To test whether virtual reality (VR) interventions reduce falls in Parkinson’s disease (PD) compared with conventional care.

Falls are a debilitating complication of PD. While many studies show VR interventions improve clinical scale scores, translation to real-world fall reduction remains uncertain. Our review aims to quantify this ultimate clinical endpoint.

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following a pre-registered PROSPERO protocol (CRD420251105376). Six major databases were searched comparing VR interventions with control in patients with PD. The primary outcome was fall rate at follow-up (incidence rate ratio [IRR]). Secondary outcomes included the number of fallers, patient-reported balance confidence and fear of falling measures.

From 5,289 records screened, 22 were included in the quantitative analyses. VR reduced the fall rate at follow-up by 46% (IRR 0.54; 95% CI 0.35, 0.84). Supporting this primary finding, the proportion of patients who experienced one or more falls was lower with VR interventions (risk ratio [RR] 0.75; 95% CI 0.60, 0.93). A sensitivity analysis on fall rate using ratio of means (RoM), based on different subset of studies, showed a reduction immediately at post-intervention (RoM 0.50; 95% CI 0.29, 0.85) and a similar, though non-significant, trend at follow-up (RoM 0.64; 95% CI 0.38, 1.07). This was complemented by psychological gains, particularly in supervised programs, with VR significantly improving scores in Falls Efficacy scales (FES) at post-intervention (standardized mean difference [SMD] -0.62; 95% CI -0.93, -0.31) and Activities-Specific Balance Confidence (ABC) scale at follow-up (mean difference [MD] 5.47; 95% CI 2.42, 8.53). Risk of bias assessment maintained some concerns, reflecting self-reported outcomes.

VR is an effective modality that can significantly reduce the rate of falls and the number of fallers in patients with PD. Further research and developments are warranted to define optimal delivery and implementation strategies.