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Table 1 Clinical information and outcome measures of studies on VAMR and traditional therapy

From: Examining the effectiveness of virtual, augmented, and mixed reality (VAMR) therapy for upper limb recovery and activities of daily living in stroke patients: a systematic review and meta-analysis

Author No. of participants Mean age (SD) Recovery stage Experimental Intervention Control Intervention Outcome Measures
Ahmad et al. 2019 [30] EG: 18 57 Chronic 1.5 h of standard physiotherapy exercise with 30 min VR training (once a week for 8 weeks) 2 h of standard physiotherapy exercise (once a week for 8 weeks) FMA-UE/WMFT/IMI/IADL/SIS
CG: 18 62.94
Aşkın et al. 2018 [31] EG: 18 53.27 ± 11.19 Chronic 20 sessions of physical therapy + 20 sessions of Kinect-based VR training 20 sessions of physical therapy FMA-UE/BBT/BRS/MAS/MI/AROM
CG: 20 56.55 ± 9.85
Assis et al. 2016 [28] EG: 3 50.5 Chronic EG sensory-motor training in using NeuroR system (4 weeks) Having a relaxation session, instructed by the physiotherapist (4 weeks) FMA-UE
CG: 3 59.5
Bergmann et al. 2017 [32] EG: 10 62 ± 11 Subacute VR-augmented robot-assisted gait training (RAGT) 12 sessions (4 weeks, 3 sessions per week) Standard RAGT 12 sessions (4 weeks, 3 sessions per week) IMI/FAC/MRC
CG: 10 65 ± 8
Brunner et al. 2017 [33] EG: 62 62 Subacute 60 min VR training (30 days, 4–5 sessions per week) 60 min standard conventional therapy program (30 days, 4–5 sessions per week) ARAT/BBT/FIM/PGIC
CG: 58 62
Byl et al.2013 [34] EG: 10 65.2 ± 5.4 Chronic Perform repetitive movements while playing task-specific games (Twice a week for 6 weeks) Repetitive task exercises involve stretching, and grasping (Twice a week for 6 weeks) FMA-UE/WMFT/BBT
CG: 5 54.2 ± 20.5
Calabrò et al. 2017 [35] EG: 12 60 ± 4 Chronic Lokomat with VR (RAGT + VR) Lokomat without VR (RAGT-VR) RMI/POMA/MAS/HRS/VAS
CG: 12 63 ± 6
Cameirão et al. 2011 [17] EG: 10 56.8 Acute Perform the Spheroids tasks (Hitting, Grasping, and Placing) (Once a week for 3 weeks) Perform pure extended occupational therapy (Once a week for 3 weeks) FMA-UE/MBI/MRC/MI
CG: 9 52.9
Chen et al. 2015 [36] EG: 8 58.2 ± 12.1 Chronic 30 min play bowling and ladder climbing games by XaviX®Port system (3 sessions per week for 8 weeks) 30 min in use of Curamotion exerciser and the climbing board and bar (3 sessions per week for 8 weeks) FMA-UE/FIM/BBT/ROM
CG: 8 48.5 ± 16.4
Cho et al. 2012 [37] EG: 15 64.0 ± 7.1 N/A VR training (60 min sessions, 5 times a week, for 4 weeks) Traditional rehabilitation (30 min sessions, 3 times a week, for 4 weeks) WMFT/MVPT
CG: 14 63.7 ± 8.8
Choi et al. 2016 [38] EG: 12 61.0 ± 15.2 N/A 30 min occupational therapy + 30 min MoU-Rehab (5 days per week for 2 weeks, 1 h per day) 1 h occupational therapy (5 days per week for 2 weeks, 1 h per day) FMA-UE/B-stage/MMT/MBI/EQ-5D/BDI
CG: 12 72.1 ± 9.9
Duff et al. 2013 [14] EG: 11 69.27 ± 7.85 Chronic Adaptive mixed reality rehabilitation (AMRR) system (3 times a week for 4 weeks) 1-h upper-extremity therapy (3 times a week for 4 weeks) FMA-UE/WMFT/MAL/SIS
CG: 10 67.7 ± 7.85
El-Kafy et al. 2021 [39] EG: 18 53.32 ± 5.13 Chronic 2 h muscle exercises, ADL tasks, and VR training program using Armeo Spring (3 times a week for 3 months) 2 h conventional functional training program (3 times a week for 3 months) ARAT/WMFT/HGS
