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Relationship Between Motion Sickness and Postural Stability: A Systematic Review
Laavanya Rajendran1, Mohd Zulkiflee Abu Bakar1, Jeyasakthy Saniasiaya1
1Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Introduction:
Motion sickness (MS) has traditionally been attributed to visual-sensory mismatch. Research on the cause-and-effect relationship between postural instability and MS has emerged, although evidence remains scarce.
Methods:
A literature review from inception to December 31, 2024, was conducted to understand the relationship between MS and postural instability by searching several databases over a 1-month period in January 2025. The search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies investigated various forms of MS, including car sickness, virtual reality (VR), simulator sickness, cybersickness, travel-related sickness, and space MS.
Results:
A total of 16 articles were identified, encompassing 1518 participants with ages ranging from 9 to 63 years. Most studies used force platforms and balance boards to assess postural instability, and 13 studies reported a relationship between postural instability and MS. These findings were consistent across VR, simulator, and transport-based motion paradigms. In contrast, 3 studies reported no consistent relationship between sway magnitude and symptom development.
Conclusions:
Although postural instability precedes MS, the quality of evidence is inadequate to determine the cause-and-effect relationship between MS and postural instability until extensive, multicentre, randomised controlled studies are conducted.
Insights
Postural instability may precede motion sickness (MS), but more research is needed. Current evidence is insufficient to confirm a cause-and-effect link between postural control and MS symptoms.
Area of Science:
- Neuroscience
- Human Physiology
- Biomedical Engineering
Background:
- Motion sickness (MS) is traditionally linked to visual-sensory conflict.
- Emerging research suggests a connection between postural instability and MS, but evidence is limited.
Purpose of the Study:
- To systematically review the literature on the relationship between motion sickness and postural instability.
- To synthesize findings from studies investigating various forms of MS, including VR and transport sickness.
Main Methods:
- A comprehensive literature search was performed from inception to December 2024.
- 16 articles involving 1518 participants were included, adhering to PRISMA guidelines.
- Postural instability was primarily assessed using force platforms and balance boards.
Main Results:
- 13 out of 16 studies reported a correlation between postural instability and MS.
- This association was observed across virtual reality, simulator, and transport-based motion scenarios.
- However, 3 studies found no consistent link between sway magnitude and symptom severity.
Conclusions:
- Postural instability appears to precede motion sickness.
- The current evidence quality is insufficient to establish a definitive cause-and-effect relationship.
- Further multicenter, randomized controlled trials are required to clarify the connection.
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