Can virtual reality replace conventional vestibular rehabilitation tools in multisensory balance exercises for vestibular disorders? A non-inferiority study.

Participants and therapists could not be blinded to the equipment, although a blinded evaluator performed outcome assessments. All participants were hospitalized and able to stand unaided, so the results do not show what happens in patients who cannot stand unaided or are treated outside inpatient rehabilitation. Most participants had chronic vestibular disorders, and the study mixed unilateral, bilateral, functional, and other disorders, so it does not answer what VR does in specific subgroups. The comparison was made inside a full multidisciplinary program, so the result does not isolate the effect of any single component; it only compares VR versus conventional multisensory balance exercises within that program. Analysis numbers differed from randomized numbers: 76 were randomized, but per-protocol analysis included 31 VR and 34 control participants, and modified intention-to-treat analysis included 36 in each group. Exercises, dose, and intensity could vary because the trial was pragmatic, and confounding variables may still have influenced the result.

The only funding statement supplied is the Research and Innovation Department of the University Hospital Center of Montpellier. No competing-interest declaration is provided in the supplied text.

Do not conclude that VR is inferior or ineffective. The trial failed to show that VR was close enough to conventional equipment on the primary balance score, not that it was worse, and all participants received the same multidisciplinary program.