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Abstract

Background

Gamification has emerged as a novel approach in rehabilitation. This systematic review and meta-analysis aimed to evaluate the effectiveness of gamification-based exercises on foot posture in children and adolescents with flatfoot.

Methods

A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, utilizing the PubMed, Scopus, Web of Science, and Google Scholar databases to search for original and peer-reviewed articles with selected keywords from inception to July 2025. The quality of the included studies was assessed using the Joanna Briggs Institute checklist. Statistical analysis was conducted with Comprehensive Meta-Analysis software version 3. To evaluate data heterogeneity, the Q-test and I² statistic were applied. Egger’s test was used to assess publication bias.

Results

After searching the mentioned databases, 2160 articles were found. Finally, seven articles were included in the current review. It was shown that gamification-based exercise had a significant effect, leading to a reduction in navicular drop (95% CI = −1.796 to −0.516, p = 0.000) and an increase in balance scores (95% CI = −1.647 to −0.462, p = 0.000), compared to the passive control groups that did not receive any intervention. However, no significant differences were seen in the Staheli index (95% CI = −3.298 to 0.023, p = 0.053). High heterogeneity was noted in the navicular drop test (95% CI = −2.412 to −0.603, p = 0.001). Egger’s test indicated no statistically significant publication bias for either navicular drop (p = 0.080) or Staheli index (p = 0.210).

Conclusion

The results showed that exercise with gamification may be effective in improving foot alignment in children and adolescents. Specifically, positive effects were evident when using the navicular drop test, whereas no significant changes were detected with the Staheli index. However, interpretation should be made cautiously due to the limited number of studies and lack of age or gender stratification.

Keywords

flatfoot gamification therapeutic exercise meta-analysis

Introduction

Abnormal foot alignment affects the function of the foot and lower limb, increasing the risk of injuries in both everyday individuals and athletes.¹ Among the most common deformities of the foot area, flatfoot is one of the most frequently observed foot deformities. In adults, its occurrence has been reported to range from 2% to 23%,² while in children, the prevalence can be as high as 44%.³ Flatfoot, commonly referred to as pes planus, is characterized by flattening of the medial longitudinal arch (MLA) of the foot,⁴ which results in overpronation of the subtalar joint, rearfoot eversion, and dorsiflexion with forefoot abduction.⁵ It has been shown that individuals with a flattened MLA have a higher incidence of lower limb discomfort and injuries.^6,7 In a recent study, it was found that individuals with flexible flatfoot exhibited alterations in inversion, eversion, hip flexion, stride length, and walking speed compared to participants with neutral feet during gait.⁸ Correcting foot posture has become a key objective in both rehabilitation and injury prevention.⁹ Traditional treatment approaches, such as the use of orthotics,¹⁰ targeted strengthening exercises,^11,12 and manual therapy,¹³ have proven effective in promoting proper foot alignment and improving associated functional outcomes. However, patient adherence to these interventions remains a significant barrier to long-term success.¹⁴

Gamification has gained attention in healthcare as a novel approach to boost user engagement,¹⁵ adherence, and motivation.¹⁶ Through features like goal setting, rewards, real-time feedback, and competitive elements, gamified strategies have shown encouraging outcomes in areas such as physical therapy and rehabilitation,^17,18 as well as motor skill development.¹⁹ For these reasons, gamification has recently been used to design therapeutic exercises with the aim of improving the effectiveness of therapeutic interventions for various conditions, including flat foot. For example, it was demonstrated that integrating Virtual Reality (VR) into traditional exercise could improve rehabilitation outcomes in flatfoot individuals.²⁰ In another study, it was indicated that game-based corrective exercises are effective in aligning the knee, ankle, and foot positions in boys with pronation syndrome.²¹ Additionally, two studies showed that corrective games could affect the navicular drop index in students with flatfoot.^22,23 Although several studies have reported significant improvements in foot posture following gamified interventions, however, some research has not found significant effects.^24,25

Although a growing body of research supports the use of gamification in physical rehabilitation, most studies to date have concentrated on upper limb function. For instance, a recent review reported that VR exercise may have potential benefits as a tool for improving spinal alignment.²⁶ Findings from studies examining the effects of gamification-based exercises on foot posture, however, remain inconsistent. To date, no systematic review or meta-analysis has specifically investigated the impact of gamified exercise on the lower limb, particularly in relation to foot posture. This gap in the literature limits our understanding of the potential role of gamification in lower limb rehabilitation. To address this, the present study systematically reviews and synthesizes the available evidence on gamification-based exercise interventions targeting flatfoot outcomes.

