Effects of Game-Based Rehabilitation Therapy on Lower Extremity Function in Stroke Patients: A Systematic Review of Non-Immersive Approaches

Abstract

Background

Conventional stroke rehabilitation often suffers from low engagement and insufficient practice, whereas non-immersive game-based rehabilitation therapy (NI-GRT) offers a low-cost, accessible approach that may enhance motivation and recovery.

Objective

This systematic review aimed to evaluate the effects, modality-specific differences, and clinical feasibility of NI-GRT for lower extremity rehabilitation in stroke patients.

Methods

Literature searches (January 2020–March 2025) were conducted in PubMed, Wiley Online Library, Embase, and the Cochrane Library (PROSPERO, CRD420251125369). Eligible studies included adults with stroke receiving NI-GRT for lower extremity function. References were managed in EndNote 20, and extracted data organized in Microsoft Excel. Extracted variables included study, participant, and intervention characteristics, comparators, outcomes, adherence, and adverse events. Methodological quality was appraised using the Arbesman hierarchy, with risk of bias assessed by RoB 2 for randomized controlled trials (RCTs) and ROBINS-I for non-randomized trials (non-RCTs). Owing to heterogeneity in study design, protocols, measurement tools, and intervention durations, results were narratively synthesized, with subgroup analyses by severity, phase, modality, and training dose.

Results

Seven studies (3 RCTs, 1 non-RCT, 2 single-group, 1 case series) were included. Interventions encompassed advanced technologies, motion-sensor systems, commercial exergaming consoles, and non-digital board-game therapy, with training doses ranging from 10–26 h and adherence rates of 85–100%. Across modalities, NI-GRT consistently improved lower-extremity motor function, balance, and mobility, with several studies demonstrating large effect sizes or exceeding minimal clinically important differences. Benefits were observed across severity levels (severe to mild–moderate) and stroke phases (subacute and chronic). Moderate training exposure (13–20 h) yielded the most consistent gains. Reported adverse events were rare, and interventions were generally well tolerated.

Conclusions

NI-GRT appears to be a safe, acceptable, and effective intervention for improving lower extremity function after stroke, with both advanced and low-cost modalities demonstrating therapeutic potential. While current evidence remains limited (with small sample sizes, variable study designs, and some inconsistency and imprecision), these findings provide a foundation for broader clinical application and highlight the need for large-scale trials to confirm efficacy and cost-effectiveness.