Balance training using virtual reality improves balance and physical performance in older adults at high risk of falls

Figures & data

Table 1 Baseline characteristics of included participants reported as median (IQR)

Baseline characteristics	BRU, N=63	Exercise, N=82	Control, N=50	Between-group p-value
Age, y	79 (74, 84)	76 (71, 82)	79 (72, 82)	0.37
Sex				0.55
Male, n (%)	19 (30.2)	31 (37.8)	15 (30%)
Female, n (%)	44 (69.8)	51 (62.2)	35 (70%)
Body mass index, kg/m^2	27.0 (25.0, 31.0)	27.0 (23.5, 31.0)	28.5 (24.1, 32.6)	0.60
Handgrip strength (kg)	19 (16, 25)	20.5 (17, 27)	22 (16, 28)	0.42
5 Sit to Stand, s	21.1 (16.9, 28.8)	18.5 (15.4, 26.4)	17.8 (14.8, 22.9)	0.11
Timed Up and Go, s	15.0 (11.8, 19.4)	11.9 (10.0, 15.8)	16.0 (10.2, 21.8)	0.005
Gait Speed, m/s	0.78 (0.58, 0.91)	1.03 (0.80, 1.13)	0.80 (0.52, 0.98)	0.002
Limits of Stability, cm^2	111 (80, 144)	132 (91, 156)	126 (53, 161)	0.55
Falls Efficacy Scale – International (16–64)	34 (27, 39)	33 (25, 41)	32 (24, 43)	0.93

Abbreviation: BRU, balance rehabilitation unit.

Table 2 Pre- and post-program results in physical performance and subjective measures for EX, Balance Rehabilitation Unit (BRU) and non-intervention groups

Assessment	Intervention	Pre		Post		Change			p-value for interaction
		N	Median (IQR)	N	Median (IQR)	Unit	Mean (95% CI)	p-value
Hand grip strength, kg	Exercise	82	20.50 (17.00, 27.00)	59	24.00 (20.50, 28.50)	%	11.32 (5.84, 17.08)	<0.001	0.021
	BRU	63	19.00 (16.00, 25.00)	44	21.50 (18.25, 26.00)	%	6.82 (0.77, 13.24)	0.027
	Control	49	22.00 (16.00, 28.00)	48	20.50 (18.00, 25.50)	%	−0.07 (−5.61, 5.79)	0.98
5 times Sit to Stand, s	Exercise	79	18.52 (15.40, 26.40)	59	13.90 (11.50, 16.80)	%	−29.84 (−35.23, −23.99)	<0.001	0.296
	BRU	61	21.10 (16.90, 28.80)	43	16.40 (11.90, 19.90)	%	−26.69 (−33.22, −19.52)	<0.001
	Control	37	17.76 (14.83, 22.90)	30	15.29 (11.25, 17.71)	%	−21.79 (−30.00, −12.62)	<0.001
Timed Up and Go, s	Exercise	78	11.90 (10.30, 15.80)	56	10.05 (8.80, 12.30)	%	−20.33 (−24.99, −15.38)	<0.001	<0.001
	BRU	60	15.00 (11.85, 19.40)	42	11.30 (9.30, 14.90)	%	−23.30 (−28.42, −17.83)	<0.001
	Control	47	15.96 (10.21, 21.75)	43	14.14 (10.86, 19.90)	%	−4.31 (−10.68, 2.50)	0.209
Four Square Step Test, s	Exercise	42	15.50 (13.10, 18.80)	37	12.30 (10.40, 14.10)	%	−23.95 (−30.45, −16.83)	<0.001	0.378
	BRU	31	19.50 (14.10, 22.70)	25	14.60 (11.90, 17.70)	%	−18.87 (−26.89, −9.96)	<0.001
	Control	30	14.62 (11.19, 18.38)	25	13.83 (11.71, 18.70)	%	−16.72 (−24.45, −8.20)	<0.001
Gait speed, m/s	Exercise	47	1.03 (0.80, 1.13)	30	1.13 (1.00, 1.25)	m/s	0.15 (0.10, 0.20)	<0.001	0.021
	BRU	48	0.78 (0.58, 0.91)	34	0.94 (0.79, 1.15)	m/s	0.12 (0.07, 0.17)	<0.001
	Control	48	0.80 (0.52, 0.98)	44	0.78 (0.59, 1.03)	m/s	0.06 (0.02, 0.10)	0.007
Falls Efficacy Scale – International	Exercise	73	32 (25, 41)	51	26 (22, 33)	%	−15.7 (−21.6, −9.5)	<0.001	0.013
	BRU	61	34 (27, 39)	40	27 (24, 35)	%	−11.3 (−18.2, −3.8)	0.004
	Control	48	32 (24, 43)	49	34 (23, 43)	%	−1.6 (−8.8, 6.1)	0.676

Abbreviation: BRU, Balance Rehabilitation Unit.