Methods

This review and meta-analysis study was registered prospectively in PROSPERO under the number CRD 420251082392.

Search strategy and keywords

This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).²⁷ All relevant articles were extracted using the search approach. We conducted a systematic search across Scopus, Web of Science, and PubMed from the databases’ inception until July 2025 to identify relevant papers. Google Scholar was also searched. The references of pertinent papers were also carefully screened by two independent reviewers (E.E., SA.N.) to see possibly more relevant literature and consulted with an expert (R.SH) in the research area.

The following keyword combinations were used with the help of AND and OR operators as follows: (“Pes planus” OR “pes cavus” OR “pes planovalgus” OR “high arch* foot” OR “low arch* foot” OR “foot arch” OR “medial longitudinal arch” OR “foot posture” OR “foot structure” OR pronat* OR supinat* OR evert* OR invert* OR “flat*foot” OR “Flat*feet” OR “foot alignment” OR “Convex Foot” OR “Convex Pes Valgus” OR “Rocker-Bottom Foot” OR Splayfoot OR “Talipes Calcaneovalgus” OR “Talipes Valgus” OR “Vertical Talus” OR “Calcaneal Valgus” OR “Calcaneal Varus” OR Calcaneo*valgus OR Calcaneo*varus) AND (exergam* OR exer-gam* OR “video gam*” OR “video-gam*” OR gamif* OR gamification OR gamified OR gameful OR “game elements” OR “game dynamics” OR “computer game” OR “electronic game” OR “serious game*” OR “game components” OR game OR playing OR play OR player OR kinect OR “nintendo wii” OR wii OR “sony eyetoy” OR irex OR “dance revolution” OR “virtual realit*” OR “realit* of virtual” OR “reality of virtual” OR vr OR “virtual environment”).

Inclusion and exclusion criteria

The study was designed based on the PICOS (Population, Intervention, Comparison, Outcomes, and Study) framework,²⁸ including:

• Population (P): Patients diagnosed with flatfoot or pronation distortion syndrome, regardless of age and gender.

• Intervention (I): Gamification-based exercise programs, including corrective games, Wii-based exergames, serious games, and virtual reality exercises.

• Comparison (C): Control groups receiving no intervention.

• Outcomes (O): Foot posture outcomes (navicular drop test, Staheli index).

• Study design (S): Quasi-experimental or randomized controlled trials.

Among the various indices used to evaluate flatfoot deformity, the Staheli Index and navicular drop test were selected as the primary quantitative outcomes because they were the most frequently reported measures across the included studies. Both provide objective, reproducible assessments of MLA height and foot pronation. Other parameters, such as hindfoot valgus angle, midfoot abduction, and dynamic functional assessments, were not reported and therefore could not be synthesized quantitatively. Nonetheless, these are recognized as important complementary indicators of flatfoot severity and function.

Moreover, eligible studies published in English or Persian in peer-reviewed journals were included up to the end of the search period (July 2025). The following exclusion criteria were implemented: (1) studies were performed on individuals with neurological problems, ligament laxity, and lower extremity injury; (2) studies did not provide sufficient information for meta-analyses; and (3) studies were published as conferences, papers, abstracts, and unpublished dissertations.

Study selection

In this study, two authors (E.E., SA.N.) independently examined and selected the articles’ titles and abstracts according to the inclusion criteria and PRISMA standard methodology, utilizing a standardized Excel data extraction sheet.²⁹ The supervising author addressed and assessed discrepancies between the researchers (R.SH). Their searched records were imported into EndNote 20. This software was also used to remove duplicate articles.

