The effectiveness of virtual reality/motion-sensing games incorporating swing-based elements on upper limb function after stroke: a systematic review and meta-analysis

BACKGROUND: Upper limb impairment is a common consequence of stroke and can markedly limit independence in daily life. Virtual reality (VR) and motion-sensing games incorporating swing-based elements have increasingly been used in rehabilitation, but their effectiveness for post-stroke upper limb recovery remains unclear. This article aims to systematically evaluate the effectiveness of VR/motion-sensing games incorporating swing-based elements on upper limb function after stroke. METHOD: This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251141175). PubMed, Web of Science, Scopus, and the Cochrane Library were searched from January 1999 to September 2025 for randomized controlled trials. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic and Cochran's Q test. Sensitivity and subgroup analyses were performed, and publication bias was explored using funnel plots and Egger's test. RESULTS: Ten randomized controlled trials involving 426 participants were included. Compared with conventional therapy, virtual reality/motion-based games incorporating swing-like elements demonstrated significant improvement in upper limb functional recovery. The overall meta-analysis showed a merge standardized mean difference of 0.64 (95% CI: 0.44, 0.84) in favour of the intervention group. Substantial between-study heterogeneity was observed (I² = 82.2%, p < 0.001). Exploratory subgroup analyses suggested relatively larger effects in older participants and in those with longer stroke duration, although these findings should be interpreted cautiously. Sensitivity analysis showed that the pooled effect was stable, and Egger's test did not indicate significant publication bias (p = 0.454). CONCLUSION: VR/motion-sensing games incorporating swing-based elements may improve upper limb function after stroke and could serve as a useful adjunct to conventional rehabilitation. Further rigorously designed trials with standardized protocols are required to strengthen the evidence base and determine optimal intervention strategies.