Do virtual reality tools in vestibular rehabilitation offer advantage beyond increased practice times? A narrative review

Background – The successful implementation of vestibular rehabilitation is frequently hindered by low patient adherence due to provoked symptoms and repetitive exercises. Virtual reality is increasingly deployed as a digital health solution to overcome these barriers through gamification, yet the specific active ingredient driving its clinical efficacy remains unclear. Objective – This review evaluates whether the therapeutic advantage of virtual reality in vestibular rehabilitation is driven by specific technological features or by the confounding effect of longer practice durations relative to traditional methods. Methods – We conducted a narrative review of studies published between 2010 and 2025 using PubMed, Scopus, and Google Scholar. The analysis focused on trials comparing virtual reality tools to conventional rehabilitation. Results – Although intervention protocols varied substantially, studies demonstrating better outcomes (e.g., Vestibulo-Ocular Reflex gain, Dizziness Handicap Inventory, Berg Balance Test) with virtual reality consistently involved greater practice exposure in the virtual reality group. Our analysis suggests that when training duration was matched between intervention arms, virtual reality demonstrated no clinical advantage over conventional rehabilitation with one recent trial reporting better outcomes for conventional rehabilitation. Conclusion – Virtual reality appears to enhance engagement in vestibular rehabilitation; however, current evidence suggests that the observed benefits could be attributed to increased practice dosage rather than unique technological effects. Future studies should standardize protocols to determine the independent contribution of virtual reality to clinical outcomes.