Virtual Reality Training for Balance in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Background: Chronic low back pain is often associated with impaired balance and reduced functional mobility. Recent studies suggest that virtual reality-based interventions may be effective in improving balance outcomes in individuals with chronic low back pain. Objective: In this systematic review and meta-analysis, we aimed to investigate the impact of virtual reality training on static and dynamic balance outcomes in patients with chronic low back pain. Methods: Two independent reviewers searched English-language studies from inception to 1 July 2024, using the following databases: PubMed, Web of Science, Scopus, Dimensions, Semantic Scholar, and ProQuest. Randomized clinical trials with a PEDro score of ≥6 were included. Fixed- and random-effects meta-analyses were conducted on eligible trials. Results: Of 3172 records screened, 13 trials were eligible. Meta-analyses of six trials (n = 183) across diverse adults using 2-8 week interventions showed that virtual reality training improved dynamic balance: timed up and go (mean difference: -2.29 s; 95% confidence interval: -2.91 to -1.66; I² = 0%; p < 0.00001) and forward reach (mean difference: 7.80 cm; 95% confidence interval: 2.08 to 13.52; I² = 0%; p = 0.008). However, no significant effects were found for static balance, single-leg stance, center of pressure medio-lateral displacement, or center of pressure velocity, compared with controls. Conclusions: Virtual reality-based training seems to be more effective than control interventions in improving dynamic and functional balance, but not static balance, in patients with chronic low back pain.