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Effects of virtual reality versus conventional balance training on balance and falls in people with multiple sclerosis: a randomized controlled trial
Molhemi F, Monjezi S, Mehravar M, Shaterzadeh-Yazdi MJ, Salehi R, Hesam S, Mohammadianinejad E
Archives of Physical Medicine and Rehabilitation 2021 Feb;102(2):290-299
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To assess the efficacy of virtual reality (VR)-based versus conventional balance training on the improvement of balance and reduction of falls in people with multiple sclerosis (PwMS). DESIGN: Single-blinded, randomized, controlled trial. SETTING: Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences. PARTICIPANTS: Thirty-nine PwMS, randomized into VR (n = 19) and control (n = 20) groups. INTERVENTION: The VR group performed exergames using Kinect while control group accomplished conventional balance exercises. Both groups received 18 training sessions for 6 weeks. OUTCOME MEASURES: Limits of stability (LOS), Timed Up-and-Go (TUG) and 10-Meter-Walk tests with and without cognitive task and their dual-task costs (DTC), Berg Balance Scale, Multiple Sclerosis Walking Scale-12, Fall Efficacy Scale-international, Activities-specific Balance Confidence scale, and fall history were obtained pre- and post-intervention, and after a three-month follow-up. RESULTS: At both post-intervention and follow-up, TUG cognitive and DTC on the TUG were significantly lower and the 10-Meter-Walk-Cognitive was significantly higher in the VR group. At follow-up, reaction time and the number of falls demonstrated significant differences favoring the VR group, whereas the directional control revealed significant difference in favor of the control group (p < 0.05). The other outcomes showed no statistically significant difference neither at post-intervention nor at follow-up. CONCLUSIONS: Both the VR-based and conventional balance exercises improved balance and mobility in PwMS, while each acted better in improving certain aspects. VR-based training was more efficacious in enhancing cognitive-motor function, and reducing falls, whereas conventional exercises led to better directional control. Further studies are needed to confirm the effectiveness of recruiting VR-based exercises in clinical settings.

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