Abstract
Objective
To determine whether virtual reality-assisted therapy (VRAT) significantly improves
the treatment of peripheral or central vestibular disorders when compared with conventional
vestibular physical therapy (CVPT) alone. Indicators of vestibular symptoms are used
to determine this.
Data Sources
Two reviewers independently searched PubMed, EMBASE, ClinicalTrials.gov, Web of Science,
and the Cochrane Collaboration database from January 2010 to January 2022 for studies
reporting on VRAT in vestibular disorders.
Study Selection
Randomized controlled trials (RCTs) were included that mainly focused on the following
measures: the Dizziness Handicap Inventory (DHI), Simulator Sickness Questionnaire,
visual analog scale, and balance measures such as the Activities-specific Balance
Confidence Scale (ABC), timed Up and Go test, sensory organization test, and center
of pressure. The primary outcome was assessment of symptomatic changes before and
after VRAT.
Data Extraction
Two authors independently conducted the literature search and selection. After screening,
meta-analysis was performed on the RCTs using RevMan 5.3 software.
Data Synthesis
The results showed that VRAT produced significantly greater improvement than CVPT
alone in scores of DHI-Total (standardized mean difference [SMD]: -7.09, 95% confidence
interval [CI]: [-12.17, -2.00], P=.006), DHI-Functional (SMD=-3.66, 95% CI: [-6.34, -0.98], P=.007), DHI-Physical (SMD=-3.14, 95% CI: [-5.46, -0.83], P=.008), and DHI-Emotional (SMD=-3.10, 95% CI: [-5.13, -1.08], P=.003). ABC scores did not show improvement (SMD: 0.58, 95% CI: [-3.69, 4.85], P=.79). Subgroup analysis showed that DHI-Total between-group differences were insignificant
for central vestibular disorders (SMD=-1.47, 95% CI: [-8.71, -5.78], P=.69), although peripheral disorders showed significant improvements (SMD=-9.58, 95%
CI: [-13.92, -5.25], P<.0001). However, the included studies showed high heterogeneity (I2>75%).
Conclusions
VRAT may offer additional benefits for rehabilitation from vestibular diseases, especially
peripheral disorders, when compared with CVPT alone. However, because of high heterogeneity
and limited data, additional studies with a larger sample size and more sensitive
and specific measurements are required to conclusively determine the evidence-based
utility of virtual reality.
Keywords
List of abbreviations:
ABC (Activities-specific Balance Confidence Scale), CI (confidence interval), COP (center of pressure), CVPT (conventional vestibular physical therapy), DHI (Dizziness Handicap Inventory), MS (multiple sclerosis), mTBI (mild traumatic brain injury), PPPD (persistent postural-perceptual dizziness), RCT (randomized controlled trial), SMD (standardized mean difference), SOT (sensory organization test), SSQ (Simulator Sickness Questionnaire), TREND (Transparent Reporting of Evaluations with Nonrandomized Designs statement), TUG (Timed Up and Go test), VAS (visual analog scale), VPT (vestibular physical therapy), VR (virtual reality), VRAT (virtual reality-assisted therapy), VRDQ (Vision-related Dizziness Questionnaire), VVAS (Visual Vertigo Analog Scale)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Virtual reality vestibular rehabilitation in 20 patients with vertigo due to peripheral vestibular dysfunction.Med Sci Monit. 2020; 26e930182
- Falls and vestibular impairment.Clin Otolaryngol Allied Sci. 2004; 29: 179-182
- Advances in vestibular rehabilitation.Adv Oto-Rhino-Laryngol. 2019; 82: 164-169
- Efficacy of vestibular rehabilitation in patients with neurologic disorders: a systematic review.Arch Phys Med Rehabil. 2021; 102: 1379-1389
- Vestibular rehabilitation for peripheral vestibular hypofunction: an updated clinical practice guideline from the Academy of Neurologic Physical Therapy of the American Physical Therapy Association.J Neurol Phys Ther. 2022; 46: 118-177
- Vestibular rehabilitation: advances in peripheral and central vestibular disorders.Curr Opin Neurol. 2019; 32: 137-144
- Treatment of persistent postural-perceptual dizziness (PPPD) and related disorders.Curr Treat Options Neurol. 2018; 20: 50
- Multimodal treatment of persistent postural-perceptual dizziness.Brain Behav. 2020; 10: e01864
