Does VR Help Arm Recovery After Stroke? The 2025 Cochrane Review

We walk through the 2025 Cochrane review of virtual reality for stroke rehabilitation – 190 randomised trials and 7,188 participants – and look at two very different comparisons: VR used instead of another therapy at the same dose, and VR added on top of usual care. We explain how the authors rate the certainty of each result with GRADE, why the larger add-on effect can’t be credited to VR alone, and what the review cannot tell clinicians, including anything about specific commercial products.

Key findings

• VR vs alternative therapy at the same dose: VR may slightly improve upper limb function (SMD 0.20, 95% CI 0.12 to 0.28; 67 studies, 2,830 participants). Certainty: low, as rated by the authors.
• VR added to usual care: VR probably improves upper limb function, with a larger estimate (SMD 0.42, 95% CI 0.26 to 0.58; 21 studies, 689 participants; moderate certainty). In add-on designs the VR group also gets extra therapy time.
• Compared with alternative therapy, VR may slightly improve balance (low certainty) and probably reduces activity limitation (moderate certainty). There was no clear benefit for participation and quality of life (low certainty) or gait speed (very low certainty).
• Programmes of 15 hours or more showed a larger arm effect than shorter ones. Rehabilitation systems and commercial games did not differ significantly.
• In a sensitivity analysis limited to 17 better-quality trials, the arm benefit was no longer seen.
• Adverse events were few and mild in the 59 trials that monitored them; the other 131 did not report monitoring.
• Only 36 of the 190 trials had more than 50 participants, and very few tested immersive headsets.

We worked from the open-access full text of the review.

Sources

1. Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Chapman M, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev 2025;6:CD008349. DOI: 10.1002/14651858.CD008349.pub5 · PubMed 40537150 · Full text (PMC12178777)
2. Wade DT. Virtual reality for stroke rehabilitation: time to rethink? Lessons from a Cochrane review. Cochrane Database Syst Rev 2025;7:ED000174. DOI: 10.1002/14651858.ED000174

Further reading

• Full written summary: What the 2025 Cochrane review says about VR after stroke
• VR in Rehabilitation: a Therapist’s Guide
• Immersive vs non-immersive VR: what’s the difference for therapy?
• Previous episode: Does VR Improve Hand Dexterity After Stroke?

This video is for educational purposes only and is not medical advice. Narration voice is AI-generated.