De Natale Giorgio, Qorri Erda, Todri Jasemin, Lena Orges
GDN Fisioterapia Avanzata, Via Bellini 55, 95030 Sant'Agata Li Battiati, Italy.
ITEM-Innovation in Manual and Physical Therapies Research Group, Physiotherapy Department, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain.
Medicina (Kaunas). 2025 Mar 17;61(3):524. doi: 10.3390/medicina61030524.
: Virtual reality (VR)-based interventions provide immersive and interactive environments that can enhance motor learning and deliver real-time feedback, offering potential advantages over conventional therapies. This systematic review evaluated the impact of non-immersive and immersive VR exergaming interventions versus conventional therapy on balance in Parkinson's disease (PD) through a detailed analysis of randomized controlled trials (RCTs). : A comprehensive search was conducted across the PubMed, Lilacs, IBECS, CENTRAL, Web of Science (WOS), EBSCOHost, and SciELO databases. Article selection and duplicate removal were managed using Rayyan QCRI. The quality of the evidence was assessed using the GRADE system. : From an initial screening of 100 studies, 58 underwent title and abstract screening. After full-text evaluation, 11 RCTs met the inclusion criteria, involving 518 participants with PD (average age: 67.3 years; 67.95% men). The balance outcomes were primarily measured using the Berg balance scale (BBS), employed in most studies (n = 9). The pooled analysis demonstrated a significant improvement in the balance scores for the experimental groups compared to the controls, with a standardized mean difference (SMD) of 0.58 [95% CI: 0.07, 1.09, = 0.03]. However, the heterogeneity was substantial (I = 77%). The analysis of the six-minute walking test (6 MWT), as another outcome of four articles, revealed a mean difference of 32.99 m [95% CI: -8.02, 74.00], but the effect was not statistically significant ( = 0.11). The heterogeneity for this outcome was moderate (I = 41%), indicating some variability across studies. Alternative tools, such as the Tinetti Performance-Oriented Mobility Assessment (POMA) scale, the UPDRS III, and the sensory organization test (SOT), were also evaluated where possible. : VR-based interventions offer promise for improving balance in Parkinson's disease, enhancing rehabilitation engagement. Their integration into clinical practice could complement conventional therapy. However, further research is needed to optimize protocols, standardize parameters, and maximize their impact on mobility, independence, and quality of life.
基于虚拟现实（VR）的干预措施提供了沉浸式和交互式环境，可增强运动学习并提供实时反馈，相较于传统疗法具有潜在优势。本系统评价通过对随机对照试验（RCT）的详细分析，评估了非沉浸式和沉浸式VR运动游戏干预与传统疗法对帕金森病（PD）平衡能力的影响。
在PubMed、Lilacs、IBECS、CENTRAL、科学网（WOS）、EBSCOHost和SciELO数据库中进行了全面检索。使用Rayyan QCRI进行文章筛选和重复文献去除。采用GRADE系统评估证据质量。
从初步筛选的100项研究中，58项进行了标题和摘要筛选。经过全文评估，11项RCT符合纳入标准，涉及518名PD患者（平均年龄：67.3岁；男性占67.95%）。平衡结果主要使用Berg平衡量表（BBS）进行测量，大多数研究（n = 9）采用该量表。汇总分析表明，与对照组相比，实验组的平衡评分有显著改善，标准化平均差（SMD）为0.58 [95% CI：0.07, 1.09，P = 0.03]。然而，异质性较大（I² = 77%）。作为四篇文章的另一项结果，对六分钟步行试验（6 MWT）的分析显示平均差值为32.99 m [95% CI：-8.02, 74.00]，但效果无统计学意义（P = 0.11）。该结果的异质性为中度（I² = 41%），表明各研究之间存在一定差异。还尽可能评估了其他工具，如Tinetti以性能为导向的移动性评估（POMA）量表、统一帕金森病评定量表第三部分（UPDRS III）和感觉统合测试（SOT）。
基于VR的干预措施有望改善帕金森病患者的平衡能力，提高康复参与度。将其纳入临床实践可补充传统疗法。然而，需要进一步研究以优化方案、规范参数，并最大限度地提高其对移动性、独立性和生活质量的影响。
