Effectiveness of a virtual reality-based balance training program on fall risk reduction in elderly patients with stroke: a randomized controlled trial

Project Abstract

This randomized controlled trial investigates the effectiveness of a virtual reality (VR)-based balance training program in reducing fall risk among elderly stroke survivors. A total of 120 participants aged 65 years and above, within six months to two years post-stroke, were recruited from three rehabilitation centers and randomized into two groups VR-based balance training (n=60) and conventional balance training (n=60). The intervention group engaged in thrice-weekly, 45-minute VR sessions for 12 weeks using an immersive motion-tracking platform designed to challenge dynamic balance, postural control, and gait adaptability in a progressively graded manner. The control group received standard conventional balance and gait therapy matched for frequency and duration. Primary outcomes were fall incidence over a 6-month follow-up, assessed via monthly fall diaries and corroborated by telephonic interviews, and changes in postural sway measured by a force platform during static and dynamic ( Limits of Stability) tasks. Secondary outcomes included gait speed (measured by the 10-meter walk test), functional balance (Timed Up and Go test and Berg Balance Scale), fear of falling (Falls Efficacy Scale-International), and quality of life (Stroke-Specific Quality of Life Scale). Assessments occurred at baseline, immediately post-intervention, 3 months, and 6 months post-intervention. Data were analyzed on an intention-to-treat basis using mixed-effects models to account for repeated measures and potential intra-individual variability, with adjustments for baseline characteristics such as age, sex, time since stroke, motor impairment level, and comorbidities. The VR group demonstrated a statistically significant reduction in fall rates over the 6-month follow-up compared with the control group (rate ratio 0.54, 95% CI 0.35–0.83, p=0.004). Postural sway measures showed greater improvement in the VR group, including reduced mediolateral sway during quiet stance and enhanced limits of stability excursion during dynamic tasks (p<0.01). Gait speed improved more in the VR cohort (mean difference 0.12 m/s, 95% CI 0.05–0.19, p=0.001), and functional balance scores were superior at all post-baseline time points (p<0.05). Fear of falling decreased more markedly in the VR group, with corresponding gains in stroke-specific quality of life domains related to mobility and daily activities (p<0.05). Subgroup analyses indicated greater benefits among participants with moderate initial balance impairment and those who completed at least 90% of prescribed sessions. Adherence to the VR program was high (average attendance 88%), and adverse events were rare and mild, limited to transient dizziness in a small minority. The findings suggest that VR-based balance training provides superior fall risk reduction and functional gains compared with conventional therapy in elderly stroke survivors, potentially through enhanced sensory-motor integration, neuroplastic adaptations, and increased task-specific engagement. These results support the integration of immersive VR modalities into post-stroke rehabilitation protocols to promote safer mobility and reduce the burden of falls in this high-risk population. Further multicenter trials with longer follow-up are recommended to confirm durability and to delineate cost-effectiveness and implementation strategies in routine clinical practice.

Project Overview

What This Project Is About

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A plain-language overview of how a balance training program using virtual reality might help older adults who have had a stroke reduce the chances of falling, and what the study will test to see if it works better than standard therapy. It looks at balance, mobility, and confidence in daily activities using engaging, computer-based exercises.

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The Problem It Addresses

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Falls are common after a stroke and can lead to injuries, loss of independence, and fear of moving. Traditional balance training can be boring or hard to access for some seniors. This project tests whether virtual reality activities can make balance practice more enjoyable, safer, and more effective in lowering fall risk.

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Objectives of the Project

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1. Assess whether VR-based balance training reduces fall risk compared with usual care.
2. Measure changes in balance, gait, and confidence in daily activities.
3. Evaluate user acceptance, safety, and feasibility of the VR program in elderly stroke patients.

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What You Will Do Step by Step

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1) Recruit suitable elderly stroke patients and obtain consent.

2) Randomly assign participants to a VR balance program or standard therapy.

3) Implement a structured training plan over several weeks, with regular sessions.

4) Collect data on balance tests, gait speed, and fall occurrences at baseline and after training.

5) Analyze differences between groups using simple statistical comparisons; check safety and enjoyment.

6) Interpret findings and discuss potential for real-world use.

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Expected Outcome

A clear indication whether VR balance training provides additional benefits in reducing falls, improving balance and confidence, and whether it is feasible for routine use in elder care after stroke.