Effects of self-directed game-based virtual reality program on upper-limb motor recovery in mild-to-moderate ischemic stroke: a randomized controlled trial

BACKGROUND: Virtual reality (VR) has been demonstrated as an effective intervention for promoting motor recovery post-stroke. A self-directed game-based VR training can reduce manpower, but its safety and efficacy still need to be evaluated. AIM: To evaluate the efficacy of a self-directed game-based VR program on upper-limb motor recovery in mild-to-moderate ischemic stroke patients. DESIGN: Randomized controlled trial. SETTING: Inpatient rehabilitation center. POPULATION: A total of 84 mild-to-moderate ischemic stroke patients with unilateral upper limb motor impairment were randomly allocated to the VR group (N.=42) and the control group (N.=42). METHODS: All participants underwent a standardized inpatient rehabilitation program. The VR group received an additional 20 minutes of user-centric VR training, while the control group engaged in an additional 20 minutes of conventional upper-limb training as a control training. The treatment plan was implemented for 6 days per week over a 4-week period. RESULTS: Blinded assessments at baseline (T0), post-intervention (T1) and 6-week follow-up (T2) revealed significant group-time interactions favoring the VR group in the Fugl-Meyer Assessment-Upper Extremity (FMA-UE, P=0.001), elbow extension strength (MMT, P=0.038) and Barthel Index (BI, P=0.002), although no significant differences were observed in MMT scores for shoulder flexion/extension and elbow flexion (P=0.407/P=0.573, P=0.407). Notably, significantly more patients in the VR group achieved the FMA-UE MCID (≥9 points) than controls (44.7% vs. 2.6%, P