BACKGROUND: Virtual reality (VR) environments have been explored in vestibular rehabilitation. However, consensus on the effectiveness of the VR-enhanced approach over traditional vestibular physiotherapy (VPT) exercises remains unclear. OBJECTIVES: To investigate whether VR combined with VPT exercises improved dizziness- and balance-related symptoms in patients with peripheral vestibular dysfunction than did VPT exercises alone. METHODS: A comprehensive search was conducted across 10 electronic databases. Methodological quality, risk of bias, and certainty of evidence were assessed. Meta-analysis was performed using a random-effects model. RESULTS: Four randomized controlled trials were included in the analysis. Compared with VPT exercises alone, VR exercises showed no significant differences in balance-related confidence (mean difference (MD) 3.52; 95% confidence interval (CI) -16.74 to 23.79; p = 0.73; I2 95%) and self-reported vertigo symptoms (MD -3,34; 95% CI -6.76 to 0.08; p = 0.06; I2 0%). CONCLUSIONS: VR-enhanced VPT showed no significant changes in balance-related confidence and self-reported vertigo symptoms.

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