Objective: The aim of this study was to assess if a VR-BT relative to BT alone is more effective to improve balance and mobility in PD subjects with balance/mobility difficulties.

Background: Previous studies demonstrated that balance exercises improve postural instability in Parkinson’s disease subjects (PD). In the last few years, virtual reality (VR) has been increasingly used to strengthen the effect of balance training (BT) in PD.

Method: 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 balance (assessed with Berg Balance Scale-BBS), mobility (assessed with 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.
Random effect meta-analyses on primary outcomes were conducted according to severity of balance and mobility deficits at study entry and according to VR modalities used.

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 the 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 seconds (95% CI= 0.04-3.06) on the TUG favoring VR-BT compared to BT (very low certainty evidence). No differences were observed on walking speed. Estimated effects were not maintained for any outcome at follow-up.

Conclusion: 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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MDS Abstracts - https://www.mdsabstracts.org/abstract/virtual-reality-for-balance-and-mobility-in-parkinsons-disease-systematic-review-and-meta-analysis/