Exergames for balance dysfunction in neurological disability : a meta-analysis with meta-regression

Objective To evaluate systematically the efcacy of exergames for balance dysfunction in neurological conditions and to identify factors of exergaming protocols that may infuence their efects. Methods We searched electronic databases for randomized clinical trials investigating the efect of commercial exergames versus alternative interventions on balance dysfunction as assessed by standard clinical scales in adults with acquired neurological disabilities. Standardized mean diferences (Hedge’s g) were calculated with random-efects models. Subgroup analyses and meta-regression were run to explore potential modifers of efect size. Results Out of 106 screened articles, 41 fulflled 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 efect size of exergames on balance was moderate (g=0.43, p<0.001), with higher frequency (number of sessions per week) associated with larger efect (β =0.24, p=0.01). There was no efect mediated by the overall duration of the intervention and intensity of a single session. The benefcial efect of exergames could be maintained for at least 4 weeks after discontinuation, but their retention efect was specifcally 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 fndings of high-frequency interventions associated with larger efect size, together with a possible sustained efect of exergaming, may guide treatment decisions and inform future research.