Dose-Response Relationship of Virtual Reality Training in Parkinson's Disease: A Meta-Analysis of Overall Motor Function, Functional Mobility, and Balance Confidence.
Dose-Response Relationship of Virtual Reality Training in Parkinson's Disease: A Meta-Analysis of Overall Motor Function, Functional Mobility, and Balance Confidence.
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
CN · Author affiliation · country only
Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China. Electronic address: 18273285993@163.com.Location evidence
MO · Author affiliation · country only
Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China. Electronic address: 18273285993@163.com.Location evidence
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Original abstract
ObjectiveTo investigate the dose-response relationship of virtual reality training (VRT) on overall motor function (Unified Parkinson's Disease Rating Scale Part III [UPDRS-III]), functional mobility (timed Up and Go [TUG]), and balance confidence (Activities-specific Balance Confidence [ABC] Scale) in individuals with Parkinson's disease (PD) to optimize rehabilitation protocols.Data sourcesA comprehensive literature search was conducted across 6 electronic databases-PubMed, Embase, Cochrane Library, Web of Science, EBSCOhost, and China National Knowledge Infrastructure -from inception to August 3, 2025.Study selectionA systematic search identified 31 randomized controlled trials (n=1110) evaluating the effects of VRT on balance capabilities and functional gait in patients with PD.Data extractionData were organized into 3 categories: bibliographic details, participant characteristics, and intervention specifics, along with quantitative data on TUG, UPDRS-III, and ABC scores. Data extraction was independently conducted by 2 reviewers, followed by cross-verification and adjudication.Data synthesisWeighted mean differences (WMDs) and univariate meta-regression were analyzed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. VRT significantly improved TUG (WMD=-3.69) and ABC scores (WMD=11.80), both of which met the minimal clinically important difference (MCID). VRT alone improved TUG but did not meet the MCID. No significant improvement was observed overall for UPDRS-III. Optimal TUG parameters were identified as 21-40 min/session and 4-7 sessions/wk for 6-8 weeks. High-frequency training (≥4 sessions/wk) was required for UPDRS-III benefits. Commercial and specialized platforms showed comparable efficacy.ConclusionsVRT significantly enhances TUG and ABC, particularly achieving clinical utility (MCID) when combined with physical therapy. While UPDRS-III effects are limited, high-frequency protocols show potential. A frequency of 4-7 sessions/wk was associated with clinically important improvements in TUG. Additionally, patients aged ≥70 years showed no statistical heterogeneity in their response to the intervention (I²=0%). However, this finding should be interpreted cautiously, as it is based on a small number of studies and may reflect limited statistical power rather than true clinical predictability.