To review, summarize, and critically appraise the evidence underpinning the effects of game-based rehabilitation on UL function in adults within the first six months following stroke.
Eight electronic and three grey literature databases were searched from their inception to 30th April 2024 for relevant articles. Two independent reviewers selected potentially relevant articles based on the inclusion criteria, and data was extracted. The Cochrane ROB-2 tool for risk of bias assessment and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach for evidence synthesis for each outcome of interest were used.
Forty-eight RCTs with a total of 2809 participants were included in the qualitative analysis, whereas data from only 41 studies were used in the meta-analyses. Significant improvements in UL function (Fugl-Meyer assessment-upper extremity) (n = 26, mean difference [MD] = 3.10, 95% confidence interval [CI] = 1.16 to 5.04; p = 0.002, I2 = 62%), UL motor recovery (Brunnstrom motor recovery stage) (n = 6, MD = 0.57, 95% CI = 0.20 to 0.93; p = .002, I2 = 15%), and independence in day-to-day activities (Barthel index) (n = 9, [MD] = 3.90, 95% CI = 0.28 to 7.52; p = 0.03, I2 = 39%) were found in patients with acute and sub-acute stroke. A non-significant improvement was noted in the quantitative analysis for grip strength, hand dexterity (the Box and block test), independence in day-to-day activities (the functional independence measure and the Korean version of the modified Barthel index), arm and hand motor ability (the action research arm test, and the manual function test), and quality of life (the European quality of life-5 dimension-3 levels). Overall, 10 studies had a low risk of bias. Twenty-nine studies had some concerns, especially because the bias arose from the process of randomization, deviation from intended interventions, and reporting of results. Nine studies had a high risk of bias due to biases in the measurement of the outcomes. The certainty of evidence was found to be low or very low for these outcomes.
Although a positive effect of game-based rehabilitation on improving UL function and motor recovery was evident, there are concerns about the risk of bias in the included studies. Furthermore, heterogeneity of interventions, inconsistency, imprecision of findings, indirectness of outcomes, and low/very low quality of evidence preclude the recommendation of a specific game-based rehabilitation program over conventional therapy for improving UL function following acute and sub-acute stroke. Further robust clinical trials with homogenous methods and outcome measures are warranted to substantiate the effects of game-based rehabilitation on UL function post-stroke.
Game-based rehabilitation implementing functional games can be used in addition to conventional therapy in restoring the UL motor function within the first six months following stroke.
sub-acute stroke
upper extremity recovery
