Restricted accessResearch articleFirst published online 2021-04
Effects of Interactive Videogames on Postural Control and Risk of Fall Outcomes in Frail and Pre-frail Older Adults: A Systematic Review and Meta-Analysis
Interactive videogames (IVGs) have been used to reduce risk of falls in the older adult and improve postural control (PC) outcomes.
Objective:
To systematically review trials that examine whether IVGs training is effective in improving PC and managing falls in frail and pre-frail older adults.
Data Sources:
Four databases were searched, Scopus, Web of science, PubMed, and MEDLINE, from January 2007 to March 2019.
Eligibility Criteria:
Frail and pre-frail older adults aged 65+. Interventions were any Nintendo® Wii™ training. The outcome measures were PC and risk of falls as measured by any validated outcome measure.
Studies Appraisal Method:
The PEDro (Physiotherapy Evidence Database) scale and Cochrane risk-of-bias tool were used by two independent authors.
Results:
Eleven papers were included, involving 388 participants, with a mean age of 79 ± 5.7 years. The mean duration of IVGs sessions was 8.8 ± 3.8 weeks, the mean total number of sessions was 20 ± 11.1 session, and the mean length of training was 44 ± 15.7 minutes.
Meta-Analysis:
IVGs achieved better results compared with traditional exercises and control on the Berg Balance Scale (mean difference [MD] 2.80; 95% confidence interval [CI] 1.21 to 4.39; P < 0.001; I2 = 16%), as well as in the short term on Timed Up and Go (MD −1.23; 95% CI −2.37 to −0.09; P = 0.03; I2 = 0%).
Limitation:
Definitive judgement could not be made due to the variability in training, training duration and outcomes measurement.
Conclusion:
IVGs is a promising modality that has a positive effect on PC but not on the outcome of falls, so it should be prescribed with caution among frail older adults.
Systematic Review Registration:
PROSPERO registration number: CRD42019129611.
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References
1.
PanjanA, SarabonN. Review of methods for the evaluation of human body balance. Sport Sci Rev, 2010; XIX. DOI: 10.2478/v10237-011-0036-5.
2.
da Silva BorgesEG, de Souza ValeRG, CaderSA, et al.Postural balance and falls in elderly nursing home residents enrolled in a ballroom dancing program. Arch Gerontol Geriatr, 2014; 59:312–316.
3.
ReevesA, MckeeM, MackenbachJ. Public pensions and unmet medical need among older people: Cross-national analysis of 16 European countries. J Epidemiol Community Health, 2017; 71:174–180.
4.
RubensteinLZ, JosephsonKR. Falls and their prevention in elderly people: What does the evidence show?. Med Clin North Am, 2006; 90:807–824.
5.
VermaSK, WillettsJL, CornsHL, et al.Falls and fall-related injuries among community-dwelling adults in the United States. PLoS One, 2016; 11:e0150939.
HanL, CleggA, DoranT, FraserL. The impact of frailty on healthcare resource use: A longitudinal analysis using the Clinical Practice Research Datalink in England. Age Ageing, 2019; 48:665–671.
9.
TurnerG, CleggA. Best practice guidelines for the management of frailty: A British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing, 2014; 43:744–747.
10.
Chodzko-ZajkoWJ, ProctorDN, Fiatarone SinghMA, et al.American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc, 2009; 41:1510–1530.
11.
De LabraC, Guimaraes-PinheiroC, MasedaA, et al.Effects of physical exercise interventions in frail older adults: A systematic review of randomized controlled trials Physical functioning, physical health and activity. BMC Geriatr, 2015; 15:154.
12.
McCullaghR, O'ConnellE, O'MearaS, et al.An Augmented Prescribed Exercise Programme (APEP) for frail medical inpatients: A randomised controlled trial. Age Ageing, 2018; 47(Suppl 5):v13–v60.
13.
ChinnDJ, WhiteM, HowelD, et al.Factors associated with non-participation in a physical activity promotion trial. Public Health, 2006; 120:309–319.
14.
ManafH. Barriers to participation in physical activity and exercise among middle-aged and elderly individuals. Singapore Med J, 2013; 54:581–586.
15.
DayL, FildesB, GordonI, et al.Randomised factorial trial of falls prevention among older people living in their own homes. BMJ, 2002; 325:128.
