Incremental vestibulo-ocular reflex adaptation training in patients with vestibular disorders: a systematic review

Background Vestibular disorders are a group of diseases affecting the peripheral or central vestibular system. Incremental vestibulo-ocular reflex (VOR) adaptation training has been used to improve the gaze stability in patients with vestibular disorders. This review aims to evaluate the effects of incremental VOR adaptation training in patients with vestibular disorders. Methods “ PubMed, Scopus, REHABDATA, PEDro, Web of Science, and Embase” were searched from inception to January 2026. Studies that examined the effects of incremental VOR adaptation training on patients with vestibular disorders were included. The “Physiotherapy Evidence Database (PEDro) Scale and Joanna Briggs Institute (JBI) critical appraisal” tools were used to evaluate the methodological quality of the studies. Results Six studies met the eligibility criteria. In total, 83 patients (Mean age 42.37 years; 55% male) with peripheral vestibular hypofunction (PVH) were included in this review. The quality of the selected studies ranged from moderate to high on the PEDro scale. The findings suggested that incremental VOR adaptation training may improve VOR gain, compensatory saccades, dizziness-related symptoms, and aspects of gait and balance. However, these findings were inconsistent across outcomes and studies. Conclusions Incremental VOR adaptation training may improve vestibular-related outcomes; however, current evidence is limited, inconsistent, and characterized by substantial uncertainty. Further high-quality trials with long-term follow-ups and standardized protocols are strongly needed to understand the treatment effects in patients with vestibular disorders.