Exergame-assisted rehabilitation for preventing falls in older adults at risk: A systematic review and meta-analysis

Introduction. Exergaming is increasingly employed in rehabilitation for older adults. However, their effects on fall rate and fall risk remain unclear. Methods. We conducted a systematic review and meta-analysis that included randomized controlled trials (RCTs) comparing exergame-assisted rehabilitation with control groups, published in French or English, from Web of Science, CINHAL, Embase, Medline and CENTRAL (last search in June 2021). Two reviewers independently assessed studies. Risk of bias was assessed using RoB2, PEDRO scale and the GRADE system. The outcomes of interest were: a) Fall rate, b) Risk of falling, measured by the Short Physical Performance Battery (SPPB), Timed up and Go (TUG), One-Leg Stance or Berg Balance Scale (BBS), c) Fear of falling, measured with the Fall Efficacy Scale (FES-I) or the Activities-specific Balance Confidence (ABC) score. Data was pooled and mean differences (MD) between exergame and control groups calculated using a random-effects model. Results. Twenty-seven RCTs were included (1415 participants, including 63.9% of women, mean age ranged from 65 to 85.2 years old). Exergame-assisted interventions were associated with a reduction in the incidence of falls (4 studies, 316 participants, MD=-0.91 falls per person per year; 95% CI: -1.65 to -0.17, p =0.02, moderate quality). Regarding fall risk (20 studies included, low-quality evidence), SPPB did not change (MD=0.74; 95% CI: -0.12; 1.60, p= 0.09), but all other scores were improved: BBS (MD= 2.85; 95% CI: 1.27 to -4.43, p=0.0004), TUG (MD=-1.46; 95%: CI -2.21 to -0.71, p=0.0001) and One-leg stance (MD=7.09; 95% CI: 4.21 to 9.98, p<0.00001). Fear of falling scores (FES-I and ABC) showed no difference. Conclusion. There is moderate quality evidence of a reduction in the fall rate with exergame-assisted rehabilitation and low-quality evidence suggesting a mild reduction of the risk of falling. Statistically significant benefits from exergame-assisted rehabilitation did not achieve clinically meaningful changes in risk of falling assessments.