Efficacy of Virtual Reality–Based Balance Training in Reducing Fall Risk Among Older Adults

Abstract

Background: Falls are a leading cause of morbidity and loss of independence in older adults, and conventional balance training, while beneficial, may be limited by low engagement and restricted ability to simulate real-world challenges. Immersive virtual reality (VR) offers a potentially more effective and engaging modality for balance rehabilitation. Objective: To compare the efficacy of VR-based balance training versus conventional balance training in improving balance, mobility, gait speed and fall risk among older adults in geriatric and rehabilitation units in Islamabad. Methods: In this single-centre randomized controlled trial, 60 adults aged ≥65 years at risk of falls were randomized to VR-based balance training (n = 30) or conventional balance training (n = 30) for 8 weeks (3 sessions/week, 40 minutes/session). Primary outcome was Berg Balance Scale (BBS). Secondary outcomes were Timed Up and Go (TUG), gait speed, composite fall risk score, Activities-specific Balance Confidence (ABC) score, fear of falling, and near-falls. Outcomes were assessed at baseline and 8 weeks by blinded assessors. Between-group differences in change were analysed using ANCOVA adjusted for baseline. Results: Compared with conventional training, VR training produced greater improvements in BBS (+7.2 vs +3.5 points; adjusted Δ +3.7, 95% CI 2.3–5.1; p < 0.001), TUG (−4.4 vs −2.1 s; Δ −2.3, 95% CI −3.3 to −1.3; p < 0.001), and gait speed (+0.20 vs +0.10 m/s; Δ +0.10, 95% CI 0.05–0.15; p < 0.001). Fall risk decreased more with VR (−19.8% vs −11.4%; Δ −8.4, 95% CI −12.2 to −4.6; p < 0.001), alongside larger gains in ABC and greater reductions in fear of falling and near-falls. Regression analysis showed VR training independently predicted a 7.8-point lower post-treatment fall risk score (p < 0.001). Conclusion: Immersive VR-based balance training is superior to conventional balance training for improving balance, mobility and fall-risk profiles in older adults in geriatric rehabilitation settings.