Table 2.
Summary of findings table.
| Outcomes assessed; study | Key findings | Grading of recommendations, assessment, development, and evaluationa |
| Pain management; Benham [53] | Between presession 1 and postsession 12 VRb sessions, there were significant improvements in pain scores with a large effect size (−1.54, 95% CI −2.50 to −0.58; P=.002; Effect size >0.8=large effect). | Moderate |
| Quality of life; Benham [53] | WHOQOL-BREFc did not find any significant differences over 6 weeks of VR therapy on overall health (−0.06, 95% CI −0.91 to 0.78; P=.66), no significant differences on overall physical health (0.41, −0.45 to 1.26; P=.08), no significant differences on social life (0.08, 95% CI −0.77 to 0.93; P=.87), and no significant differences on overall psychological health (0.33, 95% CI −0.52 to 1.18; P=.15). | Moderate |
| Posture; Gago [54] | The ADd faller group had a higher power regarding use of mechanical properties of oscillation for postural adjustments compared with the control group, alluding to worse postural stability in this group (−4 to 0s: P=.02; 0 to 4s: P=.01; and 4 to 8s: P=.008). AD participants had a time lag in cognitive strategies for postural correction compared with healthy subjects (−4 to 0s: P=.002; 0 to 4s: P=.01). | Moderate |
| Falls; Gago [54] | The AD fallers groups had a delayed reaction time for changes in power compared with the control group, with a change in power seen only in the last interval (0 to 4s vs 4 to 8s; LBe P=.008; HBf P=.01). | Moderate |
| Falls; Levy [55] | There were statistically significant differences between the 2 groups for fear of falling scores. Fear of falling scores over the 12 weeks reduced by 2.78 (SD 4.82) in the VR group and increased by 4.14 (SD 4.30) in the control group (P=.007). | Moderate |
| Falls; Parijat [57,58] | VR training led to significantly better balance on slippery surfaces with VR therapy reducing slip distance (slip distance 1: F1,18=10.34, P=.01; slip distance 2: F1,18=5.27, P=.03), reducing peak slide heel velocity (F1,18=4.54, P=.05), and reducing peak trunk extension post slip (F1,18=12.46, P=.01). Slip distance 1 and 2 are the anterior-posterior distance traveled (in cm, based on the location of the heel) from the start of the slip to when heel acceleration peaks (slip distance 1) and then from this point until the heel velocity peaks (distance 2) VR with the treadmill supported realistic walking gait after 15 to 20 min (step duration: F6,76=10.56, P=.002; step width: F6,76=9.56, P=.02). There were no significant effects on ankle, hip, or knee kinematics. | Moderate |
| Memory and cognitive function; Optale [56] | Combining music therapy with exploration of spatial and personally relevant environments in VR led to improved memory (F2,58=17.40; P<.001) and general cognitive functions (MMSEg scores F2,58=23.01, P<.001; mental status in neurology score F2,58=30.16, P<.001); executive function (cognitive estimation test group difference: F1,29=11.12, P=.002; dual task performance test group and time interaction: F2,58=10.92, P<.001; phonemic verbal fluency test group and time interaction: F2,58=14.6, P<.001); verbal memory (digital span test group and time interaction F2,58=17.4, P<.001; verbal story recall test group and time interaction F2,58=36.66, P<.001), but not in spatial abilities (F2,58=3.14, P=.05). | Low |
| Memory and cognitive function; White [59] | Navigation errors reduced during VR training, but there may be no strong positive effect on overall cognitive ability. | Low |
| Disability; Levy [55] | There were no significant differences in social life (P=.18) or family life (P=.12) impact from functional impairment between the VR exposure therapy group and the waiting-list group. | Moderate |
| Daily living; Optale [56] | There were no significant differences of VR therapy on daily living tasks (Activities of Daily living 2,58=1.5, P=.23; Instrumental Activities of Daily Living F2,58=1.05, P=.36). | Moderate |
| Anxiety; Levy [55] | There were statistically significant differences between the 2 groups’ mean state anxiety scores. The mean state anxiety score reduced by 8.86 (SD 14.46) in the VR group and increased by 9.80 (4.66) in the control group (P=.005). There were no significant differences in trait anxiety scores between the groups (P=.24). | Moderate |
| Depression; Benham [53] | There were no significant differences in PROMISh scores (0.29, 95% CI −1.14 to 0.56; P=.33). | Moderate |
| Depression; Levy [55] | There were no significant differences in Beck Depression Inventory scores between the VR and control groups (P=.47). | Moderate |
| Depression; Optale [56] | The participants receiving VR therapy had a reduced depression value on the Geriatric Depression Scale after the initial VR session (F1,29=5.61; P=.02), but not after the booster VR session (F1,29=1.35; P=.25). | Moderate |
aGRADE assessment reported per outcome, not per study.
bVR: virtual reality.
cWHOQOL-BREF: World Health Organization Quality of Life Scale Brief Version.
dAD: Alzheimer disease.
eLB: low-frequency band within kinematic time-frequency analysis.
fHB: high-frequency band within kinematic time-frequency analysis.
gMMSE: mini-mental state examination.
hPROMIS: patient-reported outcomes measurement information system.