Home-based virtual reality for upper limb stroke rehabilitation: supervised vs. unsupervised approaches – a systematic review with meta-analysis of unsupervised interventions

PURPOSE: To evaluate the effectiveness of home-based virtual reality (VR) for upper limb recovery in stroke survivors, specifically distinguishing between supervised and unsupervised approaches. MATERIALS AND METHODS: = 2) comparing unsupervised home-based VR to unsupervised active controls. RESULTS: = 0%). Conversely, narrative synthesis indicated that interventions incorporating active remote supervision consistently yielded positive outcomes. The overall certainty of evidence was "Very Low." CONCLUSIONS: Unsupervised home-based VR does not appear superior to conventional home exercise. though it serves as a comparable alternative when direct supervision is limited. However, interventions involving therapist supervision show promise. The "human factor" of supervision may be more critical than the technology itself, highlighting the need for future trials to clearly define supervision levels.