Exploring Virtual Reality’s Effects on Balance, Function, Daily Activities and Quality of Upper Limb Skills in Children with Hemiplegic Cerebral Palsy: A Systematic Review and Meta-analysis

Introduction: Hemiplegic Cerebral Palsy (CP) significantly affects balance, functional abilities, daily activities, and overall quality of upper extremity skills. Virtual Reality (VR) can enhance the quality of life in children with CP by controlling training intensity and providing feedback to deliver customised treatment in a fun, safe, and engaging environment. Aim: To examine the effectiveness of VR on balance, functional abilities, daily activities, and the quality of upper limb skills in children with hemiplegic CP. Materials and Methods: A systematic search of Web of Science, Physiotherapy Evidence Database (PEDro), EBSCO, Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Excerpta Medica database (EMBASE) and ProQuest was conducted for articles published between March 2014 and September 2024. Randomised Controlled Trials (RCTs) were included if the sample comprised children with hemiplegic CP and reported outcomes related to balance, function, daily activities, and upper limb skills. Pre and postintervention mean differences, standard deviations, 95% Confidence Intervals (CI), and p-values were calculated, along with the difference between intervention and control groups after treatment. Random-effects models were used to interpret pooled effects based on improvements in balance, function, daily activities, and upper limb skill quality. Heterogeneity was assessed using the I2 statistic. Results: Fifteen randomised trials were included. Results revealed significant improvements in the VR groups compared to the control groups for balance (MD 4.84; 95% CI: 1.44-8.23; p