System Immersion in Virtual Reality-Based Rehabilitation of Motor Function in Older Adults: A Systematic Review and Meta-Analysis

Emil Rosenlund Høeg, Tina Myung Povlsen, Jon Ram Bruun-Pedersen, Belinda Lange, Niels Christian Nilsson, Kristian Birkemose Haugaard, Sune Mølgård Faber, Søren Willer Hansen, Charlotte Kira Kimby, Stefania Serafin

Publikation: Bidrag til tidsskriftReview (oversigtsartikel)peer review

19 Citationer (Scopus)
47 Downloads (Pure)


Background: As the elderly population continues to grow, so does the demand for new and innovative solutions to tackle age-related chronic diseases and disabilities. Virtual Reality (VR) has been explored as a novel therapeutic tool for numerous health-related applications. Although findings frequently favors VR, methodological shortcomings prevent clinical recommendations. Moreover, the term “VR” is frequently used ambiguously to describe e.g., video games; the distinction remains vague between immersive VR (IVR) systems and non-immersive VR (NVR). With no distinct demarcation, results of outcome measures are often pooled in meta-analyses, without accounting for the immersiveness of the system.

Objective: This systematic review focused on virtual reality-based rehabilitation of older adults (+60) in motor rehabilitation programs. The review aims to retrospectively classify previous studies according to the level of immersion, in order to get an overview of the ambiguity-phenomenon, and to utilize meta-analyses and subgroup analyses to evaluate the comparative efficacy of system immersion in VR-based rehabilitation.

Methods: Following PRISMA guidelines, we conducted a systematic search for randomized controlled trials, describing virtual rehabilitation or video games interventions for older adults (+60). Main outcomes were pain, motivation, mobility, balance, and adverse events.

Results: We identified 15 studies which included 743 patients. Only three studies utilized IVR. The rest used various NVR-equipment ranging from commercial products (e.g., Nintendo Wii), to bespoke systems that combine tracking devices, software, and displays. A random effects meta-analysis of 10 studies analyzed outcome measures of mobility, balance, and pain. Protocols and dosage varied widely, but outcome results were in favor of immersive and non-immersive interventions, however, dropout rates and adverse events were mostly in favor of the control.

Conclusions: We initialize a call-for-action, to distinguish between types of VR-technology and propose a taxonomy of virtual rehabilitation systems based on our findings. Most interventions use NVR-systems, which have demonstrably lower cybersickness-symptoms than IVR-systems. Therefore, adverse events may be under-reported in RCT-studies. An increased demand for IVR-systems highlight this challenge. Care should be given, when applying the results of existing NVR tools to new IVR-technologies. Future studies should provide more detail about their interventions, and future reviews should differentiate between NVR and IVR.
TidsskriftFrontiers in Virtual Reality
Antal sider18
StatusUdgivet - 12 apr. 2021

Bibliografisk note

Funding Information:
Many thanks to Professor Hanne Tønnesen and colleagues from WHO Collaborating Centre for Evidence-based Health promotion in Hospitals and Health Services, Frederiksberg for letting me attend the already full Ph.D.-Course on Systematic Review Techniques, 2018. Without that course, this review would not have happened. Funding. This systematic review was funded as a joined effort between Aalborg University and VihTek Research and Test Center for Health Technologies. The systematic review was written as part of a Ph.D. study undertaken by Emil Rosenlund Høeg, funded by the municipality of Frederiksberg.

Publisher Copyright:
Copyright © 2021 Høeg, Povlsen, Bruun-Pedersen, Lange, Nilsson, Haugaard, Faber, Hansen, Kimby and Serafin.


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