CG: 19 54.46 ± 4.27
Faria et al. 2018 [40] EG: 12 57.1 ± 11.0 Chronic Underwent training with the Reh@Task (for 1 month) Conventional occupational therapy (for 1 month) MoCA
CG: 12 68.9 ± 9.8
Ho et al. 2019 [41] EG: 100 67.97 ± 11.38 Acute 40 min conventional therapy + 20 min VR program (7 times for 1 week) 1 h conventional therapy only (7 times for 1 week) mRS/NIHSS
CG: 100 67.68 ± 11.13
Hung et al. 2019 [42] EG: 17 56.58 Chronic 30 min Kinect2scratch with 3–4 games per training session (2/3 sessions per week, total 24 sessions) 30 min conventional therapy (2/3 sessions per week, total of 24 sessions) FMA-UE/WMFT/MAL
CG: 16 61.38
Ikbali Afsar et al. 2018 [43] EG: 19 69.42 ± 8.55 Subacute VR training using Xbox Kinect + conventional therapy (5 days per week, for 4 weeks) Conventional rehabilitation program (5 days per week, for 4 weeks) FMA-UE/BBT/FIM
CG: 16 63.44 ± 15.73
In et al. 2012 [44] EG: 11 63.45 ± 11.78 Chronic 30 min VR reflection therapy (5 days a week for 4 weeks) 30 min conventional therapy (5 days a week for 4 weeks) FMA-UE/BBT/MAS/MFT
CG: 8 64.50 ± 11.69
Johnson et al. 2020 [45] EG: 28 64.7 ± 13.9 Chronic 45 min Jintronix Rehabilitation System (2 times a week for 8 weeks) Usual care (2 times a week for 8 weeks) FMA-UE/ARAT/BBT/MAS
CG: 30 59.3 ± 15.6
Kalron et al. 2016 [46] EG: 15 47.3 ± 9.6 N/A 30 min Computer Assisted Rehabilitation Environment (CAREN) Integrated Reality System with D-flow software (6 weeks, 2 sessions per week) 10 min stretching exercises + 20 min intervention (6 weeks, 2 sessions per week) FRT/BBT/FSST
CG: 15 43.9 ± 10.6
Kim et al. 2018 [47] EG: 11 VR: 54.7 ± 17.3 Subacute 30 min occupational therapy + 30 min daily VR (5 days per week for 10 weekdays) 30 min occupational therapy (5 days per week for 10 weekdays) FMA-UE/B-stage/BBT/K-MBI
CG: 8 CG:53.5 ± 16.0
Kiper et al. 2011 [48] EG: 40 All: 64 ± 16.4 Chronic 1 h traditional neuromotor rehabilitation treatment + 1 h reinforced feedback in virtual environment therapy (5 days a week for 4 weeks) 2 h traditional neuromotor rehabilitation treatment (5 days a week for 4 weeks) FMA-UE/FIM/ASS
CG: 40
Kiper et al. 2014 [49] EG: 23 63.1 ± 9.5 Chronic 1 h VR treatment + 1 h conventional treatment (5 days per week for 4 weeks) 2 h of conventional training (5 days per week for 4 weeks) FMA-UE/FIM
CG: 21 65.5 ± 14.2
Kottink et al. 2014 [50] EG: 8 N/A Chronic 30 min VR rehabilitation game (Once per week for 6 weeks) 30 min conventional training (Once per week for 6 weeks) FMA-UE
CG: 10  
Lee et al. 2014 [51] EG: 12 58.33 ± 10.17 N/A 30 min virtual reality reflection equipment (Asymmetric training on hand) + 1 h standard rehabilitation training (4 weeks) 30 min symmetric training on hand + 1 h standard rehabilitation training (4 weeks) FMA-UE/BBT/MAS/ROM
CG: 12 65.42 ± 9.77
Lee et al. 2016 [52] EG: 13 66.46 ± 7.26 Chronic 30 min VR rehabilitation program (3 times per week for 8 weeks) 30 min conventional training sessions (3 times per week for 8 weeks) FMA-UE/MFT/BBT/MBI/ SF-12
CG: 13 69.92 ± 7.18
Lee et al. 2018 [53] EG: 15 VR: 61.80 ± 6.80 Subacute VR canoe paddling training (30 min each day, 3 times per week, for 5 weeks) Conventional rehabilitation program (30 min each day, 3 times per week, for 5 weeks) mFRT// MFT
