Effectiveness of Virtual Reality on Balance and Risk of Falls in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Abstract

The aim of this study was to systematically review the scientific evidence related to the physiotherapy interventions in neurorehabilitation that utilize virtual reality (VR) for balance training and risk of falls in people with multiple sclerosis (MS). A search was conducted in Medline (PubMed), PEDro, and Google Scholar to identify all the relevant studies. Clinical trials assessing the effects of VR in people with MS were included. Risk of bias was evaluated using the Cochrane Risk of Bias Tool and PEDro scale. Qualitative analysis was performed according to the GRADE. In total, 16 studies (n = 663) were included. The meta-analysis showed statistically significant differences for the VR intervention in comparison with conventional treatment for balance, with a moderate clinical effect in eight studies (SMD: 0.63; 95% CI 0.34-0.92; p < 0.05). In addition, the meta-analysis showed statistically significant differences for the VR intervention in comparison with conventional treatment for risk of falls, with a small clinical effect in six studies (SMD: -0.55; 95% CI -1.07-0.04; p < 0.05). VR-based treatments are more effective than non-intervention in improving balance and fall risk in people with MS, with a very low certainty of evidence. In addition, they also show to be more effective than conventional rehabilitation, with a very low certainty of evidence.

Keywords: balance; multiple sclerosis; neurorehabilitation; risk of falls; virtual reality.

Figure 1

PRISMA flowchart for selecting studies.

Figure 2

Risk of bias summary. Review authors’ judgements about each risk of bias item for each included study (Risk of Bias scale) and risk of bias graph. Review authors’ judgements about each risk of bias item presented as percentages across all included studies (Risk of Bias scale) [9,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53].

Figure 3

Synthesis forest plot of: (a) BSS variable (VR vs. conventional treatment); (b) BSS variable (VR vs. no-treatment); (c) TUG variable (VR vs. conventional treatment); (d) TUG variable (VR vs. no-treatment). The forest plot summarizes the results of the included studies (sample size, standardized mean differences (SMDs), and weight). The small boxes with the squares represent the point estimate of the effect size and sample size. The lines on either side of the box represent a 95% confidence interval (CI) [9,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53].