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

• Published in: Journal of advanced nursing 2022-04, Vol.78 (4), p.929-946
• Main Authors: Chan, Kendy Gui Fang, Jiang, Ying, Choo, Wen Ting, Ramachandran, Hadassah Joann, Lin, Yanjuan, Wang, Wenru
• Format: Article
• Language: English
• Subjects: Analysis; balance; Bias; chronic stroke; Clinical trials; Exercise; Exercise Therapy; exergames; Exergaming; Functional impairment; functional independence; Humans; Inappropriateness; Meta-analysis; Mobility; Physical therapy; Physiotherapy; Rehabilitation; Risk assessment; Stroke; Stroke Rehabilitation; Systematic review
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.15125

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.