- Effects of vestibular rehabilitation in the management of patients with and without vestibular migraine.Braz J Otorhinolaryngol. 2021 Oct 25; ([Epub ahead of print])
- Effectiveness of vestibular training for balance and dizziness rehabilitation in people with multiple sclerosis: a systematic review and meta-analysis.J Clin Med. 2020; 9: 590
- Advantages of virtual reality in the rehabilitation of balance and gait.Neurology. 2018; 90: 1017
- Vestibular rehabilitation following mild traumatic brain injury.NeuroRehabilitation. 2013; 32: 519-528
- Virtual and augmented reality in the vestibular rehabilitation of peripheral vestibular disorders: systematic review and meta-analysis.Sci Rep. 2021; 11: 17843
- Immersion of virtual reality for rehabilitation—review.Appl Ergon. 2018; 69: 153-161
- Motor rehabilitation using virtual reality.J Neuroeng Rehabil. 2004; 1: 10
- Interaction between vestibular compensation mechanisms and vestibular rehabilitation therapy: 10 recommendations for optimal functional recovery.Front Neurol. 2014; 5: 285
- Virtual reality experiences, embodiment, videogames and their dimensions in neurorehabilitation.J Neuroeng Rehabil. 2018; 15: 113
- Modulation of cortical activity in 2D versus 3D virtual reality environments: an EEG study.Int J Psychophysiol. 2015; 95: 254-260
- Top-down approach to vestibular compensation: translational lessons from vestibular rehabilitation.Brain Res. 2012; 1482: 101-111
- The effect of visual-vestibulosomatosensory conflict induced by virtual reality on postural stability in humans.J Med Investig. 2013; 60: 236-239
- The effect of virtual reality-based balance training on motor learning and postural control in healthy adults: a randomized preliminary study.Biomed Eng Online. 2018; 17: 124
- Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review.J Physiother. 2015; 61: 117-124
- Virtual reality and motor imagery: promising tools for assessment and therapy in Parkinson's disease.Mov Dis. 2013; 28: 1597-1608
- The potential of virtual reality and gaming to assist successful aging with disability.Phys Med Rehabil Clin North Am. 2010; 21: 339-356
- Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials.J Anxiety Disord. 2019; 61: 27-36
- Inferiority or even superiority of virtual reality exposure therapy in phobias?—a systematic review and quantitative meta-analysis on randomized controlled trials specifically comparing the efficacy of virtual reality exposure to gold standard in vivo exposure in agoraphobia, specific phobia, and social phobia.Front Psychol. 2019; 10: 1758
- Virtual reality in multiple sclerosis rehabilitation: a review on cognitive and motor outcomes.J Clin Neurosci. 2019; 65: 106-111
- Immersive virtual reality and persons with dementia: a literature review.J Gerontol Soc Work. 2020; 63: 209-226
- Neuroscience of virtual reality: from virtual exposure to embodied Mmdicine.Cyberpsychol Behav Soc Network. 2019; 22: 82-96
- Factors associated with dynamic balance in people with persistent postural perceptual dizziness (PPPD): a cross-sectional study using a virtual-reality four square step test.J Neuroeng Rehabil. 2021; 18: 55
- Brain responses to virtual reality visual motion stimulation are affected by neurotic personality traits in patients with persistent postural-perceptual dizziness.J Vestib Res. 2018; 28: 369-378
- Virtual reality for vestibular rehabilitation: a systematic review.Otol Neurotol. 2021; 42: 967-977
- Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement.Am J Public health. 2004; 94: 361-366
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: d5928
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- Estimating postural control with the balance rehabilitation unit: measurement consistency, accuracy, validity, and comparison with dynamic posturography.Arch Phys Med Rehabil. 2014; 95: 65-73
- Use of virtual reality tools for vestibular disorders rehabilitation: a comprehensive analysis.Adv Med. 2015; 2015916735
- Effect of vestibular exercise and optokinetic stimulation using virtual reality in persistent postural-perceptual dizziness.Sci Rep. 2021; 11: 14437
- Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial.Int J Rehabil Res. 2017; 40: 325-332
- The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study.J Vestib Res. 2012; 22: 273-281
