Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke

Objective: To study the clinical effectiveness and the usability of a virtual reality-based intervention compared with conventional physical therapy in the balance recovery of individuals with chronic stroke. Design: Randomized controlled trial. Setting: Outpatient neurorehabilitation unit. Participants: A total of 20 individuals with chronic stroke. Interventions: The intervention consisted of 20 one-hour sessions, five sessions per week. The experimental group combined 30 minutes with the virtual reality-based intervention with 30 minutes of conventional training. The control group underwent one hour conventional therapy. Main measures: Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale, the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment, the Brunel Balance Assessment, and the 10-m Walking Test. Subjective data of the virtual reality-based intervention were collected from the experimental group, with a feedback questionnaire at the end of the trial. Results: The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale (p < 0.05) and in the 10-m Walking Test (p < 0.05). Post-hoc analyses showed greater improvement in the experimental group: 3.8 +/- 2.6 vs. 1.8 +/- 1.4 in the Berg Balance Scale, -1.9 +/- 1.6 seconds vs. 0.0 +/- 2.3 seconds in the 10-m Walking Test, and also in the number of participants who increased level in the Brunel Balance Assessment (chi(2) = 2.5, p < 0.01). Conclusions: Virtual reality interventions can be an effective resource to enhance the improvement of balance in individuals with chronic stroke.