# Effectiveness of Augmented Reality in Stroke Rehabilitation: A Meta-Analysis
## 3 Results and Discussion
### Evaluation
The intervention was delivered within the period from 1 to 4 weeks (n = 9). The duration of one session was from 30 min to 1 h (n = 10). The QualSyst scores of the included articles were summarized in Table 5. They represented high quality with a mean of 80.99%, a standard deviation of 0.14, a maximum of 95.9%, and a minimum of 56.7%. About the upper limb rehabilitation, most studies used 4 weeks for the duration of the intervention. More of the studies (5 studies) recruited participants more than 1 year after stroke [26; 28; 31; 32; 33], with the remaining trials recruiting participants within 2 or 3 months after stroke (4 studies) [26; 28; 29; 37]. Fugl-Meyer was used by 7 investigations, Wolf Motor Function test by 2 investigations, and Box and Block Test by 3 investigations. Following the International Classification of Functioning, Disability, and Health, the Fugl-Meyer [39] is at the body structure and function level as the motor impairment group. The Wolf Motor Function test [40] and the Box and Block test [41] are at the body activities and participation level as the motor function group. Results of meta-analysis indicated that the AR group had a significant efficacy on overall function of upper limb rehabilitation (n = 9, SMD = 0.657, 95% CI = 0.287-1.026, I\({}^{2}\) = 57.033%, \(p\) < 0.001), but its heterogeneity is remarkably high (I\({}^{2}\) = 57.033% > 50%) (Figure 3). The forest plot showed one outlier, which reported a large effect size (SMD = 2.689). Without the outlier, the summary effect size decreased (n = 8, SMD = 0.484, 95% CI = 0.249-0.719, I\({}^{2}\) = 0.000) (Figure 4). Substantial improvement of the AR compared to the baseline was 32.5% (95% CI = 10.8-54.2%, \(p\) < 0.005; Figure 5) on the motor impairment and 38% (95% CI = 7.5-68.4%, \(p\) < 0.02; Figure 6) on the motor function, respectively. Furthermore, Figure 7 demonstrated that AR is moderately more effective in improving the function of the upper limb than conventional therapies (59.3% of improvement, \(p\) < 0.05). From these results, we also suggest that this approach can be used with the conventional rehabilitation methods as a new intervention to enhance upper limb function. Three papers with 49 participants identified significant effectiveness in favor of the AR group [26; 30; 35]. No adverse event was reported in these studies. Although the AR showed improvements in the recovery of the upper limb, the studies were only evaluated in a small sample size. This illustrates the approach is still in the beginnings of progression in upper limb rehabilitation. \begin{table}
\begin{tabular}{l l l} \hline \hline
**Authors** & **Averaged Summary Score** &
\begin{tabular}{l} **Standard Deviation between** \\ **Reviewers 1 and 2** \\ \end{tabular} \\ \hline [PERSON] et al. (2010) [26] & 68.8\% & 0.088 \\ [PERSON] et al. (2014) [32] & 59.9\% & 0.023 \\ [PERSON] et al. (2015) [28] & 86\% & 0.004 \\ [PERSON] et al. (2015) [27] & 83.2\% & 0.035 \\ [PERSON] et al. (2017) [30] & 66.1\% & 0.009 \\ [PERSON] et al. (2016) [33] & 91\% & 0.025 \\ [PERSON] et al. (2014) [31] & 76.4\% & 0.02 \\ [PERSON] et al. (2018) [29] & 95.9\% & 0.005 \\ [PERSON] et al. (2019) [38] & 93.2\% & 0.033 \\ [PERSON] et al. (2014) [34] & 94.7\% & 0.025 \\ [PERSON] et al. (2014) [35] & 94.4\% & 0.029 \\ [PERSON] et al. (2012) [36] & 86.6\% & 0.028 \\ [PERSON] et al. (2013) [37] & 56.7\% & 0.023 \\ \hline \hline \end{tabular}
\end{table} 
Table 5: The assessed outcomes in the QualSyst of the included investigations. Figure 4: The meta-analysis results of the included investigations in the upper limb rehabilitation except for the outlier. Figure 3: The meta-analysis results of the included investigations in the upper limb rehabilitation. On the function of lower limb rehabilitation, four studies with 79 participants measured the effects of AR intervention. All studies consisted of people who were chronic stroke survivors. The meta-analysis showed that the overall effect of the AR was SMD = 0.520 (95% CI = 0.039\(\sim\)1.001, \(p<\) 0.05, Figure 8).