IMPORTANCE: Virtual reality (VR) is increasingly used in patients after stroke upper limb rehabilitation, but the comparative effectiveness of VR-Only versus hybrid VR combined with conventional therapy (CT) remains unclear. OBJECTIVE: The objective of this review was to systematically review and meta-analyze the effectiveness of 2 distinct VR intervention approaches for patients undergoing hemiparetic upper limb rehabilitation after stroke: VR-Only versus CT, and hybrid interventions combining VR with CT versus CT alone. DATA SOURCES: A PROSPERO protocol (CRD 42022349259) for a comprehensive search was conducted across 7 databases, focusing on studies published in English and Spanish. STUDY SELECTION: Randomized controlled trials (RCTs) comparing VR-Only or hybrid VR interventions to CT were included. DATA EXTRACTION AND SYNTHESIS: Study characteristics, participant demographics, intervention specifics, and outcome measures were extracted. The risk of bias was assessed using the Risk of Bias 2 (RoB (2) tool. Meta-analyses used a random-effects model to estimate standardized mean differences (SMDs) with 95% confidence intervals. MAIN OUTCOMES AND MEASURES: Primary outcomes included motor function, motor capacity, hand dexterity, and functional capacity, measured by validated instruments such as the Fugl-Meyer Assessment and Box and Block Test. RESULTS: Twenty-seven RCTs (1156 participants) were included. Hybrid VR plus CT interventions significantly improved motor function (SMD 0.44) and manual dexterity (SMD 0.33) compared to CT alone. VR-Only interventions showed positive trends but were not statistically significant. Hybrid interventions maintained benefits at follow-up (SMD 0.63, 95% CI 0.11 to 1.15). Optimal improvements were observed with hybrid sessions of 31 to 59 minutes daily. CONCLUSIONS: Hybrid VR plus CT interventions are more effective than CT alone, improving motor function and manual dexterity after stroke, with sustained benefits over time. VR-Only interventions showed less consistent effects. RELEVANCE: These results suggest that integrating VR into CT enhances rehabilitation outcomes of stroke survivors. Future research should focus on optimizing hybrid protocols and exploring long-term outcomes.

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