title: Are virtual reality technologies effective in improving lower limb outcomes for patients following stroke - a systematic review with meta-analysis.
abstract: Stroke is one of the leading causes of disability worldwide with many survivors restricted to their immediate environment secondary to various impairments.
  
  
  
  To review existing studies assessing effects of virtual reality (VR) on lower limb outcomes in stroke patients.
  
  
  
  We searched MEDLINE, CINAHL, EMBASE, PEDro, and Cochrane Library from their beginning to August 2015. Eighteen meta-analyses were performed using weighted mean differences (WMD) and standardized mean differences (SMD) and 95% confidence intervals (CI) to summarize results.
  
  
  
  Randomized control trials using VR interventions within adult stroke populations for lower limb outcomes. Trials were screened by two independent authors for eligibility and bias.
  
  
  
  Trials were grouped according to acute-subacute and chronic stroke populations and outcomes were classified as functional balance, static balance, functional gait/mobility, spatiotemporal gait parameters, or motor function.
  
  
  
  22 studies with 552 participants were included. Significant differences in favor of VR group were found for functional balance (SMD 0.42, 95% CI 0.11-0.73), gait velocity (WMD 0.12, 95% CI 0.03-0.22), cadence (WMD 11.91, 95% CI 2.05-21.78), and stride length (WMD 9.79, 95% CI 0.74-18.84) within the chronic population.
  
  
  
  VR improves functional balance and various aspects of gait in chronic populations. Evidence also suggests that VR is just as effective as conventional therapy, hence its' use in practice is determined by affordability, and patient/practitioner preferences.
authors.affiliation: a Community and Allied Health Department, School of Rural Health , La Trobe University , Bendigo , Australia.
authors.forename: Emma Maureen
authors.initials: EM
authors.lastname: Gibbons
authors.affiliation: a Community and Allied Health Department, School of Rural Health , La Trobe University , Bendigo , Australia.
authors.forename: Alecia Nicole
authors.initials: AN
authors.lastname: Thomson
authors.affiliation: a Community and Allied Health Department, School of Rural Health , La Trobe University , Bendigo , Australia.
authors.forename: Marcos
authors.initials: M
authors.lastname: de Noronha
authors.affiliation: b Department of Civil and Construction Engineering , Swinburne University of Technology , Melbourne , Australia.
authors.forename: Samer
authors.initials: S
authors.lastname: Joseph
mesh_terms: D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care; D004856:Postural Balance / Q000502:physiology*; D020521:Stroke / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D000071939:Stroke Rehabilitation / Q000295:instrumentation*; D000076142:Virtual Reality
keywords: Balance; Gait; Lower limb; Rehabilitation; Review; Stroke; Virtual reality