Effects of Virtual Reality-Based Rehabilitation on Postural Balance in Older Adults: A Systematic Review

Abstract

Background: Population aging has been accompanied by an increased incidence of falls, fractures, and functional disability, representing a major global public health challenge. In this context, virtual reality (VR)-based rehabilitation has emerged as an innovative therapeutic strategy providing multimodal sensory and motor stimulation, facilitating motor learning, and enhancing treatment adherence through gamified, interactive environments. Objective: To investigate the effectiveness of VR-based rehabilitation on postural balance training in older adults through a systematic review. Methods: This systematic review was conducted in accordance with PRISMA 2020 and prospectively registered in PROSPERO (CRD420261303119). Comprehensive literature searches were performed in PubMed, Scopus, Web of Science, LILACS, and SciELO to identify studies published between 2015 and 2026. Randomized and non-randomized clinical trials evaluating VR rehabilitation in adults aged 60 years and older, with postural balance as the primary outcome, were eligible. Methodological quality was assessed using the PEDro Scale, and certainty of evidence was evaluated using GRADE. Data were synthesized using a qualitative, descriptive approach. Results: Nine clinical trials of moderate-to-good methodological quality were included, evaluating non-immersive commercial exergames, semi-immersive, and immersive rehabilitation-dedicated systems. Overall, findings indicated that VR was associated with improvements in static and dynamic balance and functional mobility. Between-group analyses showed no statistically significant differences between VR and conventional rehabilitation in several trials, whereas superior effects for VR were reported in others, alongside greater participant engagement and adherence. Conclusions: VR-based rehabilitation is an effective intervention for improving static and dynamic balance and functional mobility in older adults. As a complementary strategy in geriatric physiotherapy, VR has the potential to reduce fall risk, preserve functional independence, and enhance rehabilitation outcomes. Nevertheless, additional high-quality randomized controlled trials with standardized protocols and long-term follow-up are warranted to strengthen the current evidence.