A systemic review and meta-analysis of the effect of virtual reality training on balance in the elderly to prevent falls
DOI:
https://doi.org/10.15584/ejcem.2025.1.33Keywords:
virtual reality, balance, ageing, BBS, TUGAbstract
Introduction and aim. Virtual reality (VR) is used in various healthcare treatments. This review evaluates virtual reality therapy (VRT) for balance rehabilitation to prevent falls in older adults.
Material and methods. Randomised control trials from January 2013 to May 2024 were searched in databases like PubMed and Web of Science. Data were extracted and analysed using RevMan 5.4 software.
Analysis of the literature. The review included 12 studies with an average of 56 participants aged 50-80 years. Treatments last ed 4–10 weeks with 2-5 sessions per week, each 30-60 minutes. Meta-analyses of five studies using the berg balance scale (BBS) showed a weak impact on balance (Z=2.07, p=0.04; SMD=1.05, 95% CI [0.06, 2.05], p<0.0001). Conversely, the Timed Up and Go (TUG) test showed a more positive impact (Z=2.25, p=0.02; SMD=-0.74, 95% CI [-1.39, -0.09], p<0.001), with a difference of 4.4 higher in the experimental group than the control group.
Conclusion. VRT shows promising effects in balance and gait training for older adults, but further clinical trials are needed to compare its impact with other therapies.
Supporting Agencies
The study received no funding. However, the lead author is supported by institutional PhD scholarship.Downloads
References
Peterka RJ. Sensorimotor integration in human postural control. J Neurophysiol. 2002;88:1097-1118. doi: 10.1152/jn.00605.2001
Bohannon RW, Larkin PA, Cook AC, Gear J, Singer J. Decrease in timed balance test scores with aging. Phys Ther. 1984;64(7):1067-1070. doi: 10.1093/ptj/64.7.1067
Gschwind YJ, Bridenbaugh SA, Kressig RW. Gait Disorders and Falls. https://doi.org/101024/1662-9647/a000004. 2010;23(1):21-32. doi: 10.1024/1662-9647/A000004
Shumway-Cook A, Baldwin M, Polissar NL, Gruber W. Predicting the probability for falls in community-dwelling older adults. Phys Ther. 1997;77(8):812-819. doi: 10.1093/ptj/77.8.812
Gomes GA de O, Cintra FA, Batista FS, et al. Elderly outpatient profile and predictors of falls. Sao Paulo Med J. 2013;131(1):13-18. doi: 10.1590/s151631802013000100003
Pietrzak E, Cotea C, Pullman S. Using commercial video games for falls prevention in older adults: the way for the future? J Geriatr Phys Ther. 2014;37(4):166-177. doi: 10.1519/JPT.0b013e3182abe76e
Verghese J, LeValley A, Hall CB, Katz MJ, Ambrose AF, Lipton RB. Epidemiology of Gait Disorders in Community‐Residing Older Adults. J Am Geriatr Soc. 2006;54(2):255-261. doi: 10.1111/j.1532-5415.2005.00580.x
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701-1707. doi: 10.1056/NEJM198812293192604
Li F, Fisher KJ, Harmer P, McAuley E, Wilson NL. Fear of falling in elderly persons: association with falls, functional ability, and quality of life. J Gerontol B Psychol Sci Soc Sci. 2003;58(5):P283-90. doi: 10.1093/geronb/58.5.p283
Noohu MM, Dey AB, Hussain ME. Relevance of balance measurement tools and balance training for fall prevention in older adults. Journal of Clinical Gerontology and Geriatrics. 2014;5(2):31-35. doi: 10.1016/j.jcgg.2013.05.002
Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to Differentiate Balance Deficits.; 2009. www.ptjournal.org
Strini V, Schiavolin R, Prendin A. Fall Risk Assessment Scales: A Systematic Literature Review. Nursing reports (Pavia, Italy). 2021;11(2):430-443. doi: 10.3390/nursrep11020041
Buchman AS, Boyle PA, Wilson RS, Gu L, Bienias JL, Bennett DA. Pulmonary function, muscle strength and mortality in old age. Mech Ageing Dev. 2008;129(11):625-631. doi: 10.1016/j.mad.2008.07.003
Yu W, An C, Kang H. Effects of Resistance Exercise Using Thera-band on Balance of Elderly Adults: A Randomized Controlled Trial. J Phys Ther Sci. 2013;25(11):1471-1473. doi: 10.1589/jpts.25.1471
Bieryla KA, Dold NM. Feasibility of Wii Fit training to improve clinical measures of balance in older adults. Clin Interv Aging. 2013;8:775-781. doi: 10.2147/CIA.S46164
Penn IW, Sung WH, Lin CH, Chuang E, Chuang TY, Lin PH. Effects of individualized Tai-Chi on balance and lower-limb strength in older adults. BMC Geriatr. 2019;19(1):235. doi: 10.1186/s12877-019-1250-8
Michaelsen SM, Dannenbaum R, Levin MF. Task-specific training with trunk restraint on arm recovery in stroke: randomized control trial. Stroke. 2006;37(1):186-192. doi: 10.1161/01.STR.0000196940.20446.c9
Martins AC, Guia D, Saraiva M, Pereira T. Effects of A “Modified” Otago Exercise Program on the Functional Abilities and Social Participation of Older Adults Living in the Community-The AGA@4life Model. Int J Environ Res Public Health. 2020;17(4). doi: 10.3390/ijerph17041258
Bakken RC, Carey JR, Di Fabio RP, Erlandson TJ, Hake JL, Intihar TW. Effect of aerobic exercise on tracking performance in elderly people: a pilot study. Phys Ther. 2001;81(12):1870-1879.
