INTRODUCTION:

Virtual Reality (VR) has emerged as a transformative technology in healthcare, rehabilitation, and clinical assessment. Within this domain, VR-based hand function assessment stands out for its capacity to provide objective, standardized, and data-driven evaluation. Advancements in motion tracking, haptic feedback, and artificial intelligence now enable precise quantification of motor control, coordination, and grip strength—factors crucial to neurorehabilitation and motor recovery. Consequently, VR serves not only as a therapeutic medium but also as a reliable clinical assessment tool, bridging gaps between technology and patient-centered care¹.

Over the years, VR technology has been incorporated into various medical and therapeutic applications, including stroke rehabilitation, pediatric therapy, and musculoskeletal recovery². Its ability to simulate real-life scenarios enables patients to engage in tasks that promote functional improvement while providing real-time feedback on movement and performance³. Additionally, VR has been explored for broader healthcare applications, such as nursing education⁴, distraction techniques for children during cannula insertion⁵, video-based interventions for autistic children⁶, and alleviating pain and anxiety among post-mastectomy menopausal patients⁷. The continuous development of both immersive and non-immersive VR systems has expanded its role in hand function assessment, making it a growing area of research⁸. The degree of reality can make the participant feel a high presence⁹.

Hand function assessment in VR environments involves measuring parameters such as movement coordination, grip strength, and motor control through interactive tasks. VR-based assessments provide advantages such as precise motion tracking, data-driven analysis, and adaptability to individual patient needs¹⁰. Studies have demonstrated the effectiveness of VR in rehabilitation and functional assessments, emphasizing its potential to improve clinical outcomes across diverse patient populations¹¹.

The bibliometric analysis of VR applications in hand assessment from 2020 to 2025 aims to explore research trends, publication patterns, and key developments in this domain. Given the rapid evolution of VR technologies, it is essential to assess the scientific landscape to identify influential studies, leading institutions, and emerging research themes. By analyzing the academic contributions in this field, researchers and practitioners can gain valuable insights into the current state of knowledge, potential challenges, and future directions^12,13.

This study employs bibliometric methods to systematically examine literature related to VR-based hand assessment. The analysis covers key metrics such as citation trends, authorship networks, keyword distributions, and collaboration patterns. Understanding these aspects will not only highlight the impact of VR in hand assessment but also provide a roadmap for future research and innovation in this interdisciplinary field^14,15.

Through this bibliometric analysis, we aim to provide a comprehensive overview of the evolution and significance of VR in hand assessment, contributing to the broader discourse on digital health technologies and their role in enhancing clinical outcomes¹⁶. As VR-assisted hand function assessment continues to evolve, this analysis will offer valuable insights into research trends, impact, and contributions from 2020 to 2025. The following sections outline related works, research methodology, data analysis, interpretation of results, discussion, and conclusion.

RELATED WORKS:

I. Hand Function Assessment in VR Games

a) Movement

Marganska et al.¹⁷ investigated the use of an exoskeleton robot, ARMin, in a VR-based strength training program for patients with ischemic stroke. The ARMin device, with its seven degrees of freedom (DOF), enabled patients to perform movements such as shoulder rotation, elbow flexion/extension, pronation/supination, and wrist flexion/extension. The study involved two VR games: the Ball Tracking Game and the Golf Game, where patients performed various upper limb movements with the robotic assistance. The findings indicated that VR-based rehabilitation with an assisting device facilitated different hand movements, promoting motor improvement through interactive gameplay.

b) Grip Strength:

Kamel and Basha¹⁸ conducted a randomized controlled trial to examine the impact of VR-based training and task-oriented therapy on hand function in pediatric hand burn patients. Participants were divided into three groups: a VR-based rehabilitation group using Xbox Kinect, a task-oriented training (TOT) group, and a control group receiving traditional rehabilitation (TR). The study revealed significant improvements in grip strength and pinch strength in both the VR and TOT groups compared to the control group. The use of motion-based VR games, which required patients to match their movements with an avatar on the screen, demonstrated that VR interventions could enhance grip strength and functional recovery in hand-impaired individuals.

II. Technology Used in VR Games

Parong and Mayer¹⁹ explored the effectiveness of immersive VR as a learning tool compared to traditional slideshow presentations. Their study found that students who engaged with immersive VR demonstrated better knowledge retention and learning outcomes. Similarly, Ail et al.²⁰ evaluated immersive VR against cadaveric prosections for medical education. Their findings showed no significant differences between the two methods, suggesting that immersive VR could serve as a viable alternative to traditional dissection-based learning. These studies highlight the effectiveness of immersive VR in engaging users and enhancing knowledge acquisition, which could be applied to VR-based hand function assessments.

