JMIR Publications

ABSTRACT

Background:

Frailty is a geriatric syndrome associated with increased risk of falls, hospitalization, and reduced quality of life. Traditional exercises may be unsuitable for frail older adults due to mobility issues and accessibility barriers. Virtual reality (VR) offers an engaging, home-based alternative by providing interactive training with real-time feedback. VR interventions have shown potential benefits for improving balance, strength, and mobility

Objective:

To systematically evaluate the effectiveness of VR-based home training programs in improving balance, strength, and mobility among frail and pre-frail older adults.

Methods:

A systematic search was conducted in PubMed, Scopus, and Web of Science from inception to November 1, 2023, using terms related to older adults, frailty, virtual reality, balance, mobility, and strength. Eligible studies included randomized and non-randomized trials involving frail or pre-frail adults aged ≥65 years who received home-based VR interventions aimed at improving balance, strength, or functional mobility. Comparator groups included no intervention, traditional exercise, or standard care. Studies involving participants with neurological or cognitive disorders were excluded. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to calculate pooled mean differences (MD) and 95% confidence intervals (CI) for three primary outcomes Berg Balance Scale (BBS), Timed Up and Go (TUG), and Chair Stand (CS).

Results:

A total of 1063 records were identified, with 1023 screened after duplicate removal. Six studies met the inclusion criteria, involving 407 participants (mean age 75.2 ± 6.4 years), of whom 198 were allocated to VR interventions and 159 to control groups. VR interventions lasted a mean of 13.3 ± 7.7 weeks, with an average of 39.6 ± 5.2 sessions lasting 25.3 ± 5 minutes. Methodological quality was high in five studies (mean PEDro score = 5.6 ± 1.3). Four studies were included in the meta-analysis. Significant improvements were observed in balance, as measured by the BBS (mean difference = 3.62; 95% CI 2.29–4.95; P < 0.001; I² = 0%). No significant effects were found for mobility (TUG: MD = -0.37; 95% CI -1.16 to 0.41; P = 0.35; I² = 0%) or strength (Chair Stand: MD = -0.20; 95% CI -1.70 to 1.29; P = 0.79; I² = 21%).

Conclusions:

VR-based training appears effective in improving balance in frail and pre-frail older adults, but its impact on strength and mobility remains inconclusive. These inconsistencies may be attributed to differences in intervention type, progression, and outcome measures. Future research should focus on optimizing VR program design and exploring long-term adherence and functional outcomes. Clinical Trial: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023478330