The influence of virtual reality head-mounted displays on balance outcomes and training paradigms: A systematic review

Pooya Soltani, Renato Andrade

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Background: Falls are the leading causes of (non)fatal injuries in older adults. The use of active video games as forms of virtual reality (VR) seems useful for both assessment and training of balance.
Purpose: Our aim was to investigate the validity, reliability, safety, feasibility, and efficacy of head mounted display (HMD) systems for assessing and training balance in older adults.
Methods: We searched the EBSCOhost, Scopus, Web of Science, and PubMed databases until 1 September 2020 to search for studies that used HMD systems for assessing or training balance. The methodological quality was assessed using a modified version of Downs and Black. We also appraised the risk of bias using Risk of Bias Assessment tool for Non-randomized Studies (RoBANS).
Results: A total of 39 trials (1207 participants) were included. Age ranges and clinical conditions were heterogeneous across the studies. Most studies were judged as having high risk of bias. Studies reported that VR HMD systems were valid to assess balance and that could be useful to improve postural control, gait pattern and fall prevention.
Conclusion: The VR HMD systems can offer ecologically valid scenarios to assess and train functional balance and can be used alone or in addition to other interventions. The risk of bias and overall quality of studies are poor and thus no definitive recommendations could be made on the effectiveness of HMD VR training in older adults.
Original languageEnglish
JournalFrontiers in Sports And Active Living
Publication statusAcceptance date - 31 Dec 2020


  • Head-mounted display
  • Posture
  • Vestibular
  • Somatosensory
  • Visual

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