Duque 2013.

Methods	Study design: RCT Number of study arms: 2 Length of follow‐up: 9 months
Participants	Setting: Penrith, Australia Number of participants: 60 Number analysed: 60 Number lost to follow‐up: 0 Sample: community‐dwelling people attending the Falls and Fractures Clinic, Nepean Hospital Age (years): Intervention mean = 79.33 (SD 10), control mean = 75 (SD 8) Sex: 62% female Inclusion criteria: fallen within 6 months of assessment, poor performance in balance assessed using posturography component of the Balance Rehabilitaion Unit (BRU) virtual reality system Exclusion criteria: severe visual impairment, inability to walk independently with a cane or walker, inability to stand unaided for 60 secs, score of < 22/30 in MMSE, PD or any neuromuscular conditions, Geriatric Depression Scale (GDS) > 8/15, inability to understand or answer the study questionnaires
Interventions	1. Virtual reality balance training: performed in standing, 30‐minute session, 2 a week, 6 weeks 2. Control group: usual care, general recommendations and care plan on falls prevention
Outcomes	1. Rate of falls
Duration of the study	36 weeks
Adherence	Adherence not defined. Proportion that progressed through levels reported: 1. Virtual reality balance training group: 97%; most of the participants (91%) reached ≥ 10/15 possible levels in every group of virtual exercises
Notes	Source of funding: Nepean Medical Research Foundation, Department of Geriatric Medicine at Nepean Hospital Economic information: not reported Email communication regarding fall data, response received, data not included in review
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information to permit judgement
Allocation concealment (selection bias)	Unclear risk	Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Participants and personnel not blinded to allocated group, but impact of non‐blinding unclear
Blinding of outcome assessment (detection bias) Falls	Low risk	Fall outcomes were recorded using the same method in both groups Quote: "to prevent any assessment bias, different physiotherapists with no access to the subjects’ data were specifically assigned to perform either assessment or training"
Blinding of outcome assessment (detection bias) Fractures	Unclear risk	Not applicable
Blinding of outcome assessment (detection bias) Hospital admission, medical attention and adverse events	Unclear risk	Not applicable
Blinding of outcome assessment (detection bias) Health related quality of life (self report)	Unclear risk	Not applicable
Incomplete outcome data (attrition bias) Falls and fallers	Low risk	No missing fall data
Selective reporting (reporting bias)	High risk	Fall data were collected but number of fallers was not reported. Adverse events not reported
Method of ascertaining falls (recall bias)	High risk	The occurrence of falls was retrospectively assessed by asking the participant (1) whether they have suffered a fall, and (2) the number of falls during the 6 months prior to the assessment