Data extraction and quality assessment

Using a standard Excel data extraction sheet, the researchers independently collected data and subsequently compared their findings to evaluate coherence; furthermore, the supervising author addressed and assessed any discrepancies between the researchers (R.SH). The subsequent statistics were extracted from the included research based on the first author, year of publication, type of study, sample size, subjects (including age, gender, and index data), the most important methods and tools used for data collection, and the most significant results obtained. Two researchers (E.E., SA.N.) employed the Joanna Briggs Institute (JBI) Critical Appraisal tools³⁰ to evaluate the potential for bias, selecting the specific tool according to the research design included in each study. During the quality assessment process, the studies that received the lowest scores among all included articles were classified as low quality.

Data analysis

We used Comprehensive Meta-Analysis (CMA) software version 4.0 (Biostat Inc., Englewood, New Jersey) for statistical evaluation. From the eligible studies, we extracted the mean and standard deviation of pre- and post-tests (or mean differences), sample sizes, and p-values. Effect sizes were calculated as standardized mean differences (SMD) with 95% confidence intervals (CI). Using SMD made it possible to place all outcomes on a comparable scale. To account for small sample bias, Hedges’ g correction was applied. For interpretation, SMD thresholds of <0.2, 0.2–0.5, 0.5–0.8, and >0.8 were considered to indicate trivial, small, medium, and large effects, respectively.³¹ Data heterogeneity was assessed using the Q-test and the I² statistic, with I² values representing the percentage of total variation due to heterogeneity. I² values of 25%, 50%, and 75% were considered to represent low, moderate, and high heterogeneity, respectively.³² Publication bias was evaluated with Egger’s regression test, where p-values <0.05 were considered significant.

Results

A total of 2160 articles were identified in the selected databases (Figure 1). Once the data was entered into EndNote software and duplicate records were removed, 1300 articles remained. After reviewing the abstracts and titles, 60 articles were selected for further analysis, and the remaining articles were excluded. Following this, the complete text of the 25 chosen articles was carefully analyzed, and ultimately, four papers were deemed suitable for the study. Additionally, three studies from the Google Scholar database were included, resulting in a total of seven studies.

Figure 1.

The PRISMA flow diagram illustrates the process of database searching and reference identification.

Study characteristics

Publication dates ranged from 2021 to 2025. A total of seven studies, involving 273 participants, were included in this review. Of these, three studies included only male participants,^21,22,24 two studies included only female participants,^23,25 and two studies included both male and female participants.^20,33 All participants were children, adolescents, or young adults diagnosed with various forms of flatfoot or pronation distortion syndrome, with age ranges spanning from 7 to 25 years. Most studies focused on school-aged children (7–12 years), while two studies included young adults aged 18–25 years^20,33 All included studies employed a quasi-experimental design. Intervention durations ranged from 4 to 8 weeks. These included structured corrective games (e.g., maze game, kangaroo jump, bear walk, towel scrunches),^21–25 Wii-based exergames and serious games,³³ as well as virtual reality exercises.²⁰ Intervention effects were assessed using outcomes such as navicular drop,^20–24,33 Staheli index,^20,21,25 and the Y-balance test.^23,24 Further details for each study, including intervention type, outcome measures, and participant demographics, are provided in Table 1.

Table 1.

Demographic information from included studies.

