Effects of Proprioceptive Neuromuscular Facilitation (PNF)-Based and Virtual Reality (VR) Balance Training on Postural Control and Dynamic Balance in Stroke Survivors

Stroke is a leading cause of long-term disability worldwide and frequently results in impairments in postural control, dynamic balance, gait, and functional mobility.Effective rehabilitation strategies are essential to reduce fall risk and improve independence in stroke survivors.Proprioceptive neuromuscular facilitation (PNF) and virtual reality (VR)-based training have emerged as promising interventions for balance rehabilitation; their comparative effectiveness remains unclear.This study aimed to systematically review and compare the effects of PNF-based and VR-based balance training on postural control and dynamic balance in stroke survivors.A systematic literature search was conducted across PEDro, PubMed, MEDLINE, CINAHL, and Scopus to identify relevant studies published between January 2016 and April 2026.Randomized controlled trials (RCTs) evaluating PNF, VR, or combined PNF-VR interventions in adult stroke survivors were included in this review.Studies were eligible if they assessed outcomes related to postural control, balance, gait performance, trunk control, functional mobility, or activities of daily living.Outcome measures related to balance, postural control, gait, trunk control, functional mobility, and activities of daily living were evaluated.Methodological quality was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool.Twelve RCTs involving stroke survivors met the inclusion criteria.The included studies reported improvements in selected outcomes related to balance, gait performance, trunk control, functional mobility, and functional independence following PNF-based and VR-based interventions.However, the findings varied across studies, and not all trials assessed the same outcomes.Several studies investigated PNF in combination with other interventions, such as core strengthening or treadmill training, making it difficult to attribute the observed improvements to PNF alone.VR-based interventions also showed favorable findings in selected balance, gait, participation, and activities of daily living outcomes.Only one included trial investigated combined PNF and VR training; therefore, the available evidence is insufficient to establish synergy or demonstrate the superiority of combined therapy over PNF or VR alone.Risk-of-bias assessment indicated that most included studies had some concerns, particularly regarding methodological limitations and challenges associated with participant and assessor blinding.The findings of this review suggest that PNF-based and VR-based rehabilitation may improve selected outcomes related to postural control, dynamic balance, trunk control, gait performance, and functional mobility in stroke survivors.However, the included studies varied in their interventions, comparators, and outcome measures, limiting direct comparisons between the approaches.The available evidence is insufficient to establish the superiority of either intervention or to confirm that combining PNF and VR produces superior rehabilitation outcomes.Further high-quality RCTs with standardized outcome measures, appropriate effect-size reporting, and long-term follow-up are needed to clarify their comparative effectiveness and sustained benefits.