Augmented reality-based training versus standard training in improvement of balance, mobility and fall risk: a systematic review and meta-analysis

Pratik Lamichhane; Shreya Sukralia; Benish Alam; Shawn Shaikh; Shireen Farrukh; Shahid Ali; Rajeev Ojha

doi:10.1097/MS9.0000000000000986

Augmented reality-based training versus standard training in improvement of balance, mobility and fall risk: a systematic review and meta-analysis

Ann Med Surg (Lond). 2023 Jun 20;85(8):4026-4032. doi: 10.1097/MS9.0000000000000986. eCollection 2023 Aug.

Authors

Pratik Lamichhane¹, Shreya Sukralia², Benish Alam³, Shawn Shaikh⁴, Shireen Farrukh⁵, Shahid Ali⁶, Rajeev Ojha⁷

Affiliations

¹ Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
² Manipal College of Medical Sciences, Kaski, Pokhara, Nepal.
³ Karachi Medical and Dental College, Karachi, Pakistan.
⁴ Department of Computer Science, University of Texas, Austin, TX, USA.
⁵ King Edward Medical University, Lahore, Pakistan.
⁶ Lady Reading Hospital, Peshawar, Pakistan.
⁷ Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

Abstract

Augmented reality (AR) technology is being used recently in healthcare, especially for rehabilitation purposes, owing to its ability for repetition, rapid feedback, and motivation for patients. This systematic review and meta-analysis aims to compare the efficacy of AR-based interventions to conventional physical interventions in improving balance, mobility, and fall risk.

Material and methods: PubMed, Google Scholar, Scopus, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to January 2023. Randomized trials and observational cohort studies comparing the effects of AR-based exercises with conventional training in patients 18 years and older were included in the analysis. Studies using virtual reality, case reports and series, reviews, meta-analyses, letters, and editorials were excluded. Post-intervention data on the Berg Balance Scale (BBS) and Timed Up and Go (TUG) Test were extracted and studied. The fixed-effects inverse variance model was utilized to pool the extracted data.

Results: Out of 438 articles, seven articles (199 participants) comparing AR-based exercise with the standard training were included in the systematic review. Six articles with sufficient data on the parameters were included in the meta-analysis. AR-based exercises resulted in a significantly higher BBS score than conventional exercise (Hedge's g=0.48, 95% CI=0.19-0.77, P<0.001). The BBS value was significantly higher in AR-based training of 8 weeks or more (Hedge's g=0.88, 95% CI=0.46-1.31) when compared with trainings conducted for less than 8 weeks (Hedge's g=0.11, 95% CI=-0.30 to 0.52), P=0.01). Likewise, the TUG Test score was found to be to be significantly lower in ARgroup than the controls (Hedge's g= -0.54, 95% CI=-0.85 to -0.23, P<0.01).

Conclusion: In comparison to conventional methods, AR-based exercises had higher improvements in balance, mobility, and fall risk parameters. The use of AR technology in elderly patients can promote independence while preventing falls and associated morbidity and mortality. There is a need for a larger randomized controlled trial to provide a more accurate comparison on efficacy and safety of different modalities of training.

Keywords: augmented reality; balance; elderly; review; stroke.