REVIEW ARTICLE (META-ANALYSIS)| Volume 104, ISSUE 3, P490-501, March 2023

Can Virtual Reality-Assisted Therapy Offer Additional Benefits to Patients With Vestibular Disorders Compared With Conventional Vestibular Physical Therapy? A Meta-analysis

Published:October 17, 2022DOI:



      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,, 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%).


      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.


      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)
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