RESEARCH AIM:

This study aims to perform a bibliometric analysis of research related to VR applications in hand function assessment from 2020 to 2025. Specifically, it seeks to address the following questions:

1. What is the co-authorship’s status?

2. Who are the most influential authors?

3. Which are the most influential publications?

4. Which are the most influential journals?

5. Which are the most influential countries and universities?

6. What is keywords’ distribution and trend?

MATERIALS AND METHODS:

I. Research Design:

A bibliometric analysis was conducted using the Scopus database. The study focused on publications related to “virtual reality” OR “VR” AND “hand function” OR “hand assessment”, covering the timespan 2020–2025. Data extraction was performed on March 24, 2025, resulting in a dataset of 651 publications.

The analysis was divided into two key components:

1. Bibliometric Mapping: To examine research trends, influential authors, and institutional collaborations.

2. Keyword Analysis: To identify emerging research themes and key areas of focus in VR-based hand assessment.

II. Search Strategy and Inclusion Criteria:

To ensure a comprehensive bibliometric analysis^21,22,23,24, we applied a rigorous search strategy using the Scopus database. The following inclusion criteria were used: (1) articles published between 2020 and 2025, (2) studies explicitly focusing on virtual reality (VR) applications on hand, and (3) article, conference paper, review, conference review, and book chapter, and book. We excluded non-English publications, duplicate records, grey literature (such as letter, short survey and retracted materials), and studies where VR was not a primary focus. This exclusion may have introduced language bias and limited inclusion of non-English research, which is acknowledged as a study limitation.

III. Obtaining Data Set:

To perform our study, the bibliographic database Scopus was used for its coverage and peer review of its indexed publications²⁵. Scopus was used to extract a representative set of relevant literature using the keyword ''virtual AND reality'' OR ''VR'' AND ''hand AND function'' OR ''hand AND assessment'', covering 2020 to 2025 from Scopus. The following search query was constructed and applied in the database: TOPIC: (''virtual AND reality'' OR ''VR'' AND ''hand AND function'' OR ''hand AND assessment'') Timespan: 2020–2025. Scopus was consulted on March 24, 2025, and a total of 651 publications were obtained. Scopus allows downloading all 651 records simultaneously.

RESULT:

The study employed VOSviewer for bibliometric mapping, including:

1. Co-authorship analysis to determine collaborative networks between researchers.

2. Bibliographic coupling to evaluate shared references across studies.

3. Keyword co-occurrence analysis to track evolving research themes.

4. Citation analysis to identify highly influential papers.

Analyses of co-authorship, bibliographic coupling, keyword co-occurrence, and citation were performed on bibliometric meta-data using VOSviewer software. For bibliographic coupling, the relationships of elements such as publications, journals and authors. are determined according to the number of shared resources, i.e., a reference to the same publication in two different sources is considered bibliographic coupling. The analysis of the co-occurrence of keywords reveals the evolution of the domain over time²⁶. It is therefore an efficient method to identify hot topics in a given research domain. Citation analysis helps researchers to detect popular research topics and papers that other researchers worked on²⁷. The results of the analysis are presented in the form of a table or network visualization map.

Figure 1 shows the number of ''virtual AND reality'' OR ''VR'' AND ''hand AND function'' OR ''hand AND assessment'' publications published each year between 2020 and 2025. Figure 1 shows that research on ''virtual AND reality'' OR ''VR'' AND ''hand AND function'' OR ''hand AND assessment'' is significant and relatively stable, ranging from 98 (2020) to 31 (2025). There were 98 articles published in 2020, representing 18.83% of publications; 100 publications in 2021, representing 19.22%; 134 publications in 2022, representing 25.75%; 140 publications in 2023, representing 26.91%; 148 publications in 2024, representing 28.44% of publications, and 31 publications in 2025, representing 5.96% of publications. We notice that more articles were published in 2023 and 2024, and less in 2025, the year in which we expected to have more publications on virtual reality on hand research as robotics rehabilitation has emerged. Furthermore, we can observe that the number of publications increases over time.

Figure 1. Publication on Virtual Reality on Hand Research According to Years.

