Effects of Virtual Reality Based on Fall Prevention Intervention: A Systematic Review and Meta-Analysis

Abstract

Background/Objectives: Falls are recognized as a leading cause of injury, with approximately one in ten incidents resulting in physical injury. Although virtual reality (VR)-based interventions have been explored for fall prevention, systematic reviews and meta-analyses remain limited. This study aimed to assess research trends and evaluate the effectiveness of VR-based fall prevention through a systematic review and meta-analysis. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was carried out in PubMed, EBMASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Korean databases from their inception through 31 December 2024. A total of 49 studies met the inclusion criteria, and a meta-analysis was conducted on 37 studies with available data using "R" 4.4.1 software. Effect sizes (ESs) and 95% confidence intervals (CIs) were calculated for key outcomes. Results: The VR-based interventions showed a statistically significant positive effect on falls self-efficacy, as measured by the Falls Efficacy Scale (FES) (ES = 0.28, 95% CI: 0.17-0.39, p < 0.001). However, no significant reduction was observed in the number of falls (ES = -0.31, 95% CI: -0.80-0.17, p = 0.20). Subgroup analysis by participant medical condition for the FES revealed the largest effects in the Parkinson's disease (PD) group (ES = 0.61), followed by the multiple sclerosis (MS) (ES = 0.34), the "other" group (ES = 0.25), and "healthy" participants (ES = 0.24). A statistically significant reduction in the number of falls was observed only in the MS group (ES = -0.56). Conclusions: VR-based interventions are effective in improving falls self-efficacy, particularly among individuals with neurological conditions, such as Parkinson's disease and multiple sclerosis. However, evidence for a reduction in actual fall incidence remains limited. Further large-scale, long-term studies are needed to evaluate the sustained impact of VR interventions on fall prevention outcomes.

Keywords: fall efficacy scale; fall prevention; number of falls; systematic review; virtual reality.

Figure 1

Study selection flow diagram.

Figure 2

Risk of bias assessment of the included studies. (A) Randomized studies; (B) non-randomized studies [15,16,17,18,19,20,21,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71].

Figure 3

Forest plot of the effect of VR-based fall prevention intervention on the FES score and the number of falls. (A) Falls Efficacy Scale score. (B) Number of falls [15,17,19,21,31,32,34,35,36,38,39,40,41,42,43,45,46,48,50,52,53,54,55,56,58,59,60,61,62,63,65,66,67,68,69,70,71].

Figure 3

Forest plot of the effect of VR-based fall prevention intervention on the FES score and the number of falls. (A) Falls Efficacy Scale score. (B) Number of falls [15,17,19,21,31,32,34,35,36,38,39,40,41,42,43,45,46,48,50,52,53,54,55,56,58,59,60,61,62,63,65,66,67,68,69,70,71].

Figure 4

Forest plot of the effect of VR-based fall prevention intervention on the number of interventions. (A) Falls Efficacy Scale score. (B) Number of falls [15,17,19,21,31,32,34,35,36,38,39,40,41,42,43,45,46,48,50,52,53,54,55,56,58,59,60,61,62,63,65,66,67,68,69,70,71].

Figure 4

Forest plot of the effect of VR-based fall prevention intervention on the number of interventions. (A) Falls Efficacy Scale score. (B) Number of falls [15,17,19,21,31,32,34,35,36,38,39,40,41,42,43,45,46,48,50,52,53,54,55,56,58,59,60,61,62,63,65,66,67,68,69,70,71].

Figure 5

Forest plot of the effect of VR-based fall prevention intervention immediately after and at the follow-up. (A) Falls Efficacy Scale score. (B) Number of falls [15,17,19,21,31,32,34,35,36,38,39,40,41,42,43,45,46,48,50,52,53,54,55,56,58,59,60,61,62,63,65,66,67,68,69,70,71].

Figure 6

Funnel plot for (A) the FES and (B) the number of falls.