## 5 Discussion  
This comprehensive analysis of nine randomized controlled trials offers a succinct overview of the impact of VR interventions on individuals with MS, comparing them to conventional or no interventions. Particular focus is given to key outcomes such as fatigue, balance, functional mobility, and quality of life. The conclusions drawn from all the studies analyzed indicate that VR technology accessed as a rehabilitation method for balance retraining is highly effective in improving mobility in individuals with MS. However, outcomes vary across different interventions, with some showing no improvement while others exhibit results akin to conventional exercises. Notably, in areas concerning quality of life, fatigue, and balance, VR interventions demonstrate a more pronounced improvement compared to conventional exercises. It is crucial to approach these findings with discernment, given the methodological disparities and variations in training dosage across the included studies, as well as the varying methodological quality observed in some of the studies incorporated in the review. It is worth emphasizing that currently, VR training for MS patients has been combined with both traditional methods like conventional exercises and more advanced approaches such as robotic-assisted gait training (RAGT). To our knowledge, so far, there are no reviews that have examined the inclusion of RAGT studies alongside VR training. In our study, two randomized controlled trials (RCTs) meeting the inclusion criteria demonstrated superior outcomes in the RAGT + VR groups, which also maintained these results over longer periods compared to the control group. Even though an interesting systematic review of the use of RAGT in MS has recently been published [33], further exploration and investigation into the effects of integrating VR techniques with RAGT devices could provide valuable insights for a comprehensive review of the benefits and utilization of VR. Our findings are similar to two other previous meta-analyses. Firstly, [PERSON] et al. [13] conducted a systematic review analyzing the effectiveness of VR on balance and gait in patients with MS, revealing significant differences compared to no interventions. Second, [PERSON] et al. [34] suggested that VR could induce benefits that are at least similar, if not greater, than classical exercises in MS patients. However, taking all this research into account, no decisive ideas have been concluded regarding the impact of VR on improving balance in MS patients despite the promising potential of this approach, as evidenced by findings in other chronic neurological conditions [35; 36]. In this review, we found that VR can improve balance outcomes quantified with BBS compared with classical balance reeducation treatment in MS patients. We followed the evaluations performed with BBS, as it appears to be the most widely used and recommended tool for assessing balance in neurological pathologies. Interventions using Nintendo Wii or Kinect video games generally involved games or activities that require different motor and cognitive skills, such as memory or attention. Given that balanced rehabilitation consists of multiple elements, we would have appreciated it more if postural control had been assessed in all the studies we reviewed. This could have strengthened our beliefs regarding VR's capacity to rehabilitate MS patients. However, we could not identify any review in the literature that comprehensively addressed the evaluation of balance to such a degree. The measurements performed with the TUG test showed that the groups that opted for balanced rehabilitation with VR technology did not turn out to be superior but not inferior to the groups that opted for other interventions or to the groups that did not receive the intervention. This finding does not bring new information regarding the use of VR to improve functional mobility. The same was concluded with regard to walking, which was quantified by the 10 MW and 6 MWD tests.