CG: 15 CG: 61.33 ± 8.44
Levin et al. 2012 [54] EG: 6 58.1 ± 14.6 Chronic VR therapy (goal-directed reaching tasks) (4 clinical evaluations + 9 intervention sessions) Occupational therapy (4 clinical evaluations + 9 intervention sessions) FMA-UE/BBT/WMFT/CSI
CG: 6 59.8 ± 15.1
Lin et al. 2018 [55] EG: 5 45.0 ± 11.2 N/A 35 min VR game with a motion tracking device (12 sessions, 3 sessions per week) 35 min traditional rehabilitation (12 sessions, 3 sessions per week) FMA-UE
CG: 5 52.2 ± 7.7
Lin et al. 2020 [56] EG: 38 VR: 64.5 ± 13.5 Acute 3–6 days early rehabilitation + 5 days VR Training 3–6 days early rehabilitation MBI/PASS/HADS
CG: 107 CG: 66.9 ± 13.3
ÖGÜN et al. 2019 [57] EG: 33 61.48 ± 10.92 Chronic 60 min of the upper extremity immersive VR rehabilitation program 45 min of conventional therapy and 15 min of a sham VR program ARAT/FMA-UE/FIM/PASS
CG: 32 59.75 ± 8.07
Oh et al. 2019 [58] EG: 17 57.4 ± 12.2 Chronic VR combined real instrument training (6 weeks) Conventional occupational therapy (6 weeks) MMT/mAS/FMA-UE/K-MMSE/K-MoCA/BBT
CG: 14 52.6 ± 10.7
Park et al. 2016 [59] EG: 15 61.6 ± 5.34 Chronic 30 min game-based VR movement therapy using the Wii (5 days a week for 4 weeks) 30 min conventional therapy (5 days a week for 4 weeks) FMA-UE/BBT/MAL-QOM
CG: 15 62.0 ± 4.29
Park et al. 2019 [60] EG: 12 53.5 ± 13 Subacute 30 min using Smart Board (20 sessions, 5 days per week, 4 weeks) 30 min using conventional occupational therapy (20 sessions, 5 days per week, 4 weeks) FMA-UE/WMFT/AROM/MBI
CG: 13 51.5 ± 16.7
Pedreira da Fonseca, 2017 [61] EG: 15 53.8 ± 6.3 Chronic Use Nintendo Wii for VR therapy in 45 min + 15 min conventional therapy 1 h conventional therapy DGI
CG: 15 50.9 ± 10.9
Piron et al. 2010 [62] EG: 27 59 ± 8 N/A Perform motor tasks with real objects by using 3D magnetic receiver to record movement (5 days per week for 4 weeks) Perform specific exercises for the arm (5 days per week for 4 weeks) FMA-UE/FIM
CG: 23 62 ± 10
Prange et al. 2015 [63] EG: 35 60.3 ± 9.7 Subacute 30 min arm support training by using ArmeoBoom (Once per week for 6 weeks) 30 min standardized sets of arm exercises + OT (Once per week for 6 weeks) FMA-UE/SULCS
CG: 33 58 ± 11.4
Saposnik et al. 2010 [64] EG: 11 55 Chronic Use the Nintendo Wii game console to play “Wii Sports” (20 h in 2 weeks) Leisure activities, including cards, bingo and building blocks (20 h in 2 weeks) WMFT/BBT/SIS
CG: 113 67
Saposnik et al. 2016 [65] EG: 71 62 ± 13 Acute Non-immersive virtual reality using the Nintendo Wii (2 weeks) Simple recreational activities (2 weeks) WMFT/BBT/MBI/FIM/SIS
CG: 70 62 ± 12
Shin et al. 2013 [66] EG: 9 46.6 ± 5.8 N/A RehabMaster™ Conventional occupational therapy FMA-UE/MBI
CG: 7 52 ± 11.9
Shin et al. 2014 [67] EG: 9 52.0 ± 11.9 N/A Conventional occupational therapy + 20 min of RehabMaster training (10 sessions in 2 weeks) Conventional occupational therapy (10 sessions in 2 weeks) FMA-UE/MBI
CG: 7 46.6 ± 55.8
Shin et al. 2015 [68] EG:16 53.37 ± 11.8 Chronic 30 min conventional therapy + 30 min of game-based VR rehabilitation with the RehabMasterTM system (5 days a week for 4 weeks) 30 min of conventional therapy + additional 30 min therapy (5 days a week for 4 weeks) FMA-UE/HDRS
