{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T03:56:46Z","timestamp":1790567806489,"version":"4.1.0"},"reference-count":59,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["sigmapubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Nursing Scholarship"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Diabetic peripheral neuropathy (DPN) among older people is associated with significant gait and balance impairments, postural instability, and an increased fall risk. Virtual reality (VR)\u2010based interventions have been shown to be effective in improving balance and mobility; however, their design features and applicability for older people with DPN remain unclear. This systematic review was conducted to examine the effectiveness of VR systems on clinical outcomes in individuals with DPN and translate the findings into geriatric\u2010specific VR design recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A systematic review design was employed. Five electronic databases (Scopus, PubMed, CINAHL, Web of Science, and Embase) were systematically searched. Guided by the Synthesis Without a Meta\u2010Analysis (SWiM) approach, a narrative synthesis was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of eight studies met the inclusion criteria, with a pooled sample of 341 participants (mean age\u2009=\u200949 to 72). VR systems were primarily used as intervention modalities (6 of 8 studies). Most VR systems employed non\u2010immersive, screen\u2010based platforms with real\u2010time visual biofeedback. Progression algorithms were clinician\u2010guided rather than adaptive. VR\u2010based interventions demonstrated consistent improvements in postural sway, mediolateral stability, and functional mobility measures in adults with DPN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>VR systems, used as either intervention and assessment modalities, were found to be effective in assessing and improving balance and functional mobility in adults with DPN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Based on these findings, the SAFE STEP PLAN Framework, a geriatric\u2010specific design guidance for VR\u2010based and other technology\u2010assisted rehabilitation interventions in DPN, was developed to inform the design, implementation, and clinical integration of technology\u2010assisted interventions for older people.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jnu.70124","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T12:33:51Z","timestamp":1786538031000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Virtual Reality\u2013Based Rehabilitation to Improve Mobility and Prevent Falls in Older People With Diabetic Peripheral Neuropathy: Evidence Synthesis and Development of a Geriatric\u2010Specific Framework"],"prefix":"10.1111","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0315-4438","authenticated-orcid":false,"given":"Leodoro J.","family":"Labrague","sequence":"first","affiliation":[{"name":"Fran and Earl Ziegler College of Nursing The University of Oklahoma Health Campus  Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7415-064X","authenticated-orcid":false,"given":"David M.","family":"Ha","sequence":"additional","affiliation":[{"name":"Fran and Earl Ziegler College of Nursing The University of Oklahoma Health Campus  Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7438-341X","authenticated-orcid":false,"given":"Liza","family":"Visbal\u2010Dionaldo","sequence":"additional","affiliation":[{"name":"Fran and Earl Ziegler College of Nursing The University of Oklahoma Health Campus  Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8971-9958","authenticated-orcid":false,"given":"Kacy L.","family":"Aderhold","sequence":"additional","affiliation":[{"name":"Fran and Earl Ziegler College of Nursing The University of Oklahoma Health Campus  Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7843-4325","authenticated-orcid":false,"given":"Anna","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Fran and Earl Ziegler College of Nursing The University of Oklahoma Health Campus  Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.3889\/oamjms.2014.045"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.14283\/jpad.2022.16"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11233037"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc26-S013"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES-23-00268"},{"key":"e_1_2_16_7_1","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES-22-00430"},{"key":"e_1_2_16_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-23161-2_162"},{"key":"e_1_2_16_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-2287"},{"key":"e_1_2_16_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-025-04318-4"},{"key":"e_1_2_16_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-024-03954-6"},{"key":"e_1_2_16_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glac001"},{"key":"e_1_2_16_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l6890"},{"issue":"2","key":"e_1_2_16_14_1","first-page":"257","article-title":"Case Study Using Virtual Rehabilitation for a Patient With Fear of Falling due to Diabetic Peripheral Neuropathy","volume":"11","author":"Carroll K. 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