Influence of Immersion Level and Game Type on Virtual Reality Interventions for Upper Limb Function After Stroke: Protocol for a Systematic Review and Meta-Analysis.
- 1Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
- 2Ceará School of Public Health, Health Residency Program, Ceará, Fortaleza, Brazil.
- 3Florida International University, Florida, FL, United States.
Abstract
Background
Upper limb impairment is a common consequence of stroke, affecting independence and quality of life. Virtual reality (VR) interventions, including serious games designed for therapeutic purposes and commercial games developed primarily for entertainment, have been increasingly used for poststroke upper limb rehabilitation. Evidence comparing the effectiveness of these game types on functional outcomes remains unclear.Objective
This systematic review protocol aims to determine whether serious and commercial VR games differentially impact upper limb function, measured by the Action Research Arm Test, in adults after stroke. Secondary outcomes will include upper limb motor function assessed using the Fugl-Meyer Assessment-Upper Extremity, Box and Block Test, Motor Activity Log, Jebsen-Taylor Hand Function Test, and Wolf Motor Function Test; functional independence assessed using the Functional Independence Measure and Barthel index; and adherence indicators, including dropout rates and session completion. Secondary objectives include evaluating pooled VR effects vs conventional therapy (CT) and exploring potential moderators, such as VR immersion level and stroke chronicity.Methods
Parallel randomized controlled trials involving adults (aged ≥18 years) with ischemic or hemorrhagic stroke in the acute, subacute, or chronic phases will be included. Interventions using serious or commercial VR games (nonimmersive, semi-immersive, or fully immersive) delivered alone or combined with CT will be considered. Studies using nongamified VR, digital technologies without VR, or augmented reality not integrated into VR will be excluded. Eligible comparators include conventional physiotherapy, occupational therapy, usual care, educational interventions, or no therapy. This protocol was developed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols) guidelines. Systematic searches will be conducted in the PubMed (MEDLINE), Web of Science, Embase, Scopus, Virtual Health Library, ScienceDirect, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Brazilian Clinical Trials Registry, World Health Organization (WHO) International Clinical Trial Registry Platform, and ISRCTN Registry databases from inception to February 2026. Data extraction will be performed independently by 2 reviewers, and risk of bias will be assessed using the Cochrane risk of bias 2.0 tool. Meta-analyses will be conducted when clinical and methodological homogeneity permits. A random-effects model is planned; however, the final choice of model will be based on the level of heterogeneity observed at the time of analysis. Subgroup analyses will explore stroke phase, immersion level, intervention dosage, and concomitant therapy.Results
Data collection is planned from inception to February 2026. Study screening and data extraction are ongoing, with synthesis and meta-analysis expected by November 2026 and final publication anticipated in winter 2026.Conclusions
This systematic review will clarify whether different VR game formats produce distinct effects on upper limb rehabilitation after stroke, providing evidence to inform the design and implementation of VR-based neurorehabilitation interventions.Trial registration
PROSPERO CRD42024595266; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024595266.International registered report identifier (irrid)
DERR1-10.2196/95135.
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BibTeX
@article{silva2026influence,
title = {{Influence of Immersion Level and Game Type on Virtual Reality Interventions for Upper Limb Function After Stroke: Protocol for a Systematic Review and Meta-Analysis.}},
author = {Dayenne Jeneffer Souza da Silva and Vitor Leandro da Cunha and Luanna Barbara de Araújo Farias and Lara Cecília de Araújo Carlos and Candice Simões Pimenta de Medeiros and Edgar Ramos Vieira and Fabrícia Azevedo da Costa Cavalcanti},
journal = {JMIR research protocols},
year = {2026},
month = oct,
doi = {10.2196/95135},
url = {https://europepmc.org/article/MED/42837651},
note = {CC BY},
}
RIS
TY - JOUR
TI - Influence of Immersion Level and Game Type on Virtual Reality Interventions for Upper Limb Function After Stroke: Protocol for a Systematic Review and Meta-Analysis.
AU - Dayenne Jeneffer Souza da Silva
AU - Vitor Leandro da Cunha
AU - Luanna Barbara de Araújo Farias
AU - Lara Cecília de Araújo Carlos
AU - Candice Simões Pimenta de Medeiros
AU - Edgar Ramos Vieira
AU - Fabrícia Azevedo da Costa Cavalcanti
PY - 2026
DA - 2026/10/06
JO - JMIR research protocols
DO - 10.2196/95135
UR - https://europepmc.org/article/MED/42837651
AB - Background Upper limb impairment is a common consequence of stroke, affecting independence and quality of life. Virtual reality (VR) interventions, including serious games designed for therapeutic purposes and commercial games developed primarily for entertainment, have been increasingly used for poststroke upper limb rehabilitation. Evidence comparing the effectiveness of these game types on functional outcomes remains unclear.Objective This systematic review protocol aims to determine whether serious and commercial VR games differentially impact upper limb function, measured by the Action Research Arm Test, in adults after stroke. Secondary outcomes will include upper limb motor function assessed using the Fugl-Meyer Assessment-Upper Extremity, Box and Block Test, Motor Activity Log, Jebsen-Taylor Hand Function Test, and Wolf Motor Function Test; functional independence assessed using the Functional Independence Measure and Barthel index; and adherence indicators, including dropout rates and session completion. Secondary objectives include evaluating pooled VR effects vs conventional therapy (CT) and exploring potential moderators, such as VR immersion level and stroke chronicity.Methods Parallel randomized controlled trials involving adults (aged ≥18 years) with ischemic or hemorrhagic stroke in the acute, subacute, or chronic phases will be included. Interventions using serious or commercial VR games (nonimmersive, semi-immersive, or fully immersive) delivered alone or combined with CT will be considered. Studies using nongamified VR, digital technologies without VR, or augmented reality not integrated into VR will be excluded. Eligible comparators include conventional physiotherapy, occupational therapy, usual care, educational interventions, or no therapy. This protocol was developed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols) guidelines. Systematic searches will be conducted in the PubMed (MEDLINE), Web of Science, Embase, Scopus, Virtual Health Library, ScienceDirect, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Brazilian Clinical Trials Registry, World Health Organization (WHO) International Clinical Trial Registry Platform, and ISRCTN Registry databases from inception to February 2026. Data extraction will be performed independently by 2 reviewers, and risk of bias will be assessed using the Cochrane risk of bias 2.0 tool. Meta-analyses will be conducted when clinical and methodological homogeneity permits. A random-effects model is planned; however, the final choice of model will be based on the level of heterogeneity observed at the time of analysis. Subgroup analyses will explore stroke phase, immersion level, intervention dosage, and concomitant therapy.Results Data collection is planned from inception to February 2026. Study screening and data extraction are ongoing, with synthesis and meta-analysis expected by November 2026 and final publication anticipated in winter 2026.Conclusions This systematic review will clarify whether different VR game formats produce distinct effects on upper limb rehabilitation after stroke, providing evidence to inform the design and implementation of VR-based neurorehabilitation interventions.Trial registration PROSPERO CRD42024595266; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024595266.International registered report identifier (irrid) DERR1-10.2196/95135.
SN - 1929-0748
ER -