Effects of virtual reality technology on functional recovery and activities of daily living in patients with spinal cord injury: A meta-analysis of randomized controlled trials.

CONTEXT: Virtual reality (VR) has been increasingly applied in neurorehabilitation, but its effectiveness in patients with spinal cord injury (SCI) remains unclear. OBJECTIVE: To systematically review the effect of virtual reality (VR) on motor function and activities of daily living (ADL) in patients with spinal cord injury (SCI). METHODS: Randomized controlled trials (RCTs) evaluating the effects of VR on motor function and activities of daily living (ADL) in patients with SCI were retrieved from PubMed, Embase, Cochrane Library, Web of Science, CNKI, CBM, WanFang, and VIP databases from the establishment of the database to January 2026. Meta-analysis was conducted using RevMan 5.3 software. RESULTS: A total of 20 RCTs were included, comprising 5 immersive VR studies (25.0%), 2 semi-immersive VR studies (10.0%), and 13 non-immersive VR studies (65.0%), involving 662 patients with SCI, including 120 patients with complete SCI, 461 patients with incomplete SCI, and 81 patients from mixed complete/incomplete SCI samples. Meta-analysis showed that, compared with the control group, VR significantly improved lower-limb motor function (ASIA: MD = 5.62, 95% CI [1.93, 9.31], P = 0.003), walking function (FAC: MD = 0.85, 95% CI [0.69, 1.01], P < 0.001), balance function (BBS: MD = 5.47, 95% CI [4.34, 6.59], P < 0.001; mFRT: MD = 3.68, 95% CI [2.47, 4.89], P < 0.001), and ADL (BI: MD = 5.75, 95% CI [3.66, 7.84], P < 0.001). SCIM mobility showed a possible improvement (MD = 3.82, 95% CI [0.76, 6.89], P = 0.01), whereas the SCIM total score was not statistically significant. VR also shortened 10MWT completion time (MD = -3.14, 95% CI [-4.83, -1.45], P < 0.001) and TUGT completion time (MD = -3.56, 95% CI [-4.66, -2.47], P < 0.001). No significant differences were found in upper-limb motor function (FIM, MI, MB, and ARAT). CONCLUSION: Compared with conventional therapy, VR may improve lower-limb motor function, walking function, balance function, and ADL-related outcomes in patients with SCI. However, current evidence is insufficient to demonstrate the superiority of VR over conventional therapy for upper-limb rehabilitation in SCI.