Virtual reality therapy can improve balance in patients: Meta-analysis

Rehabilitation therapy that utilizes virtual reality can help to improve balance and reduce the fear of falling for people with multiple sclerosis (MS), a new analysis shows.

“Our findings provide support to the use of [virtual reality-based therapy] to recover balance in neurological diseases such as MS,” researchers wrote.

The study, “Virtual reality-based therapy improves balance and reduces fear of falling in patients with multiple sclerosis. a systematic review and meta-analysis of randomized controlled trials,” was published in the Journal of NeuroEngineering and Rehabilitation.

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Balance problems common in MS

Problems with balance are a common symptom of MS — most people with the disease experience balance problems at some point, and this symptom can cause substantial issues in daily life.

Rehabilitation therapy is often helpful for managing symptoms like balance problems. In recent years, there has been increasing interest among clinicians about whether virtual reality could be used as a tool to help with rehabilitation.

The term “virtual reality” here broadly refers to any rehabilitation setup that involves the participant interacting with a computer-generated environment. Virtual reality may be immersive — involving a headset worn by the patient that provides a 360-degree view of the computer-generated environment — but it’s more common in rehabilitation setups to use non-immersive forms of virtual reality, where participants are interacting with an environment shown to them on a computer screen.

Non-invasive forms of virtual reality are “based in the use of computers or game-stations, which allow the patients to visualize and interact with the [two-dimensional] environments projected onto a screen, using devices like keyboards, mice, and manual controllers,” the researchers wrote.

Interacting with these artificial environments “can promote the reorganization of sensorimotor circuits, resulting in an improvement of postural balance and motor skills necessary to maintain dynamic balance,” they added.

A team of scientists in Spain conducted a meta-analysis of clinical trials that had tested virtual reality-based interventions for balance problems in MS. A meta-analysis is a type of study where scientists pool data from multiple previously published studies and analyze them collectively.

Our findings provide support to the use of [virtual reality-based therapy] to recover balance in neurological diseases such as MS.

Meta-analysis of 19 studies that mostly tested non-immersive virtual reality

This meta-analysis covered a total of 19 studies published over the last decade. These studies included a total of 858 people with MS, with a mean age of 43.4 years, and most studies tested non-immersive forms of virtual reality against a control intervention.

“The current study provides the most comprehensive meta-analysis to date aimed at assessing the effect of VRBT [virtual reality-based therapy] on balance and its different dimensions,” the researchers wrote.

Results broadly suggested the virtual reality rehabilitation was effective for improving patients’ functional balance. For example, the average score on the Berg Balance Scale (BBS), which measures a person’s ability to balance while doing a series of predefined activities (standing, reaching forward, etc.), improved by more than three points compared with the control.

Comparing different studies suggested that the best BBS outcomes were achieved with virtually reality interventions that involved 40-to-45-minute sessions, conducted five times per week for eight weeks (for a total of 40 sessions). The best improvements in measures of dynamic balance (that is, balance while moving), meanwhile, were seen for patients who received 20-to-30-minute sessions twice weekly for eight to 19 sessions.

“Findings reported in this study are clinically relevant and provide the most appropriate VRBT dose for treating functional and dynamic balance in” people with MS, the researchers wrote.

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Virtual reality therapy generally had positive effects on balance outcomes

Balance outcomes with virtual reality therapy were generally superior to outcomes for patients who received only conventional rehabilitation therapy, though researchers noted that not all studies did this type of comparison, so the ability to draw firm conclusions is limited.

The data also generally suggested virtual reality therapy had positive effects on patients’ postural control, confidence about their balance, and fear of falling. However, virtual reality therapy did not have any apparent effect on walking speed.

Overall, the findings support the use of virtual reality tools to help people with MS-related balance problems, the researchers said. They noted that non-invasive virtual reality therapy is accessible for most patients because they can do it at home.

The scientists also stressed that this meta-analysis is limited by the relatively limited number of trials available, and that all of them were relatively short, so more studies are needed to assess the long-term benefits.