Effects of Virtual Reality-based Interventions on Depression, Anxiety, and Abilities of Daily Living in Stroke Survivors: A Systematic Review and Meta-analysis.

Background: Stroke survivors often experience varying levels of psychological stress, depression, and anxiety, which can exacerbate their physical impairments and adversely affect their recovery process. Virtual reality (VR) technology has been proven to be effective for patients with depression, garnering significant interest from researchers focused on stroke rehabilitation. However, the precise impact of VR on stroke-related psychology remains unclear. This meta-analysis aimed to appraise the effect of VR on depression, anxiety, and the abilities of daily living in stroke survivors.

Methods: The research involved a search of six electronic databases, including the Cochrane Library, Embase, Web of Science, PubMed, CINAHL, and PsycINFO, from the inception of the databases to June 2, 2024. Two investigators independently screened the databases based on the inclusion and exclusion criteria, extracted data from the included studies, and tested their methodological quality using Cochrane's risk of bias tool. The intervention effect was estimated using Review Manager 5.4 to calculate the standard mean difference (SMD) and 95% confidence interval (CI).

Results: This review identified 16 studies out of the 4439 records retrieved, consisting of a total of 756 stroke patients. Post-intervention analysis provided low certainty evidence that VR training reduced depression (SMD = -0.47; 95% CI: -0.88, -0.05, p = 0.03), but there was no significant effect on anxiety (SMD = -0.25; 95% CI: -0.53, 0.03, p = 0.08) and activities of daily living (SMD = 0.34; 95% CI: -0.05, 0.73, p = 0.09). Subgroup analysis indicated that participants under 60 years old who received VR intervention had a significant reduction in depression scores (SMD = -1.13; 95% CI: -1.89, -0.37, p = 0.004) compared with the control group. Those with moderate depression (SMD = -1.02; 95% CI = -1.96 to -0.07, p = 0.04) and intervention that lasted more than 6 weeks (SMD = -1.16; 95% CI: -1.87, -0.44, p = 0.002) also showed lower scores.

Conclusions: Due to heterogeneity concerns and the poor quality of included studies, our meta-analysis that provided evidence with very low certainty indicates that VR technology may be a beneficial approach for improving the psychological health issues faced by stroke survivors, helping to reduce their depression, but has no significant effect on reducing anxiety and improving their activities of daily life. However, additional comprehensive research is required to reinforce these conclusions. Specifically, future research needs to involve larger scale and more rigorous approaches, utilizing tailored VR interventions to further improve patient well-being. PROSPERO Registration: CRD42024575981, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024575981.