Effect of a four-week virtual reality-based training versus conventional therapy on upper limb motor function after stroke: A multicenter parallel group randomized trial

PLoS One. 2018 Oct 24;13(10):e0204455. doi: 10.1371/journal.pone.0204455. eCollection 2018.


Background: Virtual reality-based training has found increasing use in neurorehabilitation to improve upper limb training and facilitate motor recovery.

Objective: The aim of this study was to directly compare virtual reality-based training with conventional therapy.

Methods: In a multi-center, parallel-group randomized controlled trial, patients at least 6 months after stroke onset were allocated either to an experimental group (virtual reality-based training) or a control group receiving conventional therapy (16x45 minutes within 4 weeks). The virtual reality-based training system replicated patients´ upper limb movements in real-time to manipulate virtual objects. Blinded assessors tested patients twice before, once during, and twice after the intervention up to 2-month follow-up for dexterity (primary outcome: Box and Block Test), bimanual upper limb function (Chedoke-McMaster Arm and Hand Activity Inventory), and subjective perceived changes (Stroke Impact Scale).

Results: 54 eligible patients (70 screened) participated (15 females, mean age 61.3 years, range 20-81 years, time since stroke 3.0±SD 3 years). 22 patients were allocated to the experimental group and 32 to the control group (3 drop-outs). Patients in the experimental and control group improved: Box and Block Test mean 21.5±SD 16 baseline to mean 24.1±SD 17 follow-up; Chedoke-McMaster Arm and Hand Activity Inventory mean 66.0±SD 21 baseline to mean 70.2±SD 19 follow-up. An intention-to-treat analysis found no between-group differences.

Conclusions: Patients in the experimental and control group showed similar effects, with most improvements occurring in the first two weeks and persisting until the end of the two-month follow-up period. The study population had moderate to severely impaired motor function at entry (Box and Block Test mean 21.5±SD 16). Patients, who were less impaired (Box and Block Test range 18 to 72) showed higher improvements in favor of the experimental group. This result could suggest that virtual reality-based training might be more applicable for such patients than for more severely impaired patients.

Trial registration: ClinicalTrials.gov NCT01774669.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Middle Aged
  • Paresis / etiology
  • Paresis / physiopathology
  • Paresis / rehabilitation
  • Recovery of Function
  • Single-Blind Method
  • Stroke / complications
  • Stroke / physiopathology
  • Stroke Rehabilitation / methods*
  • Treatment Outcome
  • Upper Extremity*
  • Virtual Reality
  • Virtual Reality Exposure Therapy*
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT01774669

Grants and funding

The Swiss Commission for Technology and Innovation (project: 14454.1 PFLS-LS) and YouRehab AG (now renamed REHA STIM MEDTEC AG) funded the study. However, they had no influence on the study implementation, data collection, data analyses and interpretation, or manuscript writing.