Effects of exergaming on functional outcomes in people with chronic stroke: A systematic review and meta‐analysis

Abstract

Aims:The aim of this review is to synthesize and evaluate effectiveness of exergaming on balance, lower limb functional mobility and functional independence in individuals with chronic stroke. Design:The present review is a systematic review and meta-analysis. The review is written in accordance with the guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Data Source: Searches were conducted across seven databases (PubMed, EMBASE, Web of Science, CINAHL, CENTRAL, Scopus and PEDro) and in grey literature from inception until January 2021.Review Methods: Only randomized controlled trials (RCTs) written in English were included. All eligible studies were assessed for risk of bias by two reviewers independently. Meta-analyses were performed using RevMan 5.4.1 software. Narrative syntheses were adopted whenever meta-analysis was inappropriate. The overall quality of evidence from included studies was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.Results: 4511 records were retrieved, with 32 RCTs eligible for inclusion and 27 RCTs included in meta-analysis. Meta-analyses reported statistically significant small effect sizes favouring exergaming on balance (pooled standardized mean difference[SMD] = 0.25, 95% confidence interval [CI, 0.08-0.41], p = .004), lower limb functional mobility (pooled SMD = 0.29, 95% CI [0.08-0.50], p = .007) and functional independence (pooled SMD = 0.41, 95% CI [0.09-0.73], p = .01). Most of the included studies failed to provide adequate description of the measures taken to prevent bias. Conclusion:Exergaming has favourable effects on improving balance, lower limb functional mobility and functional independence among individuals with chronic stroke, making it a suitable adjunct to conventional physiotherapy.Impact: People with chronic stroke have difficulty achieving the required rehab intensity. Exergaming can help individuals with chronic stroke to undertake further rehabilitation exercises at home. It can be a suitable adjunct to conventional physiotherapy.

PEMOCS: Evaluating the effects of a concept-guided, PErsonalized, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke – study protocol for a randomized controlled trial

“…Based on results from studies with exergame trainings in healthy older adults or other neurological patients, superior effects on cognitive functions of the additional exergame training compared to usual care alone are hypothesised (37,38,126). Previous research has shown that exergame training may have positive effects on gait and mobility (29,33), including gait speed, spatiotemporal gait parameters, and mobility in chronic stroke. Therefore, superior improvements in various spatiotemporal gait parameters and mobility in the intervention compared to the control group are expected in this study.…”

“…This is an identi ed need since cognitive dysfunction after stroke has a persistently high prevalence (127)(128)(129). Exergames have the potential to increase motivation for training (34,49), to produce additional bene ts on physical functions as compared with conventional care modes (33,130), as well as on cognitive functions (37,38,131). Exergames that contain aspects of virtual reality have shown to be able to signi cantly effect on Body Structure/Function and Activity level outcomes, including improvements in cognitive function and there is, therefore, evidence supporting the use of such interventions as an adjunct for stroke rehabilitation (47,48).…”

“…Exergames are cognitively demanding video games, which require the player to be physically active to complete the gaming tasks (30,31). Prior studies suggest that simultaneous motor-cognitive interventions can improve gait, balance, as well as dual-task mobility, and may help preventing falls in chronic stoke patients (29,32,33). Exergames may be the most promising type of simultaneous motor-cognitive trainings for improving those functions in chronic stroke patients (29).…”

“…This comparator was chosen as the aim of this study is to determine the effect of additional motor-cognitive exergame training. This aim was based on systematic reviews, which recommend the application of exergame training in addition to usual care, aiming at increasing the amount of rehabilitation offered to patients (33,38,46). Exergames that contain aspects of virtual reality have shown to be able and signi cantly effect on Body Structure/Function and Activity level outcomes, including improvements in cognitive function and there is, therefore, evidence supporting the use of such interventions as an adjunct for stroke rehabilitation (47,48).…”

Virtual Reality in Stroke Recovery: A meta-review of Systematic Reviews

“…Other low-quality studies have also demonstrated possible bene ts of including CG and gaming devices in stroke rehabilitation (67, 69, 74). A review by Chan et al ( 74) looked solely at exergaming (video games that require people to interact with the thorough purposeful body movements) at improving functional outcomes in patients with chronic stroke and it was found that exergaming showed statistically signi cant improvement in balance, lower limb functional mobility, and functional independence (74).…”