Effect of Virtual Reality–Based Balance Training vs. Conventional Balance Training in Elderly at Risk of Falls

Abstract

Background: Falls are a major cause of morbidity, mortality, and reduced independence in older adults, with balance impairment serving as a key modifiable risk factor. Conventional balance training (CBT) has demonstrated benefits but is limited by poor engagement and adherence. Virtual Reality–based Balance Training (VRBT) has emerged as an innovative, interactive modality that may enhance both adherence and rehabilitation outcomes. Objective: To compare the effectiveness of VRBT versus CBT in improving balance, functional mobility, postural stability, and fall-related self-efficacy among elderly individuals at risk of falls in Pakistan. Methods: A randomized controlled trial was conducted at Therapy Plus Clinic, Lahore, enrolling 80 participants aged ≥60 years with fall risk (Berg Balance Scale [BBS] ≤45). Participants were randomized to VRBT or CBT for 45-minute supervised sessions, three times weekly, over six weeks. Outcomes included BBS, Timed Up and Go (TUG), Functional Reach Test (FRT), and Falls Efficacy Scale–International (FES-I). Data were analyzed using repeated-measures ANOVA, with significance set at p < 0.05. Results: Both groups improved significantly; however, VRBT yielded greater gains across all outcomes. Between-group differences favored VRBT in BBS (+4.4 points, p < 0.001), TUG (–1.7 seconds, p = 0.002), FRT (+3.6 cm, p < 0.001), and FES-I (–3.2 points, p = 0.004). Effect sizes ranged from moderate to large. Conclusion: VRBT was more effective than CBT in enhancing balance, mobility, and confidence, offering a scalable and engaging intervention for fall prevention in older adults.