It was found with the analysis of the data set that the publications related to virtual reality on hand cover 78 countries, mainly United States (23.50%), Italy (9.52%), China (8.60%), Spain (7.53%), United Kingdom (7.07%), Germany (6.76%), India (4.61%), Canada (4.45%), France (4.30%), Switzerland (3.84%) etc. as we can see on Figure 2.

Figure 3 shows the types of papers published on virtual reality on hand research between 2020 and 2025. We notice that 60.68% are “Article” (395 publications), 21.97% of the publications are “Conference Paper” (143 publications), 12.14% are “Review” (79 publications), 3.38% are “Conference Review” (22 publications), 1.38% are “Book Chapter”, (9 publications), and 0.46% are “Book”, (3 publications).

Figure 2. Publication on Virtual Reality on Hand Research According to Countries or Territories.

Figure 3. Publication on Virtual Reality on Hand Research According to Document Type.

Figure 4 shows the areas of subject that are interested in virtual reality on hand research of the publications between 2020 and 2025. Among these areas, we have mainly “Medicine” which produced 300 publications (46.08%) out of 651 publications; “Computer Science” which produced 223 publications (34.26%); “Engineering” produced 203 publications (31.18%); “Social Sciences” published 77 publications (11.82%); “Neuroscience” published 68 publications (10.44%).

Regarding the organizations, institutions or universities that provide a great work on virtual reality on hand research, we have mainly “University of Southern California’’ 8 publications (1.23%); “INSERM” (French National Institute of Health and Medical Research) with 7 publications (1.08%); “Université McGill” (McGill University from Canada) 7 publications (1.08%); “EBERHARD KARLS UNIVERSITÄT TÜBINGEN” (University of Tübingen from Germany) with 7 publications (1.08%); “UNIVERSIDAD REY JUAN CARLOS” (King Juan Carlos University from Spain) with 7 publications (1.08%) (see Figure 5).

Figure 4. Publication on Virtual Reality on Hand Research According to Subject Areas.

Figure 5. Publication on Virtual Reality on Hand Research According to Affiliations.

A. Co-authorship in terms of authors:

This parameter of analysis is considered with three different parameters related to it. The authors, organizations, and countries are considered for analyzing this parameter.

Documents with a very large number of authors are ignored in this analysis. This number is considered to be 25. Threshold is considered as 2 for minimum number of documents of an author.

It is seen that out of 3334 authors, 171 authors met the thresholds. The total strength of the co-authorship is calculated with other authors. By this method, the link strengths are obtained. bravi, marco, bressi, federica, cordella, Francesca, lapresa, martina, santacaterina, fabio, zollo, loredana found equally high link strength of 22 with the total number of citations to be 162. Here total of 13 authors found to have the relation in terms of co-authorship. So these are only shown in the Figure 6.

B. Co-authorship in terms of organizations:

Co-authorship in the unit of organizations is calculated considering minimum two documents in organizations with neglecting the citation of the same, 30 organizations meet the criteria out of 1986 number of total organizations, that are shown in the figure. An organization, Louvain bionics, University of Catholic has highest link strength of 8 with the highest citations of 102 by institute of health science, Istanbul Medical University (with 2 documents). Refer to Figure 7.

Figure 6. Co-Authorship Analysis in Terms of Authors.

Figure 7. Co-Authorship Analysis in Terms of Organizations.

C. Co-authorship in terms of country:

Co-authorship can also be obtained in relation to the country. A total of 90 countries are there, in which this databases are present. After considering the threshold of minimum 5 documents in a country, 34 countries met the threshold. Here, United States found to have the highest citations of 1959 and number of documents are 154, and the link strength of 81, that is also highest amongst all. Refer to Figure 8.

4.2.2. Network Analysis of Co-occurrences:

A. Co-occurrence analysis in terms of all keywords:

For the analysis of co-occurrences, different keywords are considered. Minimum number of occurrences in the keywords is considered to be 5. Out of 5880 keywords, 495 keywords met the threshold. Refer to Figure 9.

Figure 8. Co-Authorship Analysis in Terms of Countries.

Figure 9. Co-Occurrence Analysis in Terms of All Keywords.

B. Co-occurrence analysis in terms of author keywords:

Co-occurrence of author keywords is analyzed with the minimum threshold of 5 per author. Out of 1867 keywords by the authors, 62 keywords met the threshold. Refer to Figure 10.

C. Co-occurrence analysis in terms of index keywords:

Co-concurrence is also considered by index keywords of 4790, only 452 met the threshold. Refer to Figure 11.

