Effectiveness of intense virtual reality-based rehabilitation versus conventional physiotherapy on balance, motor recovery, and engagement in stroke survivors: a pilot randomized controlled trial with three-month follow-up

BACKGROUND: Stroke often results in motor deficits, impaired balance, and reduced functional independence, necessitating effective rehabilitation strategies. Virtual reality (VR)-based rehabilitation provides task-specific, feedback-rich, and engaging interventions that may enhance motor recovery beyond conventional physiotherapy (CPT). Non-immersive VR (screen-based systems) offers a more accessible and cost-effective alternative for outpatient settings; however, evidence regarding its comparative effectiveness, retention of gains, and feasibility remains limited and inconsistent. OBJECTIVE: To compare the effectiveness, safety, and feasibility of non-immersive VR-based rehabilitation versus dose-matched CPT on balance, motor function, functional independence, and mobility. METHODS: In this pilot randomized controlled trial, 66 stroke survivors (aged 40–70 years) were randomly assigned to either the VR (n = 33) or CPT (n = 33) group. Both interventions were delivered for 45 minutes per session, five days per week, for six weeks. Primary outcomes included balance and motor function assessed using the Berg Balance Scale (BBS) and the Fugl-Meyer Assessment (FMA). Secondary outcomes included functional independence (Barthel Index - BI) and mobility (Timed Up and Go - TUG). Assessments were conducted at baseline, post-intervention, and three-month follow-up. Statistical analyses included ANCOVA, linear mixed models, and responder analysis based on minimal clinically important differences (MCID). RESULTS: Both groups improved across all outcomes, with the VR group showing greater gains across measured outcomes. Post-intervention adjusted mean differences favored VR for BBS (+3.9; P=0.002), FMA upper limb (+3.2; P=0.005), FMA lower limb (+1.4; P=0.003), BI (+3.5; P=0.023), and TUG (-1.9 s; P=0.008). Gains were maintained during the three-month follow-up. Clinically meaningful improvements were achieved by more participants in the VR group (BBS: 82% vs 55%; FMA: 76% vs 48%; BI: 79% vs 52%; all P<0.05). Adherence was high (VR: 87%; CPT: 86%), with minimal adverse events. CONCLUSION: Non-immersive, task-oriented VR rehabilitation may be associated with greater, clinically meaningful improvements in balance, motor function, functional independence, and mobility compared with dose-matched CPT among subacute-to-chronic stroke survivors. High adherence and a favourable safety profile support its feasibility as an outpatient rehabilitation tool.