned | Activity: MBI, BI, FONEFIM, MRS, SIS (ADL) | - | Technology-based distance physical rehabilitation=traditional treatment in UL function and ADL. |
| Zhao et al. (2022)47 | RAT Devices: AMADEO, InMotion3.0 WRIST, Gloreha, Bi-Manu-Track, Rehapticknob |
Typical treatment: -therapist-assisted training -passive range of motion exercices |
Duration: M range=30-120 min Frequency: M=5 times/week Intensity: M=30 min |
Not mentionned | -Body Function: FMA-UE -Activity: NHPT, BBT, MAS, MBI, SIS |
- | RAT improves UL motor function, strength, spasticity and dexterity |
ADL: activity of daily living; AMAT-F: Arm Motor Ability Test Function; ARAT: Action Research Arm Test; ARM Guide: Assisted Rehabilitation and Measurement Guide; BBT: Box and Block Test; BI: Barthel Index; CAFE 40: California Functional Evaluation 40; CG: Commercial Gaming; CIMT: Constraint Induced Movement Therapy; CT: Conventional Therapy; CMSA: Chedoke McMaster Stroke Assessment; DASH: Disabilities of Arm Shoulder and Hand; DGFHT: unilateral Distal Glove-based Finger/Hand Training; EBAHT: end effector assisted distal and bilateral arm/hand training; EPAHT: end effector-assisted proximal emphasised unilateral arm/hand training; EXAHT: exoskeleton assisted unilateral arm/hand training; FIM: Function Independence Scale; FMA-UE: Fugl-Mayer Assessment of the Upper Extremity; FONEFIM: telephone version of FIM; JTHF: Jebsen Test of Hand Function; MAL: Motor Activity Log; MAL-QOM: motor activity log-quality of movement; MAS: Modified Ashworth Scale; MBI: Modified Barthel Index; MI: minimal intervention; MIME: mirror image movement enabler; MMT: Manual Muscle Testing; MPS: Motor Power Scale; MRC: Medical Research Council; MRS: Modified Rankin Scale; MSS: Motor Statue Scale; NDT: Neurodevelopmental Treatment; NHPT: Nine Hole Peg Test; NSVR: non-specific virtual reality; OI: other intervention; OT: occupational therapy; PT: physiotherapy; rTMS: repetitive transcranial magnetic Stimulation; RAT: Robot Assisted Therapy; SIS: Stroke Impact Scale; SVR: specific virtual reality; TR=0: RAT alone vs CT alone; UDFHT: unilateral distally emphasized finger/hand training; UPAHT: unilaterally proximal emphasized arm/ hand training; UL: upper limb; VE: virtual environments; VR: virtual reality; WFMT: Wolf Motor Function Test; WFMT-FAS: Wolf Motor Function Test-Functional Ability Score.