Effectiveness of Non-Immersive Virtual Reality on Gross Motor Function, Balance, and Functional Independence in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis.

Abstract

<b>Background/Objectives:</b> This systematic review with meta-analysis synthesizes current evidence on the effectiveness of non-immersive virtual reality (VR) interventions in enhancing gross motor function, balance, and functional independence in children with cerebral palsy (CP). <b>Methods:</b> A systematic search was performed across six databases (PubMed, Web of Science, Scopus, MEDLINE, CINAHL Complete, and Psychology and Behavioral Sciences Collection) to identify randomized controlled trials (RCTs) published up to July 2025. Primary outcomes included gross motor function (GMFM-D/E), balance (Pediatric Balance Scale, PBS), and functional independence (WeeFIM). Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated with GRADE. <b>Results:</b> From 1233 retrieved records, 13 RCTs involving 624 participants fulfilled the inclusion criteria. Pooled analyses demonstrated significant improvements with non-immersive VR in gross motor function (GMFM-D: ES = 2.04, <i>p</i> = 0.02; GMFM-E: ES = 2.02, <i>p</i> < 0.001), balance (PBS: ES = 1.34, <i>p</i> = 0.02), and functional independence (WeeFIM: ES = 0.99, <i>p</i> < 0.001). <b>Conclusions:</b> Non-immersive VR interventions were associated with meaningful gains in gross motor function, balance, and independence in children with CP. Significant differences were consistently observed in GMFM-D, GMFM-E, PBS, and WeeFIM outcomes when compared with control groups.