Virtual Reality-Based Rehabilitation to Improve Mobility and Prevent Falls in Older People With Diabetic Peripheral Neuropathy: Evidence Synthesis and Development of a Geriatric-Specific Framework

INTRODUCTION: Diabetic peripheral neuropathy (DPN) among older people is associated with significant gait and balance impairments, postural instability, and an increased fall risk. Virtual reality (VR)-based interventions have been shown to be effective in improving balance and mobility; however, their design features and applicability for older people with DPN remain unclear. This systematic review was conducted to examine the effectiveness of VR systems on clinical outcomes in individuals with DPN and translate the findings into geriatric-specific VR design recommendations. METHOD: A systematic review design was employed. Five electronic databases (Scopus, PubMed, CINAHL, Web of Science, and Embase) were systematically searched. Guided by the Synthesis Without a Meta-Analysis (SWiM) approach, a narrative synthesis was conducted. RESULTS: A total of eight studies met the inclusion criteria, with a pooled sample of 341 participants (mean age = 49 to 72). VR systems were primarily used as intervention modalities (6 of 8 studies). Most VR systems employed non-immersive, screen-based platforms with real-time visual biofeedback. Progression algorithms were clinician-guided rather than adaptive. VR-based interventions demonstrated consistent improvements in postural sway, mediolateral stability, and functional mobility measures in adults with DPN. CONCLUSION: VR systems, used as either intervention and assessment modalities, were found to be effective in assessing and improving balance and functional mobility in adults with DPN. CLINICAL RELEVANCE: Based on these findings, the SAFE STEP PLAN Framework, a geriatric-specific design guidance for VR-based and other technology-assisted rehabilitation interventions in DPN, was developed to inform the design, implementation, and clinical integration of technology-assisted interventions for older people.