- Vestibular rehabilitation in older adults with and without mild cognitive impairment: effects of virtual reality using a head-mounted display.Arch Gerontol Geriatr. 2019; 83: 246-256
- Virtual reality is a feasible intervention platform in multiple sclerosis: a pilot protocol and acute improvements in affect.Mult Scler J Exp Transl Clin. 2021; 7 (20552173211006139)
- Three-dimensional, virtual reality vestibular rehabilitation for chronic imbalance problem caused by Meniere’s disease: a pilot study.Disabil Rehabil. 2017; 39: 1601-1606
- Vestibular rehabilitation with virtual reality in Ménière’s disease.Braz J Otorhinolaryngol. 2013; 79: 366-374
- Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction: a 12-month follow-up of a randomized controlled trial.Clin Rehabil. 2019; 33: 24-33
- Evaluation of the effectiveness of immersive virtual reality-based exercise system for vestibular rehabilitation.Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020; 34: 447-451
- Vestibular rehabilitation using the Nintendo® Wii Balance Board—a user-friendly alternative for central nervous compensation.Acta Oto-laryngol. 2013; 133: 239-245
- Customised vestibular rehabilitation with the addition of virtual reality based therapy in the management of persistent postural-perceptual dizziness.J Laryngol Otol. 2021; 135: 887-891
- Evaluation of the effectiveness of a Virtual Reality-based exercise program for Unilateral Peripheral Vestibular Deficit.J Vestib Res. 2018; 28: 409-415
- Interactive 3-dimensional virtual reality rehabilitation for patients with chronic imbalance and vestibular dysfunction.Technol Health Care. 2014; 22: 915-921
- Contextual sensory integration training via head mounted display for individuals with vestibular disorders: a feasibility study.Disabil Rehabil Assist Technol. 2020; : 1-11
- Applying modern virtual and augmented reality technologies to medical images and models.J Digit Imaging. 2019; 32: 38-53
- Cortical correlate of spatial presence in 2D and 3D interactive virtual reality: an EEG study.Int J Psychophysiol. 2012; 83: 365-374
- Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial.Arch Phys Med Rehabil. 2015; 96 (e1): 1319-1328
- Discussion of the dizziness handicap inventory.J Vestib Res. 2013; 23: 271-277
- Effectiveness of conventional versus virtual reality-based vestibular rehabilitation exercises in elderly patients with dizziness: a randomized controlled study with 6-month follow-up.Braz J Otorhinolaryngol. 2021 Oct 26; ([Epub ahead of print])
- Motion sickness diagnostic criteria: Consensus Document of the Classification Committee of the Bárány Society.J Vestib Res. 2021; 31: 327-344
- External validation of abbreviated versions of the activities-specific balance confidence scale in Parkinson's disease.Mov Disord. 2010; 25: 485-489
- Effect of vestibular exercise and optokinetic stimulation using virtual reality in persistent postural-perceptual dizziness.Sci Rep. 2021; 11: 14437
- Feasibility and measurement properties of the functional reach and the timed up and go tests in the Canadian study of health and aging.J Gerontol A. 2000; 55: M70-M73
- Vestibular tests for rehabilitation: applications and interpretation.NeuroRehabilitation. 2011; 29: 143-151
- A conceptual framework for the progression of balance exercises in persons with balance and vestibular disorders.Phys Med Rehabil Int. 2015; 2: 1044
- Cortical correlate of spatial presence in 2D and 3D interactive virtual reality: an EEG study.Int J Psychophysiol : official journal of the International Organization of Psychophysiology. 2012; 83: 365-374
- Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy.PloS One. 2014; 9: e93318
Article info
Publication history
Published online: October 17, 2022
Accepted:
August 16,
2022
Received in revised form:
August 10,
2022
Received:
April 1,
2022
Footnotes
The study was supported by Natural Science Foundation of Beijing, Grant No. 7222237, on the mechanism of the central static compensation-related cerebellum-medial vestibular nucleus nerve pathway in unilateral peripheral vestibular disease (UPVD).
Systematic Review Registration No.: CRD42022297817.
Disclosures: None.
Chu, Song, and Zhou contributed equally to this work and shared the co-first authorship.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
