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 Xu²Xingxing Li¹Qian Zhang¹Guangyu Xu¹Yi Ren¹Jinxiao Pei¹Qing Xue¹Zhengang Qiu^1*

• ¹College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
• ²Jinan Vocational College of Nursing, Jinan, Shandong, China

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.