Study	Design	Participants characteristics	Sample size (Men/Women) (Age)	Intervention	Outcome	Result
Ghodsinezhad Kalahrodi et al. 2025²⁴	Quasi-experimental	Students with flexible flatfoot	20 male students aged 9 to 12 years corrective games (n = 11) and control (n = 9)	8 weeks of corrective games (The maze game)	Navicular drop, Y-balance, single-leg hop test	Improved balance (p = 0.036), not significant changes in navicular drop (p = 0.208)
Büşra Erten et al. 2025³³	Quasi-experimental	Individuals with flatfoot	69 Individuals aged 18–25 years	Wii-based exergame and wii-based serious game	Navicular drop, balance, femoral anteversion, and lower extremity muscle strength	Significant changes in navicular drop (p < 0.05) and improved muscle strength
Rahmani et al. 2024²¹	Quasi-experimental	Students with pronation foot syndrome	30 male students aged 9–11 years	8 weeks of corrective games (pedal play, kangaroo jump, bear walk, etc.)	Q-angle, navicular drop, and Staheli index	Significant changes in terms of Q angle (F = 7.69, p = 0.010), navicular drop (F = 4.65, p = 0.040), and Staheli index (F = 18.66, p = 0.001)
Rahmanifar et al. 2024²⁵	Quasi-experimental	Students with flatfoot	18 female students aged 9–11 years	6 weeks of corrective games (one-leg hopping, kneeling game, pick and drop game, towel scrunches, etc.)	Test of gross motor development second edition (TGMD-2) and Staheli index	Improved locomotor skills (p = 0.022) not significant changes in Staheli index (p = 0.604)
Bakhshandeh et al. 2024²²	Quasi-experimental	Boys with flatfoot	20 autistic boys aged 7–12 years. Corrective games group (n = 10) and a control group (n = 10)	8 weeks of corrective games	Navicular drop, attention deficit, and static and dynamic balance	Improved static and dynamic balance (p < 0.001) and significant changes in navicular drop (p < 0.001)
Yalfani et al. 2023²³	Quasi-experimental	Girls with pronation distortion syndrome	40 girls with an age range of 7–12 years	8 weeks of corrective games (pull and drop, powerful foot	Balance, proprioception, and navicular drop	Improved balance (p < 0.001) and proprioception (p < 0.001) and significant changes in navicular drop (p < 0.001)
Yalfani et al. 2023²³	Quasi-experimental	Girls with pronation distortion syndrome	40 girls with an age range of 7–12 years	Game, fabric game, etc.)	Balance, proprioception, and navicular drop
Sahan et al. 2021²⁰	Quasi-experimental	Subjects diagnosed with flexible pes planus	40 volunteered subjects	4 weeks of virtual reality exercise	Navicular drop, star excursion test right, Staheli index	Improved balance (p < 0.001) and significant changes in navicular drop (p < 0.003)

Data synthesis

Gamification effect on navicular drop

Six studies^20–24,33 examined the effect of game-based exercises on navicular drop in children and adolescents with flatfoot between the two intervention and control groups. A total of 219 participants took part in these studies. According to the meta-analyses, the results showed a significant difference between the two groups in navicular drop (95% CI = −1.796 to −0.516, p = 0.000), indicating a reduction in flatfoot score in the intervention group. Also, the Q-test and I² test results showed significant heterogeneity across navicular drop (p = 0.001, I² = 74%). Moreover, due to the observed heterogeneity in the results, sensitivity analysis was used. It revealed that excluding the studies by Sahan et al. and Erten et al.,^20,33 which were classified as low-quality, had no effect on the analysis results for navicular drop (95% CI = −2.412 to −0.603, p = 0.001). Egger’s test demonstrated that publication bias was not statistically significant in navicular drop (p = 0.080) (Figure 2).

Gamification effect on the Staheli index

Three studies^20,21,25 examined the effect of game-based exercises on the Staheli index in children and adolescents with flatfoot between the two intervention and control groups. A total of 88 participants took part in these studies. According to the meta-analyses, no significant differences were seen between the two groups in the Staheli index (95% CI = −3.298 to 0.023, p = 0.053). Also, the Q-test and I² test results showed significant heterogeneity across navicular drop (p = 0.000, I² = 90.137). Egger’s test demonstrated that publication bias is not statistically significant in the Staheli index (p = 0.210) (Figure 3).

Gamification effect on balance

Two studies^23,24 examined the effect of game-based exercises on balance in children and adolescents with flatfoot between the two intervention and control groups. A total of 60 participants took part in these studies. According to the meta-analyses, the results showed a significant difference between the two groups in balance (95% CI = −1.647 to −0.462, p = 0.000), indicating a better balance score in the intervention group (Figure 4).

Risk of bias

A methodological quality assessment was conducted across all included studies using a standardized checklist (JBI) comprising nine criteria (Table 2). The overall quality scores ranged from 6 to 8 out of a maximum of 9, indicating generally moderate to high methodological rigor across the studies. Most studies fulfilled key quality criteria, including clearly defined objectives, appropriate outcome measures, and adequate data collection methods. Five out of the seven studies achieved a high-quality score (8/9), suggesting low risk of bias. However, a notable and consistent source of bias was observed in criterion Q8 (Was follow-up complete, and if not, were differences between groups in terms of their follow-up adequately described and analyzed?), which was not satisfied by any of the included studies. Additionally, two studies^20,33 exhibited limitations in participant selection, reflecting a moderate risk of selection or detection bias. Despite these issues, the predominance of high-quality studies supports the overall reliability of the synthesized evidence, though findings should still be interpreted with caution due to the consistent deficiency in one quality domain.

