A SYSTEMATIC REVIEW OF THE EFFECTIVENESS OF COMMERCIAL GAMING SYSTEMS FOR IMPROVING UPPER LIMB FUNCTION IN ADULT PATIENTS WITH STROKE

P. Nawathe¹, H. Woodward¹, S. Ramakrishnan¹

¹Coventry University, School of Health, Coventry, United Kingdom

Background: Stroke is a global healthcare issue causing long-term deficits in function and cognition. Motor impairments resulting from stroke affect an individual’s ability to perform activities of daily living and quality of life. Approximately 80% of stroke survivors experience problems with upper limb function. Evidence suggests that recovery depends on rehabilitation programs which emphasise high-intensity, repetitive task-specific training. However, these interventions require substantial supervision of the patient, time and physiotherapist involvement which makes them labour-intensive and expensive. Moreover, the monotonous nature of repetitive tasks may reduce motivation and participation. Therefore, an economic intervention capable of delivering enjoyable, high-dose repetitive tasks is required. Virtual Reality gaming systems can be used to perform repetitive task-specific training. Commercial gaming systems such as Nintendo Wii, Microsoft Xbox and PlayStation EyeToy, are widely used for upper limb rehabilitation as these are engaging and cost-effective.

Purpose: There is a gap in literature exploring the difference between off-shelf commercial gaming systems and virtual reality systems in the rehabilitation of upper limb function. The purpose of this review was to compare the effectiveness of commercial gaming systems in improving upper limb functions in patients with stroke. Objectives/aims include,

• To determine the efficacy of commercial gaming systems compared to conventional therapy in rehabilitation of the upper limb.
• To determine the comparative effectiveness of the commercial gaming systems in enhancing upper limb function.

Methods: This systematic review included randomised controlled trials assessing the efficacy of commercial gaming systems in improving upper limb function, compared to conventional therapy, in adults with stroke. A comprehensive search for relevant literature was conducted in databases including CINAHL, Medline, AMED, CENTRAL, SCOPUS, Emerald, Academic Search Complete and ScienceDirect. Additionally, hand-searching of included articles was performed to identify relevant studies for the review. Studies that met the inclusion criteria were assessed for methodological quality with PEDro Scale and CASP checklist for randomised controlled trials. Studies with homogenous outcome measures were included in the meta-analysis and others were narratively synthesized.

Results: A comprehensive search returned 2309 articles but only 15 articles met the inclusion criteria and were included in the review, their methodological quality ranging from good (7) to excellent (9) on the PEDro scale. Eleven studies were included in the meta-analysis and four were narratively synthesized. Meta-analysis of data pooled from Fugl Meyer Assessment of the Upper Extremity function for a total of 401 participants (202 in the intervention group and 199 in the control group) showed conventional therapy was more effective than commercial gaming systems. Subgroup analysis showed no difference between Nintendo Wii and conventional therapy, but conventional therapy was more effective than Xbox.

Conclusions: This review concluded that conventional therapy is more effective compared to commercial gaming systems such as Nintendo Wii and Xbox Kinect.

Implications: The findings of this review showed that Nintendo Wii and conventional therapy are equally effective, therefore, the use of Nintendo Wii in the rehabilitation of upper limb function can be promoted as a cost-effective and motivating treatment approach for people with stroke. Further, this review helps to bridge the gaps in existing literature.

Funding acknowledgements: The study was not funded.

Keywords:
Stroke
Upper limb function
Gaming systems

Topics:
Neurology: stroke
Disability & rehabilitation
Innovative technology: robotics

Did this work require ethics approval? No

Reason: This was a systematic review; therefore, no ethical clearance was required. This review was conducted as part of a Master’s dissertation at Coventry University. The institution requires ethical permission for all types of research therefore, prior to the start of the research ethical clearance was obtained from CU ethics with the reference number P136377