OBJECTIVE: To quantify the effects of virtual reality (VR)-based exercise on balance after stroke. DESIGN: The PubMed, Embase, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature, and Web of Science databases were searched until December 31, 2021. Independent investigators abstracted data, assessed the quality of the evidence, and rated the certainty of the evidence. The intergroup differences were determined by calculating mean difference (MD) and 95% confidence interval (CI) by RevMan 5.3 software. RESULTS: Fourteen RCTs involving 423 stroke patients were included. Patients who received VR-based exercise illustrated marked improvements in the Berg Balance Scale (BBS) (MD = 1.35, 95% CI 0.58 to 1.86, P < 0.00001, I2 = 44%), Timed Up and Go test (TUG) (MD = -0.81, 95% CI -1.18 to -0.44, P < 0.0001, I2 = 0%), Functional Reach Test (FRT) (MD = 3.06, 95% CI 1.31 to 4.80, P = 0.0006, I2 = 0%), 10 Meters Walking Test (10MWT) (MD = -1.53, 95% CI -2.92 to -0.13, P = 0.03, I2 = 33%), and Modified Barthel Index (MBI) (MD = 5.26, 95% CI 1.70 to 8.82, P = 0.004, I2 = 0%) compared with the control group. CONCLUSION: Existing low-evidence analyses showed that VR-based exercise could effectively and safely improve balance in chronic stroke. Longer-term VR-based exercise was more effective on functional ability of stroke.

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