Relative Device-Output Music Intensity and Virtual-Reality-Based Postural Control in Trained Athletes

Postural control depends on the integration and reweighting of visual, somatosensory, vestibular, and contextual sensory information. Stable auditory cues may support balance, whereas complex musical stimulation may impose additional sensory-cognitive demand during multisensory conflict. This study examined the acute effects of relative device-output music intensity on virtual-reality-based postural control in trained athletes and explored whether responses differed by sport background.

Forty-eight athletes from tennis, combat sports, swimming, football, and volleyball completed the Clinical Test of Sensory Interaction in Balance delivered through virtual reality (CTSIB-VR) and Limits of Stability (LOS) assessments under four auditory conditions: routine/no sound and low (+10 dB), moderate (+20 dB), and high (+30 dB) relative device-output increments. Linear mixed-effects models included sport, auditory condition, and their interaction as fixed effects and participant-specific random intercepts and random linear condition slopes. Model-based estimated marginal means, Bonferroni-adjusted contrasts, 1.5×IQR sensitivity analyses, and robust generalized estimating equations were calculated.

Auditory condition affected all five CTSIB-VR outcomes (Wald χ²(3) = 16.773-94.404, all p < 0.001). The routine condition exceeded the high-intensity condition for composite score (adjusted mean difference = 6.05, 95% CI 3.99-8.10; Bonferroni-adjusted p < 0.001) and somatosensory score (8.62, 95% CI 6.78-10.46; adjusted p < 0.001). Sport × condition interactions were significant for all CTSIB-VR outcomes (χ²(12) = 54.869-98.953, all p < 0.001), but sport-stratified findings were exploratory. For LOS, auditory-condition effects were detected for endpoint excursion (p = 0.004), maximum excursion (p < 0.001), and directional control (p = 0.002), whereas reaction time (p = 0.648) and movement velocity (p = 0.056) did not show clear main effects. Sensitivity analyses supported the endpoint-excursion, maximum-excursion, and directional-control findings; movement-velocity inference was method-sensitive.

Relative device-output music intensity was associated with consistent changes in CTSIB-VR sensory-organization measures and outcome-specific changes in LOS performance. Sport-related patterns require confirmation in adequately powered, balanced samples.