Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate‐quality evidence) however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Secondary outcomes: when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low‐quality evidence). Primary outcome: results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) ‐0.05 to 0.20, 22 studies, 1038 participants, low‐quality evidence) when comparing virtual reality to conventional therapy. Control groups usually received no intervention or therapy based on a standard‐care approach. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. The risk of bias present in many studies was unclear due to poor reporting. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. This review includes 35 new studies in addition to the studies included in the previous version of this review. We included 72 trials that involved 2470 participants.
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