Virtual reality applications based on instrumental activities of daily living (iADLs) for cognitive intervention in older adults: a systematic review.

Only twelve of the nineteen studies were controlled trials, and not one of them concealed the allocation, so whoever enrolled a patient could have known which group came next. Much of the review rests on six pilot studies and one single case, designs that cannot show the virtual reality caused the change. The number of sessions, their length and their frequency varied enormously between studies, and so did the tests used to measure the outcome, so the results cannot be compared or added together. The studies were small: one had a single patient, the largest had 105, and the average was about 31 per study. All but two studies stopped measuring at the end of treatment, so nothing is known about whether the gains hold. The scale used most often to capture daily activities asks a questionnaire rather than watching the person perform the task, and the authors think it may be too insensitive to pick up real change. Participants ranged from cognitively healthy to dementia, so an average result across them may not describe any one patient. They averaged 8.5 years of formal education in the twelve studies that reported it, and most were women. The paper's own account of screening does not add up, reporting more articles excluded at the abstract stage than were examined, and a full-text count that does not match the number finally included. Stroke and traumatic brain injury were excluded by design, so nothing here applies to those patients.

No funding source and no competing interests are stated in the article text.

Do not read this as evidence that practising shopping or cooking in virtual reality makes an older person more independent at home. The improvements were on cognitive tests. Most of the studies that also measured instrumental daily activities found no change on them. The review never adds the studies together, so its positive conclusion is a count of studies that improved, not a measured amount of benefit.