Relationship Between Motion Sickness and Postural Stability: A Systematic Review

INTRODUCTION: Motion sickness (MS) has traditionally been attributed to visual-sensory mismatch. Research on the cause-and-effect relationship between postural instability and MS has emerged, although evidence remains scarce. METHODS: A literature review from inception to December 31, 2024, was conducted to understand the relationship between MS and postural instability by searching several databases over a 1-month period in January 2025. The search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies investigated various forms of MS, including car sickness, virtual reality (VR), simulator sickness, cybersickness, travel-related sickness, and space MS. RESULTS: A total of 16 articles were identified, encompassing 1518 participants with ages ranging from 9 to 63 years. Most studies used force platforms and balance boards to assess postural instability, and 13 studies reported a relationship between postural instability and MS. These findings were consistent across VR, simulator, and transport-based motion paradigms. In contrast, 3 studies reported no consistent relationship between sway magnitude and symptom development. CONCLUSIONS: Although postural instability precedes MS, the quality of evidence is inadequate to determine the cause-and-effect relationship between MS and postural instability until extensive, multicentre, randomised controlled studies are conducted.