Pemanfaatan Virtual Reality dalam Rehabilitasi Ekstremitas Atas pada Pasien Pasca Stroke : Tinjauan Literatur Sistematis

Latar belakang : Stroke merupakan penyebab utama disabilitas neurologis jangka panjang dengan Stroke merupakan penyebab utama disabilitas neurologis jangka panjang, dengan gangguan fungsi ekstremitas atas sebagai salah satu dampak paling persisten. Virtual reality (VR) berkembang sebagai modalitas rehabilitasi berbasis neuroplastisitas yang menjanjikan, namun bukti efektivitasnya masih tersebar dan heterogen. Tujuan : Menganalisis pemanfaatan VR dalam rehabilitasi ekstremitas atas pada pasien dewasa pasca stroke ditinjau dari karakteristik intervensi, jenis teknologi, dan efektivitasnya terhadap fungsi motorik dan fungsional dibanding rehabilitasi konvensional. Metode: Tinjauan literatur sistematis disusun mengikuti pedoman PRISMA 2020. Penelusuran pada PubMed, ScienceDirect, DOAJ, dan OpenAlex menggunakan strategi berbasis PICO menjaring 3.504 rekaman; setelah penyaringan tersisa 24 randomized controlled trial (RCT) berbahasa Inggris yang dipublikasikan pada 2015-2025. Risiko bias dinilai dengan Cochrane Risk of Bias 2.0 (RoB 2) dan sintesis dilakukan secara naratif, dijangkarkan pada studi dengan kualitas metodologi lebih baik. Hasil : Intervensi mencakup VR immersive berbasis head-mounted display, VR non-immersive standalone (Kinect dan exergame), serta kombinasi dengan tDCS, robotik, instrumen nyata, dan task-oriented training. Penilaian RoB 2 menghasilkan nol studi risiko rendah, 12 studi some concerns, dan 12 studi high risk, terutama akibat keterbatasan blinding yang inheren pada intervensi VR. Berdasarkan studi some concerns, VR immersive dan VR kombinasi menunjukkan keunggulan paling konsisten dan sebagian mencapai minimal clinically important difference (MCID), sedangkan VR non-immersive standalone umumnya tidak superior pada fungsi motorik, dengan pengecualian pada konten latihan keseimbangan yang spesifik. Kesimpulan : VR merupakan modalitas pelengkap rehabilitasi ekstremitas atas pasca stroke yang feasible dan menjanjikan, dengan potensi terbesar pada VR immersive dan kombinasi modalitas adjuvan, heterogenitas studi dan tingginya proporsi risiko bias menuntut kehati-hatian dalam generalisasi temuan.

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Background : Stroke is a leading cause of long-term neurological disability, with upper extremity impairment being one of its most persistent consequences. Virtual reality (VR) has emerged as a promising neuroplasticity-based rehabilitation modality, yet evidence of its effectiveness remains scattered and heterogeneous. Objective : To analyze the utilization of VR in upper extremity rehabilitation among adult post-stroke patients in terms of intervention characteristics, technology type, and effectiveness on motor and functional outcomes compared with conventional rehabilitation. Methods : A systematic review was conducted following the PRISMA 2020 guidelines. Searches in PubMed, ScienceDirect, DOAJ, and OpenAlex using a PICO-based strategy retrieved 3,504 records; after screening, 24 English-language randomized controlled trials (RCTs) published between 2015-2025 were included. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 (RoB 2), and findings were synthesized narratively, anchored on studies with stronger methodological quality. Results : Twenty-four articles met the inclusion criteria. VR interventions included non-immersive VR, head-mounted displays, Kinect-based VR, exergames, and combinations with robotics and neuromodulation. The majority of studies reported significant improvements in motor and functional upper extremity outcomes; however, results were heterogeneous and some did not reach the minimal clinically important difference (MCID). Risk of bias assessment (RoB 2) showed that 50% of studies were at high risk of bias, predominantly in the outcome measurement domain. Conclusion : Interventions comprised immersive VR using head-mounted displays, non-immersive standalone VR (Kinect and exergames), and combinations with tDCS, robotics, real instruments, and task-oriented training. RoB 2 yielded no low-risk studies, 12 with some concerns, and 12 at high risk, largely due to the blinding limitations inherent to VR. Based on the some-concerns studies, immersive VR and combined VR showed the most consistent superiority, some reaching the minimal clinically important difference (MCID), whereas non-immersive standalone VR was generally not superior for motor function, except where task-specific balance content was used.