Serious games and virtual reality in Parkinson's disease rehabilitation: A systematic review of randomized controlled trials

Background Serious games (SG) and virtual reality (VR) are emerging rehabilitation tools in Parkinson's disease (PD); however, clinical evidence from randomized controlled trials (RCTs) remains heterogeneous. Objective To systematically review RCTs evaluating SG and VR-based rehabilitation on motor and cognitive outcomes in PD. Methods PRISMA 2020-compliant search of PubMed/MEDLINE, Embase, CENTRAL, Web of Science, and Scopus (January 2015–January 2025), augmented with visuomotor-adaptation search terms. RCTs involving adults with idiopathic PD using SG or VR versus conventional rehabilitation were included. Risk of bias was assessed using Cochrane RoB 2.0. Results Eleven RCTs (N=242; Hoehn–Yahr I–III) were included. Balance (BBS), gait speed (10MWT), and mobility (TUG) improved consistently. UPDRS-III improvements were observed with protocols ≥8 weeks. Three trials reported significant gains in executive function and attention. Adherence was high and no serious adverse events were reported. Conclusions SG and VR-based rehabilitation are safe, feasible, and effective adjuncts to conventional therapy for improving balance, gait, and selected cognitive domains in PD. Standardized protocols and long-term follow-up are needed.