Effectiveness of Virtual Reality Therapy on Static Postural Control and Dynamic Balance in Stroke Patients: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials

<i>Background and Objectives</i>: We aimed to evaluate the effectiveness of virtual reality (VR) therapy compared with conventional rehabilitation on static postural control and dynamic balance in patients with stroke. Design: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted in accordance with the PRISMA 2020 guidelines. <i>Materials and Methods</i>: RCTs involving adults with stroke who received VR-based interventions, alone or combined with conventional therapy, were included. Outcomes were static postural control measured by center of pressure (COP) and dynamic balance assessed by the Berg Balance Scale (BBS) and Timed Up-and-Go Test (TUG). <i>Results</i>: Thirty-six RCTs (1118 participants) were analyzed. Pooled estimates favored VR-based interventions for several measures of static postural control, with standardized mean differences ranging from -0.59 to -0.38 (<i>p</i> < 0.05), whereas no clear difference was observed for COP sway speed under eyes-closed conditions (standardized mean difference (SMD) = -0.13, <i>p</i> = 0.43). For dynamic balance outcomes, pooled mean differences favored the VR group compared with conventional rehabilitation (BBS: mean difference (MD) = 3.29, 95% CI 2.76-3.83; TUG: MD = -3.43, 95% CI -4.03 to -2.82; both <i>p</i> < 0.0001). However, substantial heterogeneity and a high risk of bias were observed across several outcomes, which may affect the certainty of these findings. <i>Conclusions</i>: VR-based interventions may offer potential benefits for improving static postural control and dynamic balance in individuals with stroke, particularly when used as an adjunct to conventional rehabilitation. Nevertheless, given the substantial heterogeneity and risk of bias among included studies, the findings should be interpreted cautiously, and further well-designed, large-scale trials are required to confirm the magnitude and clinical relevance of these effects.