Barker AL, Bird ML, Talevski J. Effect of pilates exercise for improving balance in older adults: A systematic review with meta-analysis. Arch Phys Med Rehabil. 2015;96(4):715-723. doi: 10.1016/j.apmr.2014.11.021
Cromwell RL, Newton RA, Forrest G. Influence of vision on head stabilization strategies in older adults during walking. J Gerontol A Biol Sci Med Sci. 2002;57(7):M442-8. doi: 10.1093/gerona/57.7.m442
Cho GH, Hwangbo G, Shin HS. The Effects of Virtual Reality-based Balance Training on Balance of the Elderly. J Phys Ther Sci. 2014;26(4):615-617. doi: 10.1589/jpts.26.615
Park EC, Kim SG, Lee CW. The effects of virtual reality game exercise on balance and gait of the elderly. J Phys Ther Sci. 2015;27(4):1157-1159. doi: 10.1589/jpts.27.1157
Burdea GC. Virtual rehabilitation--benefits and challenges. Methods Inf Med. 2003;42(5):519-523.
Lange BS, Requejo P, Flynn SM, et al. The Potential of Virtual Reality and Gaming to Assist Successful Aging with Disability. Phys Med Rehabil Clin N Am. 2010;21(2):339-356. doi: 10.1016/j.pmr.2009.12.007
Lehrer N, Chen Y, Duff M, L Wolf S, Rikakis T. Exploring the bases for a mixed reality stroke rehabilitation system, Part II: design of interactive feedback for upper limb rehabilitation. J Neuroeng Rehabil. 2011;8:54. doi: 10.1186/1743-0003-8-54
Duff M, Chen Y, Attygalle S, Sundaram H, Rikakis T. Mixed reality rehabilitation for stroke survivors promotes generalized motor improvements. Annu Int Conf IEEE Eng Med Biol Soc. 2010;2010:5899-5902. doi: 10.1109/IEMBS.2010.5627537
Lehrer N, Attygalle S, Wolf SL, Rikakis T. Exploring the bases for a mixed reality stroke rehabilitation system, part I: a unified approach for representing action, quantitative evaluation, and interactive feedback. J Neuroeng Rehabil. 2011;8:51. doi: 10.1186/1743-0003-8-51
Weiss PL, Rand D, Katz N, Kizony R. Video capture virtual reality as a flexible and effective rehabilitation tool. J Neuroeng Rehabil. 2004;1(1):12. doi: 10.1186/1743-0003-1-12
Rand D, Kizony R, Weiss PTL. The Sony PlayStation II EyeToy: low-cost virtual reality for use in rehabilitation. J Neurol Phys Ther. 2008;32(4):155-163. doi: 10.1097/NPT.0b013e31818ee779
Flynn S, Palma P, Bender A. Feasibility of using the Sony PlayStation 2 gaming platform for an individual poststroke: a case report. J Neurol Phys Ther. 2007;31(4):180-189. doi: 10.1097/NPT.0b013e31815d00d5
Chen GB, Lin CW, Huang HY, et al. Using Virtual Reality-Based Rehabilitation in Sarcopenic Older Adults in Rural Health Care Facilities-A Quasi-Experimental Study. J Aging Phys Act. 2021;29(5):866-877. doi: 10.1123/japa.2020-0222
Schröder J, van Criekinge T, Embrechts E, et al. Combining the benefits of tele-rehabilitation and virtual reality-based balance training: a systematic review on feasibility and effectiveness. Disabil Rehabil Assist Technol. 2019;14(1):2-11. doi: 10.1080/17483107.2018.1503738
Lloréns R, Noé E, Colomer C, Alcañiz M. Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(3):418-425.e2. doi: 10.1016/j.apmr.2014.10.019
Ren Y, Lin C, Zhou Q, Yingyuan Z, Wang G, Lu A. Effectiveness of virtual reality games in improving physical function, balance and reducing falls in balance-impaired older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2023;108:104924. doi: 10.1016/j.archger.2023.104924
Rodríguez-Almagro D, Achalandabaso-Ochoa A, Ibáñez Vera AJ, Góngora-Rodríguez J, Rodríguez-Huguet M. Effectiveness of Virtual Reality Therapy on Balance and Gait in the Elderly: A Systematic Review. Healthcare (Switzerland). 2024;12(2). doi: 10.3390/healthcare12020158
de Amorim JSC, Leite RC, Brizola R, Yonamine CY. Virtual reality therapy for rehabilitation of balance in the elderly: a systematic review and META-analysis. Adv Rheumatol. 2018;58(1):18. doi: 10.1186/s42358-018-0013-0
Bleakley CM, Charles D, Porter-Armstrong A, McNeill MDJ, McDonough SM, McCormack B. Gaming for health: A systematic review of the physical and cognitive effects of interactive computer games in older adults. Journal of Applied Gerontology. 2015;34(3):NP166-NP189. Doi: 10.1177/0733464812470747
