Effectiveness of exergaming on balance, functional mobility and independence, and health-related quality of life amongst patients with chronic stroke: a systematic review and meta-analysis

Abstract

Background: Chronic stroke patients experience drastically reduced rehabilitation intensity once past the subacute phase of stroke. Compounded with declining motivation, their recovery often stagnates to result in remnant disability that hinders independent and comfortable ambulation. Several clinical trials have explored the use of exergaming to sustain engagement amongst chronic stroke patients requiring further rehabilitation. However, their effectiveness in improving these patients’ health-related outcomes remains poorly understood. Objectives: To synthesise and evaluate effectiveness of exergaming on balance, lower limb (LL) functional mobility, functional independence, and health-related quality of life (HRQoL) in chronic stroke patients. Methods: Searches were conducted across seven databases (PubMed, EMBASE, Web of Science, CINAHL, CENTRAL, Scopus, and PEDro) and in grey literature. Only randomised 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, with effect sizes reported as Hedges’ g, and narrative syntheses were adopted whenever meta-analysis was inappropriate. The overall quality of evidence from included studies was assessed using GRADE. 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, LL functional mobility, and functional independence, but not for HRQoL. However, the overall quality of evidence appraised using GRADE was low. Conclusion and Implications: Exergaming has favourable effects on improving balance, LL functional mobility, and functional independence amongst individuals with chronic stroke, making it a suitable and enjoyable adjunct to conventional physiotherapy. Nonetheless, future high-quality trials with larger sample sizes, greater variation in exergaming dosage, and longer intervention and follow-up periods are needed to gain deeper understanding and reach more definitive conclusions on the topic.