Table 1_The impact of virtual reality exercise on motor function, balance and gait function, and cognitive function in stroke patients: an umbrella review of systematic reviews and meta-analyses.docx

After deduplication and exclusion of trials with unavailable or incomplete numerical data, 138, 81, and 23 unique RCTs contributed to the motor, balance/gait, and cognitive analyses, respectively. VR exercise was associated with statistically significant improvements in several functional outcomes; however, the magnitude and certainty of effects varied across domains. VR was associated with significant improvements in functional ambulation (equivalent standardized mean difference, eSMD = 0.70, 95% CI 0.23–1.17) and upper limb motor function (eSMD = 0.38, 95% CI 0.21–0.55); gait velocity (eSMD = 0.63, 95% CI 0.43–0.82) and Berg Balance Scale scores (eSMD = 0.69, 95% CI 0.45–0.92); and global cognition measured by Montreal Cognitive Assessment (eSMD = 0.48, 95% CI 0.19–0.76).

Most outcomes had very low certainty (MoCA: moderate). Heterogeneity varied considerably across outcome measures (I² ranging from 0% to 93%), and most included systematic reviews were rated as critically low methodological quality.</p>Conclusions<p>VR exercise may be associated with improvements in selected post-stroke motor, balance and gait, and cognitive outcomes. However, statistically significant effects should not be interpreted as clinically meaningful benefits without established MCID thresholds or interpretable benchmarks.

Evidence is further limited by substantial heterogeneity, poor review methodology, and generally low certainty. VR may therefore be a potential adjunctive rehabilitation approach, but current evidence does not support replacing conventional rehabilitation or preferential use in specific patient subgroups.</p>Systematic Review Registration<p>crd.york.ac.uk/PROSPERO/view/CRD420261341936, PROSPERO CRD420261341936.</p>