Figure 10. Co-Occurrence Analysis by Author Keywords.

Figure 11. Co-Occurrence of Index Keywords.

4.2.3. Network Analysis of Citations:

This analysis is done with the units of analysis including documents, sources, authors, country and organization.

A. Citation analysis of documents:

Out of total of 651 documents, minimum 5 citations are considered as a threshold per document. So 264 documents met the threshold. chick (2020) has the highest number of citations 670 while the link strength is the highest for lee (2020). Refer to Figure 12.

B. Citation analysis of sources:

Citation analysis of sources is obtained by considering the threshold of 5 citations per source. Out of the 421 sources only 21 met the threshold. Journal of neuroengineering and rehabilitation has got maximum citations of 292. Refer to Figure 13.

Figure 12. Citation Analysis of Citations (in Terms of Documents).

Figure 13. Citation Analysis of Citation by Sources.

C. Citation analysis of authors:

Threshold considered here is 3 citations per author. A total of 28 authors met the threshold amongst the total of 3334 authors. Cuesta-Gómez, Alicia has maximum citations of 132. Refer to Figure 14.

D. Citation analysis by organization:

Considering minimum document of 1 per organization as threshold, 1986 organizations met the threshold out of 1986 organizations. Department of Psychology, University of Copenhagen, Denmark; University of Copenhagen, Denmark and University of California, Santa Barbara, United States has a maximum citation of 133. Refer to Figure 15.

Figure 14. Citation Analysis by Authors.

Figure 15. Citations by Organizations.

E. Citation analysis of country:

Total of 90 countries have the databases on virtual reality on hand research. Out of which 34 met the citation criteria considering a threshold of minimum 5 citations per country. Refer to Figure 16.

Figure 16. Citation Analysis of Country.

4.2.4. Network Analysis of Bibliographic Coupling

A. Bibliographic coupling of documents:

Figure 17. Bibliographic Coupling of Documents.

B. Bibliographic coupling of authors:

Considering, 3 documents per author as a minimum threshold value. Out of total 3334 authors, 28 authors met the threshold criteria. Refer to Figure 18.

Figure 18. Bibliographic Coupling of Authors.

DISCUSSION:

This study's findings align with prior bibliometric analyses in VR and rehabilitation, which similarly noted the growing research output and cross-disciplinary collaborations. The emphasis on neuroplasticity and AI-driven approaches underscores an ongoing shift toward adaptive rehabilitation technologies. Comparatively, previous bibliometric reviews in VR-based stroke and gait rehabilitation revealed parallel trends, concentrated in high-income countries—highlighting persistent global inequities in access and technological infrastructure. Future bibliometric work could explore how these trends translate into clinical innovation and patient-centered outcomes.

CONCLUSION:

This bibliometric analysis highlights global research patterns and emerging priorities in VR-based hand assessment from 2020 to 2025. Findings indicate strong contributions from technologically advanced nations and expanding themes in neurorehabilitation and AI integration. However, standardization and accessibility challenges persist. Future studies should focus on establishing validated VR-based assessment protocols and cost-effective solutions to enhance inclusivity across diverse clinical settings.

Despite the observed research growth, challenges such as the need for standardized assessment protocols, validation of VR tools against conventional hand function assessments, and accessibility concerns remain. The decline in research output in 2025 suggests a possible shift in research focus towards AI-driven assistive technology or diminishing novelty in VR applications. Addressing these challenges requires interdisciplinary collaboration between researchers, clinicians, and technology developers.

Future research should focus on the development of standardized VR-based assessment protocols, AI-driven personalized rehabilitation strategies, and cost-effective VR solutions to enhance accessibility in low-resource settings. By addressing these gaps, VR-based hand function assessments can be further refined, contributing to improved rehabilitation outcomes and broader clinical applications.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this study.

ACKNOWLEDGMENTS:

The authors would like to thank Universiti Tunku Abdul Rahman [Project No: IPSR/RMC/UTARRF/2023-C2/K03] for funding this and its relevant projects. We want to thank Ir. Prof. Dr. Chee Pei Song and Ir. Dr. Goh Choon Hian for their shared knowledge in this project.

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Received on 24.08.2025 Revised on 13.12.2025

Accepted on 10.02.2026 Published on 20.05.2026

Available online from May 25, 2026

Research J. Pharmacy and Technology. 2026;19(5):2145-2152.

DOI: 10.52711/0974-360X.2026.00309

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.