Table 3 Pre- and post-program results for the posturography assessment in the exercise and Balance Rehabilitation Unit (BRU) and non-intervention groups

Assessment	Intervention	Pre		Post		Change			p-value for interaction
		N	Median (IQR)	N	Median (IQR)	Unit	Mean (95% CI)	p-value
Limits of stability, cm^2	Exercise	33	132 (91, 156)	21	150 (128, 182)	%	23.76 (5.19, 45.60)	0.01	0.008
	BRU	62	111 (80, 144)	42	158 (131, 187)	%	36.93 (22.03, 53.65)	<0.001
	Control	45	126 (53, 161)	42	120 (43, 169)	%	5.08 (−6.83, 18.51)	0.419
Eyes Open Ellipse Area, cm^2	Exercise	33	5.83 (3.12, 12.38)	21	6.86 (3.18, 12.84)	%	4.03 (−24.52, 43.39)	0.809	0.456
	BRU	62	6.81 (4.13, 12.60)	42	6.33 (3.53, 10.45)	%	−18.96 (−35.49, 1.81)	0.071
	Control	45	4.28 (2.70, 9.26)	42	4.21 (2.68, 5.86)	%	−13.97 (−32.33, 9.38)	0.219
Eyes Closed Ellipse Area, cm^2	Exercise	33	6.08 (3.92, 15.24)	21	5.93 (4.45, 14.10)	%	−9.73 (−33.94, 23.35)	0.52	0.140
	BRU	62	9.91 (5.63, 16.98)	42	6.55 (4.08, 11.67)	%	−29.97 (−43.90, −12.59)	0.002
	Control	40	5.36 (2.46, 10.41)	38	4.63 (2.83, 9.64)	%	−3.52 (−24.85, 23.85)	0.778
Foam Eyes Closed Ellipse Area, cm^2	Exercise	23	20.42 (15.09, 30.11)	12	16.45 (14.05, 20.63)	%	−23.26 (−40.68, −0.72)	0.044	0.310
	BRU	44	28.81 (17.54, 39.80)	29	20.44 (15.11, 28.83)	%	−21.01 (−33.22, −6.56)	0.006
	Control	23	18.58 (11.98, 37.11)	24	18.64 (11.68, 33.89)	%	−4.61 (−22.84, 17.93)	0.663
Saccadic Ellipse Area, cm^2	Exercise	27	6.32 (2.81, 10.58)	17	6.75 (3.72, 14.11)	%	−0.77 (−24.45, 30.32)	0.956	0.455
	BRU	60	7.05 (4.20, 11.89)	40	6.63 (3.91, 10.64)	%	−10.85 (−25.39, 6.54)	0.207
	Control	39	4.59 (2.09, 9.40)	36	4.87 (2.59, 8.53)	%	5.65 (−13.64, 29.24)	0.593
Visuo-Vestibular Interaction Ellipse Area, cm^2	Exercise	24	9.51 (5.99, 13.85)	15	10.69 (7.53, 19.46)	%	−13.34 (−29.98, 7.26)	0.188	0.928
	BRU	56	13.41 (7.88, 24.18)	39	12.98 (7.87, 18.68)	%	−12.33 (−23.15, 0.02)	0.05
	Control		n/a		n/a		n/a

Abbreviation: BRU, Balance Rehabilitation Unit.

Figure 1 Percentage change for handgrip strength, five time sit to stand (5 STS), timed up and go (TUG), four square step test (FSST) and falls efficacy scale (FES-I) assessments. Absolute change included for gait speed. p-values for comparisons between pre and post intervention are listed on the right hand side for each intervention. Significant difference was found between the exercise and BRU groups compared to control (non-intervention) for handgrip strength, TUG, gait speed and fear of falling (FES-I) assessments.

Figure 2 Percentage change for the posturography assessment results for limits of stability (LOS) and ellipse areas for the following tasks: eyes open (EOEA), eyes closed task (ECEA), foam eyes closed (FECEA), saccadic (SEA), visuo-vestibular interaction (VVIEA). p-values for comparisons between pre and post intervention are listed on the right hand side for each intervention. Although the BRU group reported larger and more significant changes, only improvements in limits of stability were significantly different between groups.

Abbreviation: BRU, Balance Rehabilitation Unit.