Approximately two thirds of stroke survivors maintain upper limb (UL) impairments and few among them attain complete UL recovery 6 months after stroke. Technological progress and gamification of interventions aim for better outcomes and constitute opportunities in self- and tele-rehabilitation. Our objective was to assess the efficacy of serious games, implemented on diverse technological systems, targeting UL recovery after stroke. In addition, we investigated whether adherence to neurorehabilitation principles influenced efficacy of games specifically designed for rehabilitation, regardless of the device used. This systematic review was conducted according to PRISMA guidelines (PROSPERO registration number: 156589). Two independent reviewers searched PubMed, EMBASE, SCOPUS and Cochrane Central Register of Controlled Trials for eligible randomized controlled trials (PEDro score ≥ 5). Meta-analysis, using a random effects model, was performed to compare effects of interventions using serious games, to conventional treatment, for UL rehabilitation in adult stroke patients. In addition, we conducted subgroup analysis, according to adherence of included studies to a consolidated set of 11 neurorehabilitation principles. Meta-analysis of 42 trials, including 1760 participants, showed better improvements in favor of interventions using serious games when compared to conventional therapies, regarding UL function (SMD = 0.47; 95% CI = 0.24 to 0.70; P < 0.0001), activity (SMD = 0.25; 95% CI = 0.05 to 0.46; P = 0.02) and participation (SMD = 0.66; 95% CI = 0.29 to 1.03; P = 0.0005). Additionally, long term effect retention was observed for UL function (SMD = 0.42; 95% CI = 0.05 to 0.79; P = 0.03). Interventions using serious games that complied with at least 8 neurorehabilitation principles showed better overall effects. Although heterogeneity levels remained moderate, results were little affected by changes in methods or outliers indicating robustness. This meta-analysis showed that rehabilitation through serious games, targeting UL recovery after stroke, leads to better improvements, compared to conventional treatment, in three ICF-WHO components. Irrespective of the technological device used, higher adherence to a consolidated set of neurorehabilitation principles enhances efficacy of serious games. Future development of stroke-specific rehabilitation interventions should further take into consideration the consolidated set of neurorehabilitation principles.

中文翻译：

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中风后上肢康复的严肃游戏：荟萃分析

大约三分之二的中风幸存者仍存在上肢 (UL) 损伤，其中很少有人在中风后 6 个月内完全恢复上肢。技术进步和干预措施的游戏化旨在获得更好的结果，并为自我和远程康复提供机会。我们的目标是评估在不同技术系统上实施的严肃游戏的功效，以中风后的 UL 恢复为目标。此外，我们还调查了无论使用何种设备，遵守神经康复原则是否会影响专门为康复设计的游戏的功效。本系统评价是根据 PRISMA 指南（PROSPERO 注册号：156589）进行的。两名独立评审员检索了 PubMed、EMBASE、SCOPUS 和 Cochrane 对照试验中央注册库，寻找符合条件的随机对照试验（PEDro 评分≥ 5）。使用随机效应模型进行荟萃分析，比较严肃游戏干预措施与传统治疗对成人中风患者 UL 康复的效果。此外，我们根据纳入的研究对 11 项神经康复原则的遵守情况进行了亚组分析。对 42 项试验（包括 1760 名参与者）的荟萃分析表明，与传统疗法相比，使用严肃游戏进行干预在 UL 功能（SMD = 0.47；95% CI = 0.24 至 0.70；P < 0.0001）、活动（ SMD = 0.25；95% CI = 0.05 至 0.46；P = 0.02）和参与（SMD = 0.66；95% CI = 0.29 至 1.03；P = 0.0005）。此外，观察到 UL 功能的长期效果保留（SMD = 0.42；95% CI = 0.05 至 0.79；P = 0.03）。使用符合至少 8 条神经康复原则的严肃游戏进行干预，显示出更好的总体效果。尽管异质性水平仍然中等，但结果几乎不受方法变化或表明稳健性的异常值的影响。这项荟萃分析表明，与传统治疗相比，通过严肃的游戏进行康复，以中风后的 UL 恢复为目标，可以在 ICF-WHO 的三个组成部分中取得更好的改善。无论使用何种技术设备，严格遵守一套统一的神经康复原则都可以提高严肃游戏的效果。未来针对中风的康复干预措施的发展应进一步考虑一套综合的神经康复原则。