CG: 16 54.67 ± 13.4
Shin et al. 2016 [69] EG: 24 57.2 ± 10.3 N/A Smart glove intervention (4 weeks with 20 sessions for 30 min per day) Conventional therapy (4 weeks with 20 sessions for 30 min per day) FMA-UE/JTT
CG: 22 59.8 ± 13
Sin et al. 2013 [70] EG: 18 71.78 ± 9.42 Chronic Xbox Kinect with 30 min + conventional OT for 30 min (3 times a week for 6 weeks) 1 h conventional occupational therapy (3 times a week for 6 weeks) FMA-UE/BBT/AROM
CG: 17 75.59 ± 5.55
Subramanian et al. 2013 [71] EG: 16 62 ± 9.7 Chronic 3D virtual environment (CAREN system) simulated a supermarket scene (3 times a week for 4 weeks) Point to the target in the physical environment (3 times a week for 4 weeks) FMA-UE/WMFT/MAL-AS
CG: 16 60 ± 11
Thielbar et al. 2020 [72] EG: 9 59.7 ± 10.5 Chronic Virtual Environment for Rehabilitative Gaming Exercises system (3 evaluation sessions) Conventional therapy (3 evaluation sessions) FMA-UE
CG: 9 59.8 ± 4.8
Tramontano et al. 2018 [73] EG: 13 63.1 ± 8.5 Subacute 20 min vestibular rehabilitation (12 sessions, 3 times per week for 4 weeks) 20 min conventional rehabilitation training (12 sessions, 3 times per week for 4 weeks) MBT/FAC/BBS/RMI/T-total/T-balance
CG: 12 65.1 ± 15.5
Turolla et al. 2013 [29] EG: 263 60.2 ± 14.3 N/A 1 h of upper limb conventional therapy and 1 h of VR therapy (4 weeks) 2 h conventional treatment (4 weeks) FMA-UE/FIM
CG: 113 65.4 ± 12.5
Viana et al. 2014 [74] EG: 10 56.0 ± 10.2 Subacute 1 h VR exercises for the UL + 13 min transcranial direct current stimulation (primary motor cortex) (5 weeks) 1 h transcranial direct current stimulation (primary motor cortex) (5 weeks) FMA-UE/WMFT/MAS/SSQOL
CG: 10 55.0 ± 12.2
Yin et al. 2014 [75] EG: 11 62 N/A Nine 30 min upper extremity VR therapy + 30 min conventional therapy (5 weekdays for 2 weeks) 1 h conventional therapy (5 weekdays for 2 weeks) FMA-UE/ARAT/MAL/FIM
CG: 12 56
  1. ARAT, Action Research Arm Test; ASS, Ashworth scale score; BBT, Box and Block Test; BDI, Beck Depression Inventory; B-stage, Brunnstrom stage; DGI, Dynamic Gait Index; EQ-5D, EuroQol-5 Dimension; FAC, Functional Ambulation Categories; FIM, Functional Independence Measure; FMA-UE, Fugl-Meyer Upper Extremity; FRT, Functional Reach Test; FSST, Four Square Step Test; HADS, Hospital Anxiety and Depression Scale; HDRS, Hamilton Depression Rating Scale; IADL, The Lawton Instrumental Activities of Daily Living; IMI, Intrinsic motivation inventory; MMSE, Mini-Mental State Examination; MAL, Motor Activity Log; MAS, Motor Assessment Scale; MBI, Modified Barthel Index; MI, Motricity Index; MMT, Manual muscle testing; MoCA, Montreal Cognitive Assessment; MRC, Muscle Power Assessment; mRS, Modified Rankin Handicap Scale; MVPT, Motor-free Visual Perception Test; NIHSS, National Institutes of Health Stroke Scale; PASS, Postural Assessment Scale for Stroke; PGIC, Paramedic Global Impression of Change; POMA, Performance Oriented Mobility Assessment; RMI, Rivermead Mobility Index; ROM, Range of Motion; SF-12, 12-item Short Form Health Survey; SIS, Stroke Impact Scale; SSQOL, Stroke Specific Quality of Life Scale; SULCS, Stroke Upper Limb Capacity Scale; VAS, Visual analogue scale; WMFT, Wolf Motor Function Test