Oliveira JA de, Guaratto TF, Bacha JMR, et al. Virtual reality in the rehabilitation of the balance in the elderly. Manual Therapy, Posturology & Rehabilitation Journal. Published online July 13, 2020:1-5. doi: 10.17784/mtprehabjournal.2017.15.481
Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898. doi: 10.1136/bmj.l4898
Armijo-Olivo S, Ospina M, da Costa BR, et al. Poor reliability between Cochrane reviewers and blinded external reviewers when applying the Cochrane risk of bias tool in physical therapy trials. PLoS One. 2014;9(5):e96920. Doi: 10.1371/journal.pone.0096920
Yoo HN, Chung E, Lee BH. The Effects of Augmented Reality-based Otago Exercise on Balance, Gait, and Falls Efficacy of Elderly Women. J Phys Ther Sci. 2013;25(7):797- 801. doi: 10.1589/jpts.25.797
Levy F, Leboucher P, Rautureau G, Komano O, Millet B, Jouvent R. Fear of falling: efficacy of virtual reality associated with serious games in elderly people. Neuropsychiatr Dis Treat. 2016;12:877-881. doi: 10.2147/NDT.S97809
Yang JE, Lee TY, Kim JK. The effect of a VR exercise program on falls and depression in the elderly with mild depression in the local community. J Phys Ther Sci. 2017; 29(12):2157-2159. doi: 10.1589/jpts.29.2157
Schwenk M, Grewal GS, Honarvar B, et al. Interactive balance training integrating sensor-based visual feedback of movement performance: A pilot study in older adults. J Neuroeng Rehabil. 2014;11(1). doi: 10.1186/1743-0003-11-164
Htut TZC, Hiengkaew V, Jalayondeja C, Vongsirinavarat M. Effects of physical, virtual reality-based, and brain exercise on physical, cognition, and preference in older persons: a randomized controlled trial. European Review of Aging and Physical Activity. 2018;15(1). doi: 10.1186/s11556-018-0199-5
Grigorova-Petrova K, Dimitrova A, Lubenova D, Zaharieva D, Vassileva D. Feasibility of interactive video games for influence on balance in institutionalized elderly people. Journal of Physical Education and Sport. 2015;15(3):429-432. doi: 10.7752/jpes.2015.03064
Im DJ, Ku J, Kim YJ, et al. Utility of a Three-Dimensional Interactive Augmented Reality Program for Balance and Mobility Rehabilitation in the Elderly: A Feasibility Study. Ann Rehabil Med. 2015;39(3):462-472. doi: 10.5535/arm.2015.39.3.462
Kamińska MS, Miller A, Rotter I, Szylińska A, Grochans E. The effectiveness of virtual reality training in reducing the risk of falls among elderly people. Clin Interv Aging. 2018;13:2329-2338. doi: 10.2147/CIA.S183502
Prasertsakul T, Kaimuk P, Chinjenpradit W, Limroongreungrat W, Charoensuk W. The effect of virtual reality-based balance training on motor learning and postural control in healthy adults: a randomized preliminary study. Biomed Eng Online. 2018;17(1):124. doi: 10.1186/s12938-018-0550-0
Žukienė K, Barasaitė Ž, Markauskienė A. EFFECTIVENESS OF VIRTUAL REALITY FOR BALANCE AND COORDINATION TRAINING OF ELDERLY PATIENTS. Vol 1.; 2018.
Jung DI, Ko DS, Jeong MA. Kinematic effect of Nintendo Wii(TM) sports program exercise on obstacle gait in elderly women with falling risk. J Phys Ther Sci. 2015;27(5): 1397-1400. doi: 10.1589/jpts.27.1397
Lee K. Virtual reality gait training to promote balance and gait among older people: A randomized clinical trial. Geriatrics (Switzerland). 2021;6(1):1-11. doi: 10.3390/geriatrics6010001
Lee GH. Effects of Virtual Reality Exercise Program on Balance, Emotion and Quality of Life in Patients with Cognitive Decline. The Journal of Korean Physical Therapy. 2016;28(6):355-363. doi: 10.18857/jkpt.2016.28.6.355
Tsang WWN, Fu ASN. Virtual reality exercise to improve balance control in older adults at risk of falling. Hongkong Med J. 2016;22 Suppl 2:S19-22.
Dockx K, Alcock L, Bekkers E, et al. Fall-Prone Older People’s Attitudes towards the Use of Virtual Reality Technology for Fall Prevention. Gerontology. 2017;63(6):590-598. doi: 10.1159/000479085
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