Video game therapy was found to have a minor impact on postural balance in patients with multiple sclerosis (MS); however, more research is needed to determine whether it should be recommended in clinical practice, investigators concluded.
Commercial video game therapy, also known as exergame therapy, may have only a small effect on postural balance in patients with multiple sclerosis (MS), according to a recent literature review published in Neurología.
The investigators of the systematic study provided a comprehensive review of the limited published, peer-reviewed evidence evaluating the effects of exergame therapy, suggesting exergame therapy should not be recommended in clinical practice until more research using appropriate assessment tools are available.
Postural imbalance is among the most disabling symptoms of MS and affects approximately 80% of patients. Commercial video games can serve as an inexpensive and accessible tool for improving postural balance in various populations and can increase patient motivation and satisfaction with treatment.
Exergames involve activities where players can use their arms and legs to activate commands to accomplish objectives, such as dancing, running, throwing, cycling, boxing, or playing tennis. However, despite increasing evidence on the use of exergames in various populations, it is unclear whether exergames can benefit MS populations.
The investigators searched 11 electronic databases for randomized controlled trials evaluating the effects of commercial video games on postural balance in patients with MS that have been published in full-text format in international, peer-reviewed journals. Out of the 230 studies that were identified, 5 studies published between 2013 and 2015 were included in the qualitative analysis, 4 of which were selected for the meta-analysis.
A total of 259 patients with MS were included in the systematic review, of whom 176 were women, and their ages ranged from 35.3 to 53.9 years. Regarding the characteristics of the commercial video games used, Wii Fit and Wii Fit Plus were used with the Nintendo Wii and Kinect Sports, Kinect Joy Ride, and Kinect Adventures were used with the Xbox 360. Across the studies, exergaming training ranged from 2 to 5 times per week and sessions lasted between 30 and 60 minutes.
The studies generally reported on whether the interventions led to any short-term (4 to 12 weeks) improvements compared with controls, who received no treatment or performed strength and proprioception exercises. Exergaming improved dynamic balance by 9% to 16%, which was measured using Berg balance scale (BBS), Tinetti balance scale, timed 25-foot walk (T25-FW), and the 4-step square test (FSST). Static balance was also improved when measured using center of pressure (CoP) displacement, CoP velocity, and CoP displacement range in the anteroposterior and mediolateral axes. CoP sway area was also decreased by 44% during open-eye stabilometry and 38% for closed-eye stabilometry. Two of the studies showed no differences in any of the variables analyzed between the intervention and control groups.
However, the results from 3 meta-analyses revealed no significant differences between studies for any of the variables analyzed. Although improvements for BBS scores were marked more often in patients receiving exergame therapy than patients in the control groups, no significant differences were observed between patients for scores for FSST or T25-FW.
The investigators noted, “The magnitude of change for each variable cannot be interpreted as a true change in patients’ clinical status but rather is due to variability in the assessment tool.” They also said that their results for Tinetti scale scores and static stabilometry variables should be interpreted with caution because for the minimal detectable change has not been established for patients with MS.
They also listed the small number of studies exploring the effects of exergames on postural balance in MS as a main study limitation. “This review identifies methodological issues that may be accounted for in future research into the effects of exergame therapy on postural balance in patients with MS,” wrote the investigators.
Parra-Moreno M, Rodríguez-Juan JJ, Ruiz-Cárdenas JD. Use of commercial video games to improve postural balance in patients with multiple sclerosis: a systematic review and meta-analysis of randomised controlled clinical trials. Neurología. 2021;36(8):618-624. doi:10.1016/j.nrleng.2017.12.002