# Effectiveness of Augmented Reality in Stroke Rehabilitation: A Meta-Analysis
###### Abstract  
Augmented reality (AR)-based rehabilitation shows potential to improve upper and lower limb function after stroke. This study aims to review the effect of AR technology in the recovery of the upper and lower limb function in stroke patients. Published randomized controlled trials and observational investigations with adult stroke patients were retrieved from five electronic databases to analyze the effect of the AR systems in improving motor function and balance and gait function for stroke patients. The treatment effect was estimated by standardized mean difference (SMD) and 95% confidence interval (CI) using a random effect model for motor function outcomes at the body structure and function, body activity and participation level of the International Classification of Functioning, and balance and gait outcomes. In total, 13 investigations (9 for the upper limb and 4 for the lower limb) were identified. AR demonstrated a significant influence on the upper limb function (SMD = 0.657; 95% CI, 0.287 to 1.026; \(p\) = 0.000) and the lower limb function (SMD = 0.52; 95% CI, 0.039 to 1.001; \(p\) = 0.034). The present analysis suggests that AR applications could offer options for increasing treatment intensity and promoting motor recovery after a stroke. This approach can be used with the conventional rehabilitation methods as a new intervention for recovering upper and lower limb function.  
augmented reality; stroke; upper extremity; lower limb; rehabilitation +
Footnote †: journal: Medical  
simple and repetitive exercises induce boredom in the patients, which reduces their motivation [13]. Furthermore, treatment data are not collected because simple exercising devices are designed with no sensors.  
Due to these limitations, the requirement for more interactive and automatic rehabilitation therapeutic tools has accumulated. Thanks to recent rapid progress in electrical and mechanical engineering, new concepts in the rehabilitation therapeutic tool, such as robotic system, virtual reality (VR) system, and AR system, have been proposed and tested. These new conceptual tools bring about several advantages: (1) highly motivated and repetitive exercises without therapist's assistance; and (2) stimulation of brain plasticity for fast recovery of motor functions. AR is a technology that combines real and virtual objects to provide an interactive experience in real time in a common environment [14]. During the intervention, patients are guided and corrected by reliable and accurate feedback of the virtual objects which AR accommodates to enhance motor learning and motivation [15; 16]. The virtual interactive objects created by AR in the real world induce more embodiment toward users than those created by VR in the virtual world [17]. Moreover, AR creates a safe environment to allow users to interact with real objects in real-world circumstances. It is easily modified to adapt to the individual's impairment or personal preferences. As AR technology becomes more accessible and affordable, AR interventions could be used widely in clinical rehabilitation settings. Hence, determining the efficacy of AR treatments in stroke recovery is crucial to guide future utilization for clinicians.  
Many reports reviewed AR technology in the rehabilitation field [18; 19; 20; 21]. These articles only reviewed information on AR technology and described the obtained results in the clinical rehabilitation of each study. However, no meta-analysis of AR applications in motor recovery has been conducted. Based on the main findings of a single study, it is not enough evidence to conclude whether AR has effectiveness in this field for the clinicians, because their findings are not statistically significant. This paper conducted a meta-analysis to evaluate the effectiveness of the AR for the upper and lower limb functional recovery after stroke and to provide some potential implications for clinicians to consider using AR in rehabilitation in the future.