Effects of virtual reality on physical and psychological function of people living with osteoporosis and osteopenia: a systematic review

This review aims to determine the effect of VR on the physical and psychological function of people living with osteoporosis and osteopenia. 

Two researchers independently screened and extracted data from eligible studies published between January 2010 to August 2024. The databases used were Embase, Pubmed and Scopus. Randomised Controlled Trials (RCT) with outcome measures assessing physical and psychological measures were included in the analysis. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of studies. A search strategy that includes keywords such as “Virtual reality”, “osteoporosis”, “osteopenia” and “bone disease” was used.

A total of 1755 non-duplicated records were screened based on titles and abstracts. The full text of twelve records was retrieved and assessed for eligibility. Nine studies fulfilled the inclusion criteria. Cohen’s Kappa (k) for inter-reviewer reliability was found to be 0.95, indicating almost perfect agreement between reviewers. Based on the PEDro scale, eight studies were considered to have ‘good’ methodological quality and one of ‘fair’ methodological quality. 

All modes of VR evaluated in this review were found to be effective in improving physical function, endurance and balance. Little or no side effects and adverse events were observed in all studies with the use of VR for exercise. Exercise programmes using VR demonstrated more significant improvements in physical outcomes ^8-14, specifically for Berg Balance Score and Timed Up and Go Test ^8-11. Significant improvement in bone mineral density and fracture risk assessment tool ^{10, 13-14} was also found with the use of VR.   VR was found to be as effective as conventional exercise programmes in reducing fear of falling^{13, 15}. However, inconclusive results were found for psychological measures like quality of life (QoL) and wellbeing ^{9, 14}. 

The use of VR in exercise programmes for individuals living with osteoporosis and osteopenia is effective in improving their physical outcomes. However, more studies are required to explore its psychological effect on this population.

Incorporating VR into exercise programmes allows more variations in the type of exercises included in exercise programmes. This may better engage people with osteoporosis and osteopenia, which in turn could maximise the psychological benefits in addition to physical gains that individuals may achieve from participating in an exercise programme.