Effects of Virtual Reality-Based Intervention Combined With Conventional Therapy on Upper-Limb Function in Children With Hemiplegic Cerebral Palsy: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

backgroundHemiplegic cerebral palsy (CP) commonly affects upper-limb function in children and may limit functional use of the affected arm and hand. Virtual reality (VR)-based rehabilitation can provide interactive, feedback-based, and task-oriented practice, but whether adding VR-based intervention to conventional therapy provides additional benefits remains uncertain. Previous reviews have often included broader CP populations, mixed comparators, or broad upper-limb outcome labels, limiting domain-specific interpretation.

objectiveThis systematic review and meta-analysis evaluated VR-based intervention combined with conventional therapy versus conventional therapy alone for upper-limb-related outcomes in children with hemiplegic CP.

methodsThis review was prospectively registered with PROSPERO (CRD420261486172). PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception to April 15, 2026. Eligible randomized controlled trials included children aged ≤12 years with hemiplegic CP and compared VR-based or interactive game-based intervention plus conventional therapy with conventional therapy alone. Outcomes were grouped into upper-limb activity, dexterity, motor control and movement quality, activities of daily living (ADLs), and grip strength. Risk of bias was assessed using the revised Cochrane risk-of-bias 2 tool. Random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman adjustment were performed; Nagashima-corrected prediction intervals (PIs) were calculated where applicable; and certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

resultsThirteen randomized controlled trials involving 458 children were included. Pooled estimates generally favored VR combined with conventional therapy, but no outcome reached statistical significance; effect estimates were as follows: upper-limb activity (standardized mean difference [SMD] 0.28, 95% CI -0.07 to 0.64), dexterity (SMD 0.26, 95% CI -0.34 to 0.86), motor control and movement quality (SMD 0.29, 95% CI -0.22 to 0.80), ADLs (SMD 0.17, 95% CI -0.22 to 0.55), and grip strength (mean difference 0.89, 95% CI -1.93 to 3.72). PIs also crossed the null value for all outcomes, ranging from -0.51 to 1.04 for upper-limb activity and from -4.89 to 6.45 for grip strength, suggesting variable effects across settings. Heterogeneity was low to moderate for most outcomes but substantial for grip strength. Most trials had some risk-of-bias concerns. Certainty of evidence was low for all outcomes except grip strength, which was very low.

conclusionsVR-based intervention combined with conventional therapy did not provide clear evidence of additional benefits over conventional therapy alone. Although effects generally favored the combined intervention, CIs, PIs, risk-of-bias concerns, and low to very low certainty of evidence support cautious interpretation. VR may be considered a potentially engaging adjunct, but current evidence does not support its use as a replacement for therapist-led rehabilitation or as a definitively effective intervention. Larger, adequately powered trials with clearer reporting of VR characteristics, intervention dose, task specificity, and longer follow-up are needed.

trial registrationPROSPERO CRD420261486172; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261486172.