Ren Yuanyuan, Lin Chenli, Zhou Qin, Yingyuan Zhang, Wang Guodong, Lu Aming
Physical Education and sport science, Soochow University, Suzhou, Jiangsu Province, China.
Hebei Normal University of Science & Technology, Hebei, Hebei Province, China.
Arch Gerontol Geriatr. 2023 May;108:104924. doi: 10.1016/j.archger.2023.104924. Epub 2023 Jan 5.
In recent years, sports games based on virtual reality (VR) have been widely used in the prevention and treatment of diseases related to the elderly. However, there seems to be no consensus on the improvement and comparison of physical function, balance and falls in elderly people with balance impairment.
This study aims to explore the effects of VR intervention on physical function, balance and falls in elderly people with balance impairment.
Systematic literature searches of the PubMed, Web of Science, Elsevier, Cochrane, CNKI, and Wanfang databases were performed for VR games-related randomized controlled trials or comparison studies among elderly participants with impaired balance, published in English or Chinese until March 20, 2022. The Cochrane collaboration risk of bias tool was used to evaluate the methodological quality of the studies. A meta-analysis was performed to calculate the standardized mean deviation or mean difference of the sample and its 95% confidence interval (CI) in VR games.
The systematic review included 23 studies. The results showed that VR intervention had significant effects on hand grip strength (MD:1.30, P = 0.040), knee extension strength (MD:-6.27, P<0.001), five times sit-to-stand test scores (MD:1.13, P = 0.030), timed up-and-go test scores (MD:-1.01, P = 0.001), berg balance scale scores (MD:2.37, P<0.001), and falls efficacy scale scores (SMD:-0.28, P = 0.020). Subgroup analysis results showed that VR intervention was more effective on improving TUG and BBS scores than the conventional exercise group (MD=-0.54, P = 0.004; MD=3.24, P<0.001) and the non-intervention group (MD=-0.98, P = 0.001; MD=3.30, P < 0.001). The balance training-based VR had a significant effect on improving TUG (MD=-1.03, P = 0.004) and BBS (MD=2.93, P<0.001), and 20-45 min intervention, ≥3 times/wk, 5-8 wk cycles were significant in improving TUG (MD=-0.89, P<0.001; MD=-0.75, P = 0.0003; MD=-1.54, P<0.0001). VR intervention significantly improved TUG (MD=-2.27, P<0.0001) and BBS (MD=3.41, P<0.0001) in older adults in the hospital or nursing home compared with those residing in communities.
VR interventions can help the elderly with impaired balance to overcome traditional sports obstacles and improve physical function, balance and minimize falls. Balance training-based VR intervention is more effective in balance recovery and fall prevention compared with game program. An intervention plan comprising 20-45 min, 5-8 wk cycles, and ≥3 times/wk frequency has significantly higher effects for high-risk elderly populations living in hospitals or nursing homes.
近年来，基于虚拟现实（VR）的体育游戏已广泛应用于老年人相关疾病的防治。然而，对于平衡功能受损的老年人的身体功能、平衡能力和跌倒情况的改善及比较，似乎尚未达成共识。
本研究旨在探讨VR干预对平衡功能受损老年人的身体功能、平衡能力和跌倒情况的影响。
对PubMed、Web of Science、Elsevier、Cochrane、中国知网（CNKI）和万方数据库进行系统文献检索，查找2022年3月20日前发表的、关于VR游戏相关的随机对照试验或针对平衡功能受损老年参与者的比较研究，语种限定为英文或中文。采用Cochrane协作网偏倚风险工具评估研究的方法学质量。进行荟萃分析，计算VR游戏中样本的标准化均数差值或均数差及其95%置信区间（CI）。
系统评价纳入23项研究。结果显示，VR干预对手握力（MD：1.30，P = 0.040）、膝关节伸展力量（MD：-6.27，P<0.001）、五次坐立试验得分（MD：1.13，P = 0.030）、计时起立行走试验得分（MD：-1.01，P = 0.001）、伯格平衡量表得分（MD：2.37，P<0.001）和跌倒效能量表得分（SMD：-0.28，P = 0.020）有显著影响。亚组分析结果显示，与传统运动组（MD=-0.54，P = 0.004；MD=3.24，P<0.001）和非干预组（MD=-0.98，P = 0.001；MD=3.30，P < 0.001）相比，VR干预在改善计时起立行走试验（TUG）和伯格平衡量表（BBS）得分方面更有效。基于平衡训练的VR对改善TUG（MD=-1.03，P = 0.004）和BBS（MD=2.93，P<0.001）有显著效果，干预时间为20 - 45分钟、每周≥3次、周期为5 - 8周时，对改善TUG有显著效果（MD=-0.89，P<0.001；MD=-0.75，P = 0.0003；MD=-1.54，P<0.0001）。与社区老年人相比，VR干预对住院或养老院老年人的TUG（MD=-2.27，P<0.0001）和BBS（MD=3.41，P<0.0001）有显著改善。
VR干预可帮助平衡功能受损的老年人克服传统运动障碍，改善身体功能、平衡能力并减少跌倒。与游戏程序相比，基于平衡训练的VR干预在平衡恢复和跌倒预防方面更有效。对于住院或养老院的高危老年人群，包含20 - 45分钟、5 - 8周周期且每周≥3次的干预计划效果显著更高。
