The application potential of virtual reality technology in managing elderly frailty: a meta-analysis

Frailty is a prevalent geriatric syndrome linked to adverse health outcomes, yet optimal intervention strategies remain limited. Virtual Reality (VR), a technology that enables subjects to immerse themselves in a computer-generated environment, is increasingly used in clinical nursing. Virtual reality has demonstrated both theoretical and practical benefits in mitigating physical, cognitive, and functional impairments among frail older adults; however, its overall efficacy remains to be systematically synthesized. This study aimed to evaluate the specific effects of VR-based training on frailty in elderly patients. A comprehensive search of one clinical trial registry and nine Databases including China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Chinese Biomedical Literature Service System, PubMed, Web of Science, CINAHL, Cochrane Library, and Embase was conducted up to 30 May 2025. Randomized controlled trials (RCTs) of virtual reality-based training for frail elderly individuals aged ≥ 60 years with normal mobility and no cognitive impairment, were included. Data extraction and quality assessment were conducted independently by 2 reviewers. All Statistical analyses were conducted using a random effects model in RevMan 5.4. A total of 9 RCTs involving 634 patients were screened, and risk of bias was assessed across all included studies using the Cochrane risk-of-bias tool version 2 (ROB2). Our results indicate that VR-based training group can fluence frailty severity as measured by the Fried Frailty Phenotype (FFP) scale [MD = - 0.33, 95%CI (- 0.54, - 0.12), P  = 0.002], fear of falling [MD = - 1.34, 95%CI (- 3.08,0.39), P = 0.13], static balance (One-Leg Stand Test duration and Functional Reach Test distance) (P < 0.05), dynamic balance as measured by the Berg Balance Scale [MD = 1.17, 95%CI (- 1.41,3.75), P = 0.37], Timed Up and Go test [MD = - 0.19, 95%CI (- 0.80,0.42), P = 0.54], and Mini-BESTest [MD = - 0.70, 95%CI (- 1.62,0.22), P = 0.13], gait speed [SMD = - 0.17, 95%CI (- 0.56,0.22), P = 0.39], handgrip strength [SMD = 0.02, 95%CI (- 0.21,0.24), P = 0.89], lower limb strength as measured by the Five-Times Sit-to-Stand Test [SMD = - 0.24, 95%CI (- 2.50,2.03), P = 0.84], 30-Second Chair Stand Test repetitions (P < 0.05) and Global cognitive function [MD = 0.63, 95%CI (- 0.11,1.37), P = 0.09]. VR-based training is effective in improving frailty status, static balance, and lower limb strength in elderly patients with frailty, considering as a promising nursing strategy.