Effect of Immersive Virtual Reality and Audiovisual Treatment for Gait Disorder in Parkinson's Disease (IVRTFPD study ) : A Prospective Randomised Controlled Clinical Trial

Abstract OBJECTIVE Immersive Virtual Reality Treatment for Parkinson's Disease (IVRTFPD study ) aims to compare the effect of immersive virtual reality training(VR) and audiovisual training (AV) for gait disorder in Parkinson's disease. METHODS Forty-four PD patients with gait disorder were enrolled and randomly divided into an immersive virtual reality (VR) group (n = 22), Audiovisual Treatment (AV) group (n = 22). The primary efficacy outcome measure was the change from baseline (Pre) to 6 weeks (Post 6w) and 14 weeks (Post 14w) visit in the Timed Up and Go test (TUGT). Magnetic resonance imaging (MRI) was assessed in baseline (Pre) and Post 14w visits. RESULTS The TUGT was reduced by 3.16s (95% CI, -4.18 to -2.13, P < 0.001) at 6 weeks and 2.36s (95% CI, -3.77 to -0.96, P < 0.001) at 14 weeks from baseline in VR group. The between-group difference (VR vs. AV) in the TUGT was − 2.64s (95% CI, -4.84 to -0.45; P = 0.019) at 6 weeks and − 2.44s (95% CI, -4.67 to -0.21; P = 0.013) at 14 weeks. The quantitative susceptibility mapping (QSM) value of the right internal Globus pallidus, right Pulvinar, and right Substantia nigra decreased, and the FA value of the left Superior Longitudinal Fasciculus, right Uncinate Fasciculus increased in the VR group compared with the Pre-test. CONCLUSIONS This study confirmed that the virtual reality and audiovisual training improved motor symptoms of PD patients, and the efficacy persisted even longer in the VR group. It may be related to improved iron metabolism and reduced iron deposition.