BACKGROUND: Parkinson's Disease (PD) is the second most common progressive neurodegenerative disorder, mostly affecting balance and motor function caused mainly by a lack of dopamine in the brain. The use of virtual reality (VR) and motor imagery (MI) is emerging as an effective method of rehabilitation for people with Parkinson's disease. Motor imagery and virtual reality have not been compared in patients with Parkinson's disease. This randomized clinical trial is unique to compare the effects of virtual reality with routine physical therapy, motor imagery with routine physical therapy, and routine physical therapy alone on balance, motor function, and activities of daily living in patients with Parkinson's disease. METHODS: A total of sixty patients with Parkinson's disease were randomized into three groups using lottery method; twenty with virtual reality therapy in addition to physical therapy (group A = VR plus RPT), twenty with imagery therapy in addition to physical therapy (group B = MI plus RPT), and twenty were treated with only routine physical therapy (group C = RPT). All patients were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) for motor function and activities of daily living, the Berg balance scale (BBS) for balance, and the Activities-specific Balance Confidence Scale (ABCs) for balance confidence at baseline, six and twelve weeks, and one month after treatment discontinuation. The one-way ANOVA was used to compare the outcomes between three groups, and the repeated measures ANOVA was used to compare the outcomes within each of the three groups at a significance level of p-value = 0.05. RESULTS: According to UPDRS III, the VR plus RPT group showed significant improvement in motor function, compared to the MI plus RPT and RPT groups, as the mean +/- SD at baseline was 33.95 +/- 3.501 and at the 12-week assessment was 17.20 +/- 9.451 with a p-value = 0.001. In the VR plus RPT group, the BBS score at baseline was 37.15 +/- 3.437 and at 12th week was 50.10 +/- 4.897 with a p-value = 0.019. Among the VR plus RPT group, the ABCS score showed significant improvement as the M +/- SD at baseline was 57.95 +/- 4.629, and at the 12th week was 78.59 +/- 6.386 with a p-value = 0.010. At baseline, the UPDRS II for activities of daily living in the VR plus RPT group was 25.20 +/- 3.036 and at 12th week it was 15.30 +/- 2.364 with p-value of 0.000. CONCLUSION: The current study found that the combination of VR and RPT proved to be the most effective treatment method for improving balance, motor function, and activities of daily living in patients with Parkinson's disease when compared to MI plus RPT or RPT alone.

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