Multimodal benefits of VR-based treadmill training in multiple sclerosis: A systematic review

Motor and cognitive impairments in multiple sclerosis are progressive in nature and impair independence and overall quality of life. Although the use of a treadmill improves gait and endurance, there is limited benefit in regard to cognitive motor integration. Virtual reality offers multi-sensory, task-oriented environments that can enhance engagement and combine motor and cognitive rehabilitation.

This systematic review assessed the effectiveness of VR-enhanced treadmill training versus conventional treadmill training on gait, endurance, balance, and cognitive-motor performance in individuals with MS.

The comprehensive database search identified randomized controlled trials and observational studies comparing VR+TT with TT in adults with MS. Study screening, data extraction, and quality assessment were performed independently by two reviewers using Cochrane RoB 2 and Newcastle-Ottawa Scale tools.

Six studies met inclusion criteria, three of which were RCTs, and three were observational. VR+TT resulted in larger improvements in gait speed, stride length, and functional mobility compared with TT alone. Improved performance was also seen in the Timed Up and Go, 25-Foot Walk, and 6-Minute Walk Tests. Dual-task walking and cognitive performance, assessed using the Symbol Digit Modalities Test, significantly improved in VR+TT groups. Participants were highly motivated and demonstrated good adherence, with few adverse effects.

VR-treadmill training was associated with greater improvements in both motor and cognitive performance relative to treadmill training alone in people with multiple sclerosis. Our results indicate that immersive, feedback-driven environments could facilitate the integration of motor-cognitive function yet sufficiently powered, and methodologically rigorous trials are necessary to confirm long-term efficacy and clinical relevance.