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Peer-reviewedCC BY 4.0Frontiers in Public Health

Comparative efficacy of different virtual reality-based interventions for static balance, dynamic balance, and fear of falling in older adults: a systematic review and network meta-analysis

  • Meng Tian1,2
  • Qiang Chen3
  • Tianwei Lou4
4 affiliations
  1. 1Shandong Institute of Sport Science
  2. 2Shandong University of Traditional Chinese Medicine
  3. 3Shandong Public Health Clinical Center
  4. 4Affiliated Hospital of Shandong University of Chinese Medicine
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Abstract

Background and objectives: Virtual reality (VR) is increasingly used to improve balance and reduce fear of falling in older adults, but comparative effectiveness of different VR types remains unclear. This network meta-analysis (NMA) aimed to compare and rank the efficacy of various VR interventions against usual care for static balance, dynamic balance, and fear of falling.

Methods: Two investigators independently searched Embase, PubMed, PsycINFO, Cochrane Library, CNKI, and VIP for RCTs published from inception to May 30, 2026. Eligible studies included older adults receiving VR versus usual care or active control, with outcomes measured by validated tools. Risk of bias was assessed using RoB 2. A random-effects consistency model was applied, using MDs or SMDs with 95% CIs.

Results: Nineteen RCTs (1,815 participants) were included. For static balance, Kinect (MD = 6.83, 95% CI: 1.78–11.89), IVR (6.80, 0.28–13.30), and Wii (3.89, 0.34–7.44) significantly outperformed UC; SUCRA rankings placed Kinect first (82.2%), followed by IVR (78.1%) and BTSNVR (56.8%). For dynamic balance, BTSNVR (SMD = −3.66, −5.22 to −1.20), Wii (−2.79, −3.93 to −1.66), Kinect (−1.87, −2.53 to −1.22), and AC (−1.66, −2.35 to −0.97) were superior to UC; SUCRA ranked BTSNVR best (87.5%), Wii (82.0%), and Kinect (57.1%). For fear of falling, only Kinect showed significant reduction (SMD = −3.52, −5.48 to −1.56), ranking highest (78.7%), with IVR (66.3%) and BTSNVR (60.9%) less effective. However, several comparisons were based on few studies, so findings are preliminary.

Conclusion: Specific VR interventions offer distinct advantages: Kinect may benefit static balance and fear reduction, while BTSNVR improves dynamic balance. Rankings should be interpreted cautiously. Larger head-to-head RCTs with standardized protocols and longer follow-up are needed to validate these findings and establish clinical recommendations.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261464816 , CRD420261464816.

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Cite

BibTeXRIS
BibTeX
@article{tian2026comparative,
  title = {{Comparative efficacy of different virtual reality-based interventions for static balance, dynamic balance, and fear of falling in older adults: a systematic review and network meta-analysis}},
  author = {Meng Tian and Qiang Chen and Tianwei Lou},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1973306},
  url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1973306/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Comparative efficacy of different virtual reality-based interventions for static balance, dynamic balance, and fear of falling in older adults: a systematic review and network meta-analysis
AU  - Meng Tian
AU  - Qiang Chen
AU  - Tianwei Lou
PY  - 2026
DA  - 2026/10/20
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1973306
UR  - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1973306/full
AB  - Background and objectives: Virtual reality (VR) is increasingly used to improve balance and reduce fear of falling in older adults, but comparative effectiveness of different VR types remains unclear. This network meta-analysis (NMA) aimed to compare and rank the efficacy of various VR interventions against usual care for static balance, dynamic balance, and fear of falling.  Methods: Two investigators independently searched Embase, PubMed, PsycINFO, Cochrane Library, CNKI, and VIP for RCTs published from inception to May 30, 2026. Eligible studies included older adults receiving VR versus usual care or active control, with outcomes measured by validated tools. Risk of bias was assessed using RoB 2. A random-effects consistency model was applied, using MDs or SMDs with 95% CIs.  Results: Nineteen RCTs (1,815 participants) were included. For static balance, Kinect (MD = 6.83, 95% CI: 1.78–11.89), IVR (6.80, 0.28–13.30), and Wii (3.89, 0.34–7.44) significantly outperformed UC; SUCRA rankings placed Kinect first (82.2%), followed by IVR (78.1%) and BTSNVR (56.8%). For dynamic balance, BTSNVR (SMD = −3.66, −5.22 to −1.20), Wii (−2.79, −3.93 to −1.66), Kinect (−1.87, −2.53 to −1.22), and AC (−1.66, −2.35 to −0.97) were superior to UC; SUCRA ranked BTSNVR best (87.5%), Wii (82.0%), and Kinect (57.1%). For fear of falling, only Kinect showed significant reduction (SMD = −3.52, −5.48 to −1.56), ranking highest (78.7%), with IVR (66.3%) and BTSNVR (60.9%) less effective. However, several comparisons were based on few studies, so findings are preliminary.  Conclusion: Specific VR interventions offer distinct advantages: Kinect may benefit static balance and fear reduction, while BTSNVR improves dynamic balance. Rankings should be interpreted cautiously. Larger head-to-head RCTs with standardized protocols and longer follow-up are needed to validate these findings and establish clinical recommendations.  Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261464816 , CRD420261464816.
SN  - 2296-2565
ER  -