Table 2.

Critical appraisal results of eligible studies systematic reviews.

	Study	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Overall score
1	Ghodsinezhad Kalahrodi et al. 2025	Y	N	Y	Y	Y	Y	Y	Y	Y	8
2	Büşra Erten et al. 2025	Y	N	Y	Y	Y	Y	N	N	Y	6
3	Rahmani et al. 2024	Y	N	Y	Y	Y	Y	Y	Y	Y	8
4	Rahmanifar et al. 2024	Y	N	Y	Y	Y	Y	Y	Y	Y	8
5	Bakhshandeh et al. 2024	Y	N	Y	Y	Y	Y	Y	Y	Y	8
6	Yalfani et al. 2023	Y	N	Y	Y	Y	Y	Y	Y	Y	8
7	Sahan et al. 2021	Y	N	Y	Y	Y	Y	N	N	Y	6

JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses: Q1. Is it clear in the study what is the “cause” and what is the “effect”? Q2. Was there a control group? Q3. Were participants included in any comparisons similar? Q4. Were the participants included in any comparisons receiving similar treatment/care, other than the exposure or intervention of interest? Q5. Were there multiple measurements of the outcome, both pre and post the intervention/exposure? Q6. Were the outcomes of participants included in any comparisons measured in the same way? Q7. Were outcomes measured in a reliable way? Q8. Was follow-up complete and if not, were differences between groups in terms of their follow-up adequately described and analyzed? Q9. Was appropriate statistical analysis used?

Discussion

This study found that gamification-based exercises, including VR exercise, Wii-based exergames, and corrective games, may have a positive effect on foot posture in children and adolescents with flatfoot, particularly as reflected in the navicular drop test. No significant changes were observed in the Staheli index. Improvements in balance performance were also noted in some studies. A major factor behind the success of gamified corrective exercises is the immersive and entertaining experience these games offer.¹⁸ This interactive and enjoyable approach tends to boost motivation and encourages consistent participation in such interventions. Regarding the results of navicular drop, it seems that game-based exercises involve strengthening the intrinsic foot muscles, particularly through the short foot exercise (SFE),²³ which targets the plantar intrinsic muscles that play a crucial role in sustaining the MLA.³⁴ In addition, SFE works by contracting plantar muscles, which reduces foot length and pulls the first metatarsal toward the heel while elevating the MLA.³⁵ Moreover, strengthening of the abductor hallucis muscle is essential for promoting greater calcaneus inversion and elevation of the MLA.¹ An additional benefit of gamified exercises lies in their ability to integrate principles of motor control and neuromuscular training,³⁶ including tasks that enhance coordination and provide proprioceptive feedback.³⁷ These features actively engage the neuromuscular system, promoting improvements in postural stability and movement control. Although gamification-based exercises appear to enhance neuromuscular control and proprioception, these benefits are likely not unique to the gamified format. Similar adaptations can be achieved through traditional exercise programs, while gamification may therefore serve primarily as an engaging delivery method that promotes motivation and adherence rather than introducing novel neuromuscular mechanisms. In a study comparing the short-term effects of SFE and VR exercises on balance and navicular drop showed that using VR-based exercises have improved the symptoms of navicular drop better than SFE on the left foot.²⁰ Furthermore, some research has found that game-based corrective exercise may affect navicular drop test in individuals with flatfoot.^21,22,24 Utilizing gamified exercises, such as VR exercises and serious games, may require cognitive involvement, alongside physical activity. This cognitive load may positively impact motor learning and performance by enhancing neural plasticity and sharpening concentration.³⁸ Moreover, these interventions use sensory-motor and perceptual-motor skills,³⁹ a key element in achieving effective and lasting rehabilitation outcomes.

