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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)-based 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-specific VR design recommendations.
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-Analysis (SWiM) approach, a narrative synthesis was conducted.
A total of eight studies met the inclusion criteria, with a pooled sample of 341 participants (mean age = 49 to 72). VR systems were primarily used as intervention modalities (6 of 8 studies). Most VR systems employed non-immersive, screen-based platforms with real-time visual biofeedback. Progression algorithms were clinician-guided rather than adaptive. VR-based interventions demonstrated consistent improvements in postural sway, mediolateral stability, and functional mobility measures in adults with DPN.
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.
Based on these findings, the SAFE STEP PLAN Framework, a geriatric-specific design guidance for VR-based and other technology-assisted rehabilitation interventions in DPN, was developed to inform the design, implementation, and clinical integration of technology-assisted interventions for older people.
Near-falls, defined as events in which individuals momentarily lose their balance but avoid falling, are strong predictors of subsequent falls. Wearable technologies have the potential to accurately detect near-falls in both laboratory and real-world settings, providing opportunities for early intervention in geriatric nursing practice.
This study has a two-fold aim: (1) to appraise and synthesize current evidence on wearable sensor technologies for near-fall detection, and (2) to discuss their potential applications for monitoring near-fall risk and implementing prevention strategies in older adults.
This is a systematic review. Articles were searched in five electronic databases (PubMed/MEDLINE, Embase, CINAHL, Web of Science, and IEEE Xplore) that explored wearable sensors for near-fall detection. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
A total of 18 studies, mostly experimental or observational, were included. Inertial Measurement Units (IMUs) were the most commonly used wearable technology, and the most frequently captured biomarker was linear acceleration. Lower-body placements (feet, ankles, and lower back) demonstrated superior performance in detecting near-falls. Single-sensor systems achieved sensitivities of 80%–98%, whereas multi-sensor configurations achieved 100% sensitivity, 99% specificity, and 100% accuracy.
Integrating wearable technologies for near-fall detection into geriatric nursing practice may enhance early identification of older adults at high risk for falls and enable timely, personalized interventions. Future research should validate these technologies in real-world settings and assess their acceptability among nurses, caregivers, and older adults.
To appraise and synthesise existing research on the relationship between patient safety culture and missed nursing care.
Systematic review and meta-analysis.
Peer-reviewed articles published from 2010 onwards were searched from five databases (CINAHL, ProQuest, PubMed, ScienceDirect and Web of Science). A total of nine studies were identified. Among these, seven studies with a combined sample size of 1661 participants were included in the meta-analysis.
The meta-analysis revealed a significant negative correlation between overall patient safety culture and missed nursing care, with a pooled correlation coefficient of −0.205 (95% CI: −0.251 to −0.158) (p < 0.001). Heterogeneity was low to moderate (I 2 = 13.18%, 95% CI: 0.00 to 78.60), and publication bias tests indicated no significant bias (Egger's test p = 0.0603; Begg's test p = 0.3476).
The findings underscore a significant inverse relationship between patient safety culture and missed nursing care, highlighting the specific predictive roles of management support, organisational learning and unit-level safety culture. Enhancing patient safety culture within healthcare organisations can be a strategic approach to mitigate missed nursing care.
Nursing leaders and administrators should prioritise fostering a safety-oriented culture through targeted interventions, continuous education and supportive policies to improve patient care outcomes.
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.
No patient or public contribution.
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