Exercise-based games interventions at home in individuals with a neurological disease: A systematic review and meta-analysis

OBJECTIVE:The objective of this review was to summarize the current best evidence for the effectiveness, feasibility, user compliance and safety of exercise-based games (EBGs), including virtual reality and interactive video game interventions, for the rehabilitation of individuals with neurological disorders at home. MATERIAL AND METHODS:We identified randomized controlled trials (RCT) evaluating the effects of EBGs in neurological patients in home settings by searching 3 electronic databases (MEDLINE, SCOPUS, CENTRAL Library) from inception to March 2018. All data pertaining to participants, interventions, outcomes, supervision and cost-effectiveness were independently extracted by 2 reviewers. Risk of bias was independently assessed by 2 reviewers. RESULTS:Reports of 11 RCT studies with heterogeneous populations (i.e., stroke, Parkinson disease and multiple sclerosis) were included in the review. The treatment of experimental groups included EBGs (i.e., commercially available games such as Nintendo Wii or Dance Dance Revolution or custom-designed devices), and control groups received a controlled (i.e., conventional therapy) or uncontrolled (i.e., usual care) intervention. Across studies, EBGs at home tended to have limited effects on upper and lower limbs. We demonstrated an increased risk of participants dropping out of the program or discontinuing training in experimental groups (n=51 participants) as compared with controls (n=23 participants). Few adverse events (2 of 6 studies), such as minor musculoskeletal pain, were reported in balance training. CONCLUSIONS:This systematic review reveals that EBGs seem a relevant alternative for rehabilitation at home because the effectiveness of these interventions was at least equivalent to conventional therapy or usual care. We give recommendations for the development of new EBG therapies.