OBJECTIVE: To investigate the efficacy of virtual reality (VR)- and gaming-based interventions for improving upper extremity function post-stroke, and to examine demographic and treatment-related factors that may moderate treatment response. DATA SOURCES: A comprehensive search was conducted within the PubMed, CINAHL/EBSCO, Scopus, Ovid Medline and Embase databases for articles published between 2005 and 2019 (PROSPERO Registration number 95052). STUDY SELECTION: Articles investigating gaming and VR methods of treatment for upper extremity weakness were collected with the following study inclusion criteria: (1) participants aged 18 or older with upper extremity deficits, (2) randomized controlled trials or prospective study design, (3) Downs-Black rating score of >= 18, and 4) outcome measure was the Wolf Motor Functioning Test (WMFT), the Fugl-Meyer (FM) or the Action Research Arm Test (ARAT). DATA EXTRACTION: Thirty-eight articles met inclusion criteria. The primary outcome was proportional improvement on the WMFT, FM, or ARAT. The following individual or treatment factors were extracted: VR/gaming dose, total treatment dose, chronicity (> or < 6 months), severity of motor impairment, and presence of a gaming component. DATA ANALYSIS: Random effects meta-analysis models were utilized to quantify (1) the proportional recovery that occurs following VR/gaming, (2) the comparative treatment effect of VR/gaming versus conventional physiotherapy, and (3) whether the benefit of virtual reality differed based on participant characteristics or elements of the treatment. RESULTS: On average, VR/gaming interventions produced an improvement of 28.5% of the maximal possible improvement. Dose and severity of motor impairment did not significantly influence rehabilitation outcomes. Treatment gains were significantly larger overall (10.8%) when the computerized training involved a gaming component versus just visual feedback. VR/gaming interventions showed a significant treatment advantage (10.4%) over active control treatments. CONCLUSIONS: Overall, VR/gaming-based upper extremity rehabilitation post-stroke appears to be more effective than conventional methods. Further in-depth study of variables impacting improvement, such as individual motor presentation, treatment dose, and the relationship between the two, are needed.

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