16.
ForkanR, PumperB, SmythN, et al.Exercise adherence following physical therapy intervention in older adults with impaired balance. Phys Ther, 2006; 86:401–410.
17.
PetersenT, LarsenK, JacobsenS. One-year follow-up comparison of the effectiveness of McKenzie treatment and strengthening training for patients with chronic low back pain: Outcome and prognostic factors. Spine (Phila Pa 1976), 2007; 32:2948–2956.
18.
SmaerupM, LaessoeU, GrönvallE, et al.The use of computer-assisted home exercises to preserve physical function after a vestibular rehabilitation program: A randomized controlled study. Rehabil Res Pract, 2016; 2016:7026317.
19.
KappenDL, Mirza-BabaeiP, NackeLE. Older adults' physical activity and exergames: A systematic review. Int J Hum Comput Interact, 2019; 35:140–167.
20.
VázquezFL, OteroP, García-CasalJA, et al.Efficacy of video game-based interventions for active aging. A systematic literature review and meta-analysis. PLoS One, 2018; 13:e0208192.
21.
ZengN, PopeZ, LeeJE, GaoZ. A systematic review of active video games on rehabilitative outcomes among older patients. J Sport Health Sci, 2017; 6:33–43.
22.
SkjaeretN, NawazA, MoratT, et al.Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy. Int J Med Inform, 2016; 85:1–16.
23.
FranklinNC. Technology to promote and increase physical activity in heart failure. Heart Fail Clin, 2015; 11:173–182.
24.
LordSR, CloseJCT. New horizons in falls prevention. Age Ageing, 2018; 47:492–498.
25.
LarsenLH, SchouL, LundHH, LangbergH. The physical effect of exergames in healthy elderly—A systematic review. Games Health J, 2013; 2:205–212.
26.
AlhasanH, HoodV, MainwaringF. The effect of visual biofeedback on balance in elderly population: A systematic review. Clin Interv Aging, 2017; 12:487–497.
27.
BarryG, GalnaB, RochesterL. The role of exergaming in Parkinson's disease rehabilitation: A systematic review of the evidence. J Neuroeng Rehabil, 2014; 11:33.
28.
KlompstraLV, JaarsmaT, StrombergA, et al.Exergaming in older adults: A scoping review and implementation potential for patients with heart failure. Eur J Cardiovasc Nurs, 2014; 13:388–398.
29.
MuraG, CartaMG, SancassianiF, et al.Active exergames to improve cognitive functioning in neurological disabilities: A systematic review and meta-analysis. Eur J Phys Rehabil Med, 2018; 54:450–462.
30.
CacciataM, StrombergA, LeeJA, et al.Effect of exergaming on health-related quality of life in older adults: A systematic review. Int J Nurs Stud, 2019; 93:30–40.
31.
McauliffeL, ParfittGC, EstonRG, et al.Combining perceptual regulation and exergaming for exercise prescription in low-active adults with and without cognitive impairment. BMC Sports Sci Med Rehabil, 2018; 10. DOI: 10.1186/s13102-018-0091-7.
32.
ChaoY-Y, SchererYK, MontgomeryCA. Effects of using Nintendo WiiTM exergames in older adults: A review of the literature. J Aging Health, 2015; 27:379–402.
33.
SatoK, KurokiK, SaikiS, NagatomiR. Improving walking, muscle strength, and balance in the elderly with an exergame using Kinect: A randomized controlled trial. Games Health J, 2015; 4:161–167.
34.
RuivoJ. Exergames and Cardiac Rehabilitation: A review. J Mol Signal, 2014; 34:2–20.
35.
GaoZ, ZengN, PopeZC, et al.Effects of exergaming on motor skill competence, perceived competence, and physical activity in preschool children. J Sport Health Sci, 2019; 8:106–113.
36.
RaviDK, KumarN, SinghiP. Effectiveness of virtual reality rehabilitation for children and adolescents with cerebral palsy: An updated evidence-based systematic review. Physiotherapy, 2017; 103:245–258.
37.
LiberatiA, AltmanDG, TetzlaffJ, et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol, 62(10):e1–e34.
38.
