title: The effect of visual biofeedback on balance in elderly population: a systematic review.
abstract: BACKGROUND
  Balance is commonly affected by multiple factors, especially among the elderly population. Visual biofeedback (VBF) is an intervention tool that can be used in balance rehabilitation.
  
  
  OBJECTIVE
  This study aimed to systematically review randomized controlled trials that examine whether VBF training is effective in improving balance in an elderly population.
  
  
  METHODS
  Three databases were searched: CIAHL, EMBASE, and MEDLINE. The searches were limited to the period from 2010 to 2016.
  
  
  METHODS
  Healthy adults, aged ≥65 years, with no specific disorders were included. Interventions were any VBF intervention with the aim of improving balance and were compared to no intervention, traditional exercises, placebo, or standard care. The outcome measures were balance as measured by any validated outcome measure.
  The Physiotherapy Evidence Database quality assessment tool and The Cochrane Collaboration tool for assessing risk of bias were used by two independent authors (HA and FM) in order to appraise the included studies.
  
  
  RESULTS
  The database search resulted in 879 articles, of which five papers were included. VBF was compared to no intervention, a placebo, and traditional exercise. The total number of participants in all the five included studies was 181, with a mean age of 74.3 years (standard deviation 6.7). Two studies were rated as high-quality studies, and three were rated as fair quality.
  
  
  CONCLUSIONS
  Engaging elderly people living in the community in VBF training was found to be effective and could improve their balance ability. However, the variation between studies in methodology, intervention protocol, and outcomes utilized made it difficult to inform a definitive statement regarding the potential application of VBF for balance training with the elderly. Furthermore, high-quality randomized control trials are required. The systematic review level of evidence is moderate, and the strength of recommendation is that VBF is likely to be beneficial.
authors.affiliation: Physiotherapy Department, Faculty of Applied Medical Science, Umm al-Qura University, Mecca, Kingdom of Saudi Arabia.
authors.forename: Hammad
authors.initials: H
authors.lastname: Alhasan
authors.affiliation: School of Health Science, University of Nottingham, Nottingham, Nottinghamshire, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Hood
authors.affiliation: School of Health Science, University of Nottingham, Nottingham, Nottinghamshire, UK.
authors.forename: Frederick
authors.initials: F
authors.lastname: Mainwaring
mesh_terms: D000368:Aged; D001676:Biofeedback, Psychology / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D004856:Postural Balance / Q000502:physiology; D014796:Visual Perception / Q000502:physiology
keywords: exergames; older adult; postural balance; visual feedback