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Virtual reality balance training to improve balance and mobility in Parkinson’s disease: a systematic review and meta-analysis

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Abstract

Background

In the last few years, virtual reality (VR) has been increasingly used to strengthen the effect of balance training (BT) in Parkinson’s disease (PD).

Objective

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the effects of VR-BT relative to BT alone for improving balance and mobility PD subjects with balance/mobility difficulties.

Methods

Four electronic databases were searched: two reviewers independently selected RCTs, extracted data, and applied the Cochrane risk-of-bias tool for randomized trials (version 2) and the GRADE framework for assessing the certainty of evidence. Primary outcomes were balanced (Berg Balance Scale-BBS), mobility (Timed Up and Go-TUG) and walking speed. Secondary outcomes were falls, walking distance and stability, spatial gait parameters, balance confidence, sensory integration ability, motor signs and quality of life.

Results

We included 22 studies (901 patients). Meta-analysis on fourteen trials (430 patients) showed a mean difference (MD) of 2.09 points (95% confidence interval [CI] 0.86–3.33) on BBS favoring VR-BT compared to BT (low certainty evidence). Subgroup analyses showed higher balance improvement in most affected subjects (moderate certainty evidence) and using VR rehabilitation-specific systems vs. VR non-specific systems. Eight trials (236 patients) assessing mobility showed a MD of 1.55 s (95% CI 0.04–3.06) on TUG favoring VR-BT (very low certainty evidence). No differences were observed in walking speed. Estimated effects were not maintained for any outcome at follow-up.

Conclusions

This review suggests that VR-BT is more effective than BT to improve balance in PD subjects immediately after training, particularly in individuals with higher postural instability at baseline.

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Data availability

All data used in this review are available in the studies included that are reported in the results. Our search strategies for every database are reported in the supplementary materials.

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Funding

Italian Ministry of Health (MoH) Grant: Ricerca Finalizzata 2018 (GR-2018-12366005).

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Authors

Contributions

ES: research project: conception, organization, execution; statistical analysis: design, execution, review and critique; manuscript: writing of the first draft, review and critique. AG: research project: execution; statistical analysis: execution; manuscript: writing of the first draft, review and critique. AT: statistical analysis: review and critique; manuscript: review and critique. FA: statistical analysis: review and critique; manuscript: review and critique. MF: statistical analysis: review and critique; manuscript: review and critique. DC: research project: conception, organization, execution; statistical analysis: design, execution, review and critique; manuscript: writing of the first draft, review and critique.

Corresponding author

Correspondence to Massimo Filippi.

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Conflicts of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. E. Sarasso, A. Gardoni, A. Tettamanti, D. Corbetta have nothing to disclose. F. Agosta is Section Editor of NeuroImage: Clinical; received compensation for consulting services and/or speaking activities from Biogen Idec, Philips and Roche; and receives or has received research supports from the Italian Ministry of Health and the European Research Council. M. Filippi is Editor-in-Chief of the Journal of Neurology and Associate Editor of Human Brain Mapping; received compensation for consulting services and/or speaking activities from Almiral, Alexion, Bayer, Biogen, Celgene, Eli Lilly, Genzyme, Merck-Serono, Novartis, Roche, Sanofi, Takeda, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA).

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Sarasso, E., Gardoni, A., Tettamanti, A. et al. Virtual reality balance training to improve balance and mobility in Parkinson’s disease: a systematic review and meta-analysis. J Neurol 269, 1873–1888 (2022). https://doi.org/10.1007/s00415-021-10857-3

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