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

Research output: Contribution to journalReview articlepeer-review

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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.
Original languageEnglish
Article number647993
JournalFrontiers in Virtual Reality
Number of pages18
Publication statusPublished - 12 Apr 2021

Bibliographical note

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


  • balance
  • functional mobility
  • immersive displays
  • older adults
  • pain
  • rehabilitation
  • systematic review
  • virtual reality


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