Digital rehabilitation for vestibular dysfunction: a systematic scoping review and meta-analysis on remote strategies for managing dizziness in older adults

INTRODUCTION: Dizziness is a prevalent and disabling symptom of vestibular dysfunction, particularly in older adults, adversely affecting mobility, independence, and quality of life (QoL). Digital rehabilitation, delivered through remote technologies such as virtual reality (VR), mobile applications, and telehealth platforms, has emerged as a scalable and potentially effective approach to vestibular rehabilitation. This scoping review and meta-analysis aimed to synthesize the current evidence on digital rehabilitation strategies for managing dizziness in older adults with vestibular dysfunction and to identify research gaps in this emerging field. METHOD: A systematic search of PubMed, The Cochrane Library, PEDro, Ovid, and Scopus was conducted from inception through October 2024. The search strategy followed PRISMA-ScR guidelines and included studies investigating digital interventions targeting vestibular symptoms in adults aged ≥60 years. After removing duplicates and screening 1,585 titles and abstracts, eight studies met the eligibility criteria. A descriptive synthesis was conducted, and where data allowed, a meta-analysis was performed to estimate the pooled effect of digital interventions on dizziness severity and postural balance outcomes. RESULTS: Digital rehabilitation interventions, particularly those involving VR-based balance training, mobile platforms, and remote monitoring, were associated with significant improvements in dizziness severity, postural control, and QoL among older adults. The meta-analysis demonstrated a moderate pooled effect size favoring digital rehabilitation over standard or home-based care (standardized mean difference [SMD] = –0.62; 95% CI: –0.91 to –0.33) in reducing dizziness intensity. However, heterogeneity among studies was moderate to high, reflecting variability in intervention type, duration, and outcome measures. CONCLUSION: Digital rehabilitation interventions, particularly those involving VR-based balance training, mobile platforms, and remote monitoring, were associated with significant improvements in dizziness severity, postural control, and QoL among older adults. The meta-analysis demonstrated a moderate pooled effect size favoring digital rehabilitation over standard or home-based care (standardized mean difference [SMD] = –0.62; 95% CI: –0.91 to –0.33) in reducing dizziness intensity. However, heterogeneity among studies was moderate to high, reflecting variability in intervention type, duration, and outcome measures.