Efeitos das soluções de realidade virtual na prevenção de acidentes por quedas em pessoas idosas: revisão sistemática e metanálise

Abstract

Accidental falls are one of the geriatric syndromes responsible for the rapid functional decay of the elderly, resulting in trauma, fear of another accident, and severe outcomes such as hospitalization and death. The use of educational/technological resources can help avert this condition. Using Virtual Reality (VR) with realistic simulation can help prevent falls. Aim: to evaluate the effects of virtual reality solutions in thwarting accidents caused by falls in older adults. Methodology: Systematic Literature Review (SLR) followed the Cochrane recommendations for Systematic Reviews of Interventions. The research question followed the PICO strategy (Population/Patient/Problem) for people aged 60 and over; (Intervention) Use of VR; (Control/Comparison); Intervention without VR or no intervention; (Outcome) Prevention of falls. Studies using VR technologies to prevent falls in older adults were included, with no restrictions on the year of publication or language. We excluded duplicate studies and those with no measure of outcomes. We used the following databases: Medical Literature Analysis and Retrieval System Online/National Library of Medicine (MEDLINE/PubMed), Latin American and Caribbean Health Sciences Literature (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane and Web of Science. Grey literature is composed of Clinical Trials and Open Grey. We collected the data on 30 January 2023. We exported the selected studies to the Rayyan reference synthesizer. The risk of bias in randomized trials was determined using the Revised Cochrane risk-of-bias tool (RoB 2.0), and at the same time, the certainty of the evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, utilizing the GRADEpro software. The registration number of the RSL protocol in the International Prospective Register of Systematic Reviews (PROSPERO) is CRD42023393984. The study description followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and synthesization of the results through meta-analysis. Results: We found one hundred seventy-eight articles in the databases and 15 in the grey literature; after the inclusion criteria, the sample resulted in 11 articles. Non-immersive VR comprised 81.8 percent (n = 9) of the studies (Exergaming, exercise/dance stations and memory game with screen stimulus, treadmill with screen projection). Two studies used immersive VR interventions through VR goggles using the "Bru-Training" protocol. Seven studies (63.7%) had a low risk of bias, one (9%) had some concerns, and three (37.3%) had a high risk of bias. GRADE classified the quality of the evidence as high. The results indicate that using VR prevents falls compared to interventions without VR. Combining the 11 studies resulted in 1369 patients, with a random effect model of -0.09 with 95% CI [-0.75; 0.56], Z= -0.27 p-value - 0.79. There was no significant difference in the use of VR when compared globally, given the clinical heterogeneity of the participants. Conclusion: The RSL presented here provides a scientific ground for clinical practice using VR and envisages future immersive and non-immersive VR research.