Effect of virtual reality-based training on postural balance in children and adolescents with neurodevelopmental disorders: a systematic review and meta-analysis

Purpose: Virtual reality, an emerging rehabilitation technology, is increasingly used to improve postural balance in children and adolescents with neurodevelopmental disorders. This review evaluated the effectiveness of virtual reality interventions for improving postural balance in this population based on randomized controlled trials. Materials and methods: PubMed, Web of Science, Scopus, Embase, Cochrane Library, CNKI, and Wanfang were systematically searched from database inception through November 6, 2025, for English- and Chinese-language randomized controlled trials examining virtual reality-based interventions on objective measures of postural balance in children and adolescents with neurodevelopmental disorders. Methodological quality was evaluated using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was appraised according to the GRADE approach. Pooled standardized mean differences with 95% confidence intervals were computed using the meta package in R (version 4.5.1), and heterogeneity, subgroup, and leave-one-out sensitivity analyses were performed. Results: = 0.004). Although trials with shorter session durations, lower weekly training frequencies, and shorter intervention periods appeared to yield larger effects, subgroup analyses failed to identify statistically significant between-subgroup differences. Conclusion: This systematic review and meta-analysis indicates that virtual reality-based interventions may enhance postural balance in children and adolescents with neurodevelopmental disorders. However, the certainty of evidence remains limited owing to the paucity of included trials and methodological limitations. Future large-scale randomized controlled trials with extended follow-up periods and standardized balance assessments are warranted to corroborate these findings and optimize intervention parameters. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251135718, CRD420251135718.