Home-Based Virtual Reality Training for Enhanced Balance, Strength, and Mobility Among Frail Older Adults: A Systematic Review and Meta-Analysis (Preprint)

Abstract

BACKGROUND Frailty is a significant concern for older adults, it involves a decline in physiological systems, leading to increased vulnerability to falls, hospitalization, and mortality, necessitating effective interventions and one promising approach is the use of Virtual Reality (VR)-based exercises. OBJECTIVE To systematically review all published studies investigating the effect of VR as a home-based training modality to improve balance, strength, and mobility in frail and pre-frail older adults. METHODS Data Source: Three databases were searched, Scopus, Web of Science, and PubMed, from inception to November 2023. Eligibility Criteria: Frail and pre-frail older adults aged 65+. Interventions were any VR training. Outcome measures were balance, strength and functional mobility as measured by any validated outcome measure. RESULTS Results: Six articles were included, involving 407 participants with a mean age of 68 ±4.4 years. The mean duration of VR sessions was 13.3 ±7.7 weeks, mean total number of sessions was 39.6 ±5.2 sessions, and the mean length of each session was 25.3 ±5 minutes. Meta-Analysis: VR group demonstrated significant improvements on the Berg Balance Scale compared to both traditional exercise and control groups (mean difference [MD] = 3.62; 95% confidence interval [CI] 2.29 to 4.95; P < 0.001; I2 = 0%). However, non-significant effects were found on Timed Up and Go and Chair Stand tests. Limitation: Definitive judgement on VR effect on frail and pre-frail older adults is limited due to heterogeneity in interventions, training duration, and outcome measures. CONCLUSIONS Conclusion: VR training enhances balance but yields inconsistent effects on strength and mobility. Further research is required to refine VR interventions for frail older adults. CLINICALTRIAL Registration Systematic Review: PROSPERO registration number: CRD42023478330.