BACKGROUND: Improving motor coordination is an important prerequisite for the functional development of children with cerebral palsy (CP). Virtual reality (VR) may be efficient, interactive, adjustable and motivating physiotherapy choice for children with deficient coordination. This review aimed to identify, evaluate and formulate all the evidence concerning the efficacy of VR on motor coordination in children with CP and to compare the Physiotherapy Evidence Database (PEDro) with Cochrane Risk of Bias (RoB). MAIN TEXT: Five databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Science Direct and google scholar) were systemically searched from inception up to 1st January 2019. Studies included VR intervention for children with cerebral palsy with motor incoordination. Studies methodological quality was assessed by Cochrane RoB and PEDro scale. Nineteen studies met the prespecified eligibility criteria. There was a large effect size (SMD 0.75) on fine motor coordination. However, there was a non-significant, small beneficial effect (SMD 0.15) on gross motor coordination. The association between the overall Cochrane RoB and PEDro scores was fair (r = 0.28, p value 0.248). There was a slight agreement between overall and moderate categories PEDro scores and Cochrane RoB (kappa = 0.02) and kappa = 0.10), respectively. However, high and low categories were moderately agreed with Cochrane RoB (kappa = 0.43) and (kappa = 0.46). CONCLUSIONS: VR seems to be effective for improving fine motor coordination with questionable effect on gross motor coordination. PEDro scale is fairly correlated with Cochrane RoB, so development and validation of a more compatible quality assessment tools specific to physiotherapy trials are needed.

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