Luca Prosperini1, Valentina Tomassini2,3, Letizia Castelli4, Andrea Tacchino5, Giampaolo Brichetto5,6, Davide Cattaneo7, Claudio Marcello Solaro8. 1. Department of Neurosciences, S. Camillo-Forlanini Hospital, c.ne Gianicolense 87, 00152, Rome, Italy. luca.prosperini@gmail.com. 2. Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara "G. D'Annunzio", Via Luigi Polacchi, 66100, Chieti, Italy. 3. Multiple Sclerosis Centre, Neurology Unit, "SS. Annunziata" University Hospital, Via dei Vestini 31, 66100, Chieti, Italy. 4. Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Via Marengo 3, 09123, Cagliari, Italy. 5. Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy. 6. Rehabilitation Centre, Italian Multiple Sclerosis Society, Via Operai 40, 16149, Genoa, Italy. 7. LaRiCE Lab, IRCCS Don Carlo Gnocchi Foundation, Via Capecelatro 66, 20148, Milan, Italy. 8. Rehabilitation Unit 'Mons. L. Novarese' Hospital, Loc. Trompone, 13040, Moncrivello, VC, Italy.
Abstract
OBJECTIVE: To evaluate systematically the efficacy of exergames for balance dysfunction in neurological conditions and to identify factors of exergaming protocols that may influence their effects. METHODS: We searched electronic databases for randomized clinical trials investigating the effect of commercial exergames versus alternative interventions on balance dysfunction as assessed by standard clinical scales in adults with acquired neurological disabilities. Standardized mean differences (Hedge's g) were calculated with random-effects models. Subgroup analyses and meta-regression were run to explore potential modifiers of effect size. RESULTS: Out of 106 screened articles, 41 fulfilled criteria for meta-analysis, with a total of 1223 patients included. Diseases under investigation were stroke, Parkinson's disease, multiple sclerosis, mild cognitive impairment or early Alzheimer's disease, traumatic brain injury, and myelopathy. The pooled effect size of exergames on balance was moderate (g = 0.43, p < 0.001), with higher frequency (number of sessions per week) associated with larger effect (β = 0.24, p = 0.01). There was no effect mediated by the overall duration of the intervention and intensity of a single session. The beneficial effect of exergames could be maintained for at least 4 weeks after discontinuation, but their retention effect was specifically explored in only 11 studies, thus requiring future investigation. Mild to moderate adverse events were reported in a minority of studies. We estimated a low risk of bias, mainly attributable to the lack of double-blindness and not reporting intention-to-treat analysis. CONCLUSIONS: The pooled evidence suggests that exergames improve balance dysfunction and are safe in several neurological conditions. The findings of high-frequency interventions associated with larger effect size, together with a possible sustained effect of exergaming, may guide treatment decisions and inform future research.
OBJECTIVE: To evaluate systematically the efficacy of exergames for balance dysfunction in neurological conditions and to identify factors of exergaming protocols that may influence their effects. METHODS: We searched electronic databases for randomized clinical trials investigating the effect of commercial exergames versus alternative interventions on balance dysfunction as assessed by standard clinical scales in adults with acquired neurological disabilities. Standardized mean differences (Hedge's g) were calculated with random-effects models. Subgroup analyses and meta-regression were run to explore potential modifiers of effect size. RESULTS: Out of 106 screened articles, 41 fulfilled criteria for meta-analysis, with a total of 1223 patients included. Diseases under investigation were stroke, Parkinson's disease, multiple sclerosis, mild cognitive impairment or early Alzheimer's disease, traumatic brain injury, and myelopathy. The pooled effect size of exergames on balance was moderate (g = 0.43, p < 0.001), with higher frequency (number of sessions per week) associated with larger effect (β = 0.24, p = 0.01). There was no effect mediated by the overall duration of the intervention and intensity of a single session. The beneficial effect of exergames could be maintained for at least 4 weeks after discontinuation, but their retention effect was specifically explored in only 11 studies, thus requiring future investigation. Mild to moderate adverse events were reported in a minority of studies. We estimated a low risk of bias, mainly attributable to the lack of double-blindness and not reporting intention-to-treat analysis. CONCLUSIONS: The pooled evidence suggests that exergames improve balance dysfunction and are safe in several neurological conditions. The findings of high-frequency interventions associated with larger effect size, together with a possible sustained effect of exergaming, may guide treatment decisions and inform future research.
Authors: Giulio E Lancioni; Nirbhay N Singh; Mark O'Reilly; Jeff Sigafoos; Gloria Alberti; Lorenzo Desideri Journal: JMIR Rehabil Assist Technol Date: 2022-04-07
Authors: Dario Calafiore; Marco Invernizzi; Antonio Ammendolia; Nicola Marotta; Francesco Fortunato; Teresa Paolucci; Francesco Ferraro; Claudio Curci; Agnieszka Cwirlej-Sozanska; Alessandro de Sire Journal: Front Neurol Date: 2021-12-10 Impact factor: 4.003