MoseleyAM, HerbertRD, SherringtonC, MaherCG. Evidence for physiotherapy practice: A survey of the Physiotherapy Evidence Database (PEDro). Aust J Physiother, 2002; 48:43–49.
39.
HerdCR, MeserveBB. A systematic review of the effectiveness of manipulative therapy in treating lateral epicondylalgia. J Man Manip Ther, 2008; 16:225–237.
40.
HigginsJPT, GreenS. Cochrane Handbook for Systematic Reviews of Interventions, vol. 4. John Wiley & Sons; 2011.
41.
HigginsJPT, ThompsonSG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002; 21:1539–1558.
42.
FuAS, GaoKL, TungAK, et al.Effectiveness of exergaming training in reducing risk and incidence of falls in frail older adults with a history of falls. Arch Phys Med Rehabil, 2015; 96:2096–2102.
43.
KwokBC, PuaYH. Effects of WiiActive exercises on fear of falling and functional outcomes in community-dwelling older adults: A randomised control trial. Age Ageing, 2016; 45:621–628.
44.
TsangWWN, FuASN. Virtual reality exercise to improve balance control in older adults at risk of falling. Hong Kong Med J, 2016; 22(Suppl 20):S19–S22.
45.
GomesGCV, Simões M doS, LinSM, et al.Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit PlusTM for frail older adults: A randomized feasibility clinical trial. Maturitas, 2018; 118:20–28.
46.
DanielK. Wii-hab for pre-frail older adults. Rehabil Nurs, 2012; 37:195–201.
47.
FrancoJR, JacobsK, InzerilloC, KluzikJ. The effect of the Nintendo Wii Fit and exercise in improving balance and quality of life in community dwelling elders. Technol Health Care, 2012; 20:95–115.
48.
CarvalhoIFD, LemeGLM, ScheicherME. The influence of video game training with and without subpatelar bandage in mobility and gait speed on elderly female fallers. J Aging Res, 2018; 2018:1–6.
49.
ChaoY-Y, SchererYK, MontgomeryCA, et al.Physical and psychosocial effects of Wii Fit exergames use in assisted living residents: A pilot study. Clin Nurs Res, 2015; 24:589–603.
50.
WilliamsMA, SoizaRL, JenkinsonAM, StewartA. EXercising with Computers in Later Life (EXCELL)—Pilot and feasibility study of the acceptability of the Nintendo(R) WiiFit in community-dwelling fallers. BMC Res Notes, 2010; 3:238.
51.
AgmonM, PerryCK, PhelanE, et al.A Pilot Study of Wii Fit Exergames to Improve Balance in Older Adults. J Geriatr Phys Ther, 2011; 34:161–167.
52.
ChaoY-YY, SchererYK, WuY-WW, et al.The feasibility of an intervention combining self-efficacy theory and Wii Fit exergames in assisted living residents: A pilot study. Geriatr Nurs, 2013; 34:377–382.
53.
Montero-AlíaP, Miralles-BassedaR, López-JiménezT, et al.Controlled trial of balance training using a video game console in community-dwelling older adults. Age Ageing, 2019; 48:506–512.
54.
PetersonMJ, GiulianiC, MoreyMC, et al.Physical activity as a preventative factor for frailty: The health, aging, and body composition study. J Gerontol Ser A, 2009; 64:61–68.
55.
FinneganS, SeersK, BruceJ. Long-term follow-up of exercise interventions aimed at preventing falls in older people living in the community: A systematic review and meta-analysis. Physiotherapy, 2019; 105:187–199.
56.
O'HareL, SavageE, McCullaghR, et al.Frail older adults' perceptions of an in-hospital structured exercise intervention. Physiotherapy, 2017; 103:478–484.
57.
MoyerVA. Prevention of falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. Ann Intern Med, 2012; 157:197–204.
58.
MorleyJE, VellasB, Abellan van KanG, et al.Frailty consensus: A call to action. J Am Med Dir Assoc, 2013; 14:392–397.
59.
LimaCA, RicciNA, NogueiraEC, PerraciniMR. The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: A systematic review. Physiotherapy, 2018; 104:383–394.
60.
PotterK, AnderbergL, AndersonD, et al.Reliability, validity, and responsiveness of the Balance Evaluation Systems Test (BESTest) in individuals with multiple sclerosis. Physiotherapy, 2018; 104:142–148.
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