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

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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.

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Acknowledgements

We thank Jen-Wen Hung, Giovanni Morone, Jòzsef Tollàr and Rosa Ortiz-Gutiérrez for data sharing.

Funding

This study was supported by FISM—Fondazione Italiana Sclerosi Multipla—cod. 2017/R/22 and financed or co-financed with the ‘5 per mille’ public funding.

LP: personal fees and non-financial support from Biogen, Celgene, Genzyme, Merck, Mylan, Novartis, Roche, Teva; research grants from Genzyme and Fondazione Italiana Sclerosi Multipla. VT: personal fees and non-financial support from Biogen and Novartis; research grants from Biogen. LC: personal fees and non-financial support from Almirall. AT: nothing to disclose. GB: nothing to disclose. DC: research grants from Fondazione Italiana Sclerosi Multipla. CMS: personal fees and non-financial support from Almirall, Biogen, GW Pharma, Merck; research grants from Fondazione Italiana Sclerosi Multipla.

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Authors and Affiliations

  1. Department of Neurosciences, S. Camillo-Forlanini Hospital, c.ne Gianicolense 87, 00152, Rome, Italy

    Luca Prosperini

  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

    Valentina Tomassini

  3. Multiple Sclerosis Centre, Neurology Unit, “SS. Annunziata” University Hospital, Via dei Vestini 31, 66100, Chieti, Italy

    Valentina Tomassini

  4. Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Via Marengo 3, 09123, Cagliari, Italy

    Letizia Castelli

  5. Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy

    Andrea Tacchino & Giampaolo Brichetto

  6. Rehabilitation Centre, Italian Multiple Sclerosis Society, Via Operai 40, 16149, Genoa, Italy

    Giampaolo Brichetto

  7. LaRiCE Lab, IRCCS Don Carlo Gnocchi Foundation, Via Capecelatro 66, 20148, Milan, Italy

    Davide Cattaneo

  8. Rehabilitation Unit ‘Mons. L. Novarese’ Hospital, Loc. Trompone, 13040, Moncrivello, VC, Italy

    Claudio Marcello Solaro

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  1. Luca Prosperini
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  2. Valentina Tomassini
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  3. Letizia Castelli
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Correspondence to Luca Prosperini.

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Prosperini, L., Tomassini, V., Castelli, L. et al. Exergames for balance dysfunction in neurological disability: a meta-analysis with meta-regression. J Neurol 268, 3223–3237 (2021). https://doi.org/10.1007/s00415-020-09918-w

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  • DOI: https://doi.org/10.1007/s00415-020-09918-w

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