Effects of immersive virtual reality training on balance, gait and mobility in older adults: A systematic review and meta-analysis.

To examine whether immersive virtual reality (VR) can improve balance, gait, mobility and fear of falling in older people. MEDLINE, EMBASE, CINAHL, PsycINFO, ProQuest Central (Engineering and Computer Science) and reference lists of included articles. Randomised controlled trials that administered immersive VR training and assessed balance, gait and mobility outcomes in older adults without neurological disorders (mean age ≥ 65). Primary outcomes were standing balance (e.g. postural sway), multi-item balance scales (e.g. Berg Balance Scale), gait (e.g. gait speed) and mobility (e.g. Timed Up and Go test). Secondary outcomes comprised measures of enjoyment, fear of falling, adherence (e.g. dropout rate), feasibility/usability and adverse effects (e.g. motion sickness). Meta-analyses showed that immersive VR training significantly improved standing balance (SMD: 0.51, 95% CI:.15, 0.86, p = 0.005, I2 = 28% - 3 studies, n = 79) and performance on the Berg Balance Scale (MD: 2.36, 95% CI: 1.17, 3.56, p=0.0001, I2=0% - 4 studies, n = 190). No significant improvement in gait, mobility or fear of falling was found. Subgroup analyses revealed higher training doses (≥4.5 total hours) and VR interventions using non-head mounted displays were more likely to improve standing balance. No meta-analyses were conducted for enjoyment, adherence, feasibility/usability and adverse events. The findings indicate immersive VR has beneficial effects on balance, but not gait, mobility or fear of falling. Further research is required to examine these outcomes in trials that also include quantitative measurements of enjoyment, adherence, clinical feasibility, usability and adverse effects. • Immersive virtual reality (VR) can improve balance in older people. • At least 4.5 hours of total training dose was necessary to improve balance. • Immersive VR without a head-mounted display may be more effective. • Effects of VR training on gait, mobility and fear of falling were not clear. • More research is needed for enjoyment, adherence, usability and side effects. [ABSTRACT FROM AUTHOR]