Effect of virtual reality training on dual-task performance in older adults: a systematic review and meta-analysis.

Only four studies contributed data for the dual-task cost outcomes, so those pooled estimates rest on a small evidence base. Several included studies had high risk of bias, mainly due to inadequate randomization or lack of blinding of participants and assessors. Many VR interventions bundled non-VR elements such as muscle-strengthening exercises, so the independent contribution of the virtual reality component cannot be isolated. Only 7% of participants were aged 60 to 64, and no age-stratified outcome data were available, so the findings say little about younger seniors. All included studies reported short-term outcomes; no data on whether benefits persist after training stops. Egger's test indicated possible publication bias (P = 0.019), and the trim-and-fill correction reduced the gait speed effect size by about a third. The authors note that the dual-task timed up-and-go improvement, while statistically significant, may fall below the 1.5-second minimal clinically important difference needed to meaningfully reduce fall incidence.

Funded by the College Students' Innovation and Entrepreneurship Training Program and the National Natural Science Foundation of China. No industry or device-manufacturer funding was declared.

Do not read this as proof that VR replaces conventional training for all older adults. In healthy older adults the gait speed benefit did not reach significance (P = 0.17). The strongest effects were in people with mild cognitive impairment or early Parkinson's, and cadence, reaction time, and fast-walking speed showed no benefit in any group. The overall certainty of evidence is rated moderate-to-low by the authors.