SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Stroke
Efficacy of virtual reality technology and robotic-assisted rehabilitation training on upper limb motor function and activities of daily living in stroke patients: a systematic review and network meta-analysis
Zhixiang Hao 1
Hongli Xu 2
Xingxing Li 1
Qian Zhang 1
Guangyu Xu 1
Yi Ren 1
Jinxiao Pei 1
Qing Xue 1
Zhengang Qiu 1
1. College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
2. Jinan Vocational College of Nursing, Jinan, Shandong, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Background: Over the past decade, with the rapid advancement of technology and artificial intelligence (AI), virtual reality (VR) and robot-assisted training (RAT) have been gradually applied to stroke patients’ rehabilitation, either used alone or in combination with each other. They have shown great promise in improving upper limb motor function and activities of daily living (ADL) in stroke patients. Objective: This systematic review and network meta-analysis (NMA) aim to evaluate the efficacy of VR, RAT (either alone or in combination) for upper limb rehabilitation and daily function in stroke patients. Method: This study was conducted in strict compliance with PRISMA principles and registered with PROSPERO (CRD420251029030). PubMed, Web of Science, EMBASE, Scoups, ProQuest Dissertations, the Cochrane Library and grey literature from ClinicalTrials.gov. were searched from the time of each database was constructed until April 13, 2025, and the references of the included literature were consulted. The Cochrane Risk of Bias Assessment Tool (RoB 2.0) was utilized to evaluate the risk of bias. A network meta-analysis was conducted employing Bayesian methods. Data analysis was executed with R version 4.2.1 and Stata version 17.0. Results: A total of thirty-nine studies involving 1646 patients were included. In terms of improving Fugl-Meyer Assessment of Upper Extremity (FMA-UE) (Surface Under the Cumulative Ranking Curve [SUCRA]: 44.6%, Mean Difference [MD]: 4.10, 95% Confidence Interval [95% CI ]:0.70 to 7.45) and Functional Independence Measure (FIM) scores (SUCRA: 47%, MD:3.61, 95% CI:-2.64 to 9.71 ), robot-assisted training combined with virtual reality for unilateral upper limb patients (RAT+ VR [unilateral]) was the most likely to be the best intervention; RAT had the highest likelihood of being the best intervention in terms of improving Wolf Motor Function Test (WMFT) (SUCRA: 60.5%, MD:4.25, 95% CI:-2.33 to 12.74) and Modified Barthel Index (MBI) scores (SUCRA: 50%, MD:7.53, 95% CI:-7.03 to 21.99). Conclusions: RAT+VR (unilateral) may be the most effective intervention for improving FMA-UE and FIM scores. RAT may be more effective in improving WMFT and MBI scores.
Summary
Keywords
Stroke, artificial intelligence, Upper extremities, ADL, Robot-assisted training, virtual reality, Network meta-analysis
Received
15 May 2025
Accepted
03 November 2025
Copyright
© 2025 Hao, Xu, Li, Zhang, Xu, Ren, Pei, Xue and Qiu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Zhixiang Hao; Zhengang Qiu
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.