In addition to these findings, certain methodological factors should be considered when interpreting the results. In children, the presence of a plantar fat pad may limit the accuracy of the Staheli index as a reliable measure of foot posture. The increased soft tissue contact due to the fat pad can affect the precision of footprint-based indices, potentially leading to measurement bias. Since several of the included studies were conducted in pediatric populations, this limitation may partly explain why no significant changes were observed in the Staheli index. Due to this, a study showed that game-based corrective exercise may not have an effect on the Staheli index in female students.²⁵ In addition, the high degree of heterogeneity observed in both foot posture indices may indicate that the collected data require further investigation. Also, the discrepancy between navicular drop test and the Staheli index may be attributed to the differences in the sensitivity and reliability of these two assessment methods. The navicular drop test, as a dynamic and clinically validated measure of MLA mobility,⁴⁰ has been shown to be sensitive to changes in foot posture resulting from muscular activation and neuromuscular training.⁴¹ It is considered particularly effective in detecting improvements following interventions targeting intrinsic foot muscle strength and motor control.⁴²

Additionally, some studies have shown that game-based intervention produced significant between-group differences in Y-balance test scores.^23,24 These findings support the use of gamification not only for improving the structural aspects of flatfoot but also for enhancing functional performance and dynamic balance capabilities, which are often compromised in this population. From a biomechanical standpoint, gamified interventions specifically target the postural control impairments commonly seen in individuals with flatfoot.⁴³ By introducing carefully designed physical challenges that create controlled instability, these games prompt users to shift their center of gravity, move in multiple directions, and execute weight transfers.⁴⁴ These activities activate the postural and stabilizing muscles,⁴⁵ directly tackling the balance and proprioception issues that underlie functional deficits in flatfoot. The motor learning benefits extend beyond simple balance training through comprehensive movement integration. Exergames promote general body mobility while requiring coordinated movement of both upper and lower limbs, which engages semantic and working memory.^46,47 In addition, gamification may also facilitate motor learning processes. Exergames and VR-based tasks often combine implicit learning (e.g., adapting to in-game challenges without conscious focus on movement mechanics) with explicit learning (e.g., receiving visual feedback or performance scores).^48,49 This dual pathway can enhance retention and transfer of skills, as implicit learning is less susceptible to performance breakdown under stress or fatigue, while explicit cues reinforce correct technique. By engaging both pathways, gamified interventions may provide a more robust foundation for long-term improvements in foot posture and balance. Healthcare professionals and rehabilitation experts might explore the use of gamified interventions as part of treatment strategies for individuals with flatfoot to enhance participation, motivation, and therapeutic results.^50–52

Several limitations should be acknowledged in this systematic review and meta-analysis. First, the small number of studies included may reduce the robustness and generalizability of the findings. Additionally, there was considerable variation among the included studies in terms of intervention type, duration, intensity, and outcome measures, making direct comparisons and pooled analyses more complex. While the included studies confirmed benefits over passive controls, this design does not clarify whether gamified exercises outperform traditional physiotherapy. Future trials should therefore include active comparison groups to assess their relative efficacy and clinical value. Furthermore, most participants were children or adolescents, which limits the applicability of the results to adult or elderly populations. The overall strength of the conclusions is constrained by the moderate methodological quality and quasi-experimental design of most included studies, underscoring the need for future high-quality randomized controlled trials to strengthen the evidence base. Also, due to insufficiently detailed age reporting in several studies, stratified analysis by age group could not be conducted. Another potential bias in the included studies relates to gender distribution. Most included studies recruited single-gender samples, likely due to convenience rather than clinical rationale, which introduces potential selection bias and limits generalizability; future research should therefore include mixed-gender cohorts and report sex-stratified outcomes. Future research, utilizing standardized protocols, larger sample sizes, and long-term follow-up, is needed to confirm and expand upon these findings.

Conclusion

By combining mental and physical challenges, gamification provides a well-rounded approach that stimulates both neuromuscular function and proprioceptive awareness. Looking ahead, incorporating game-based interventions alongside traditional therapies could offer added value in addressing foot posture issues and improving long-term outcomes.

Figure 2.

Forest plot summarizing the effect of gamification-based exercise on navicular drop.

Figure 3.

Forest plot summarizing the effect of gamification-based exercise on the Staheli index.

Figure 4.

Forest plot summarizing the effect of gamification-based exercise on balance outcomes.

Footnotes

ORCID iDs

Ebrahim Ebrahimi

Seyed Alihossein Nourbakhsh

Author contributions

EE and RS contributed to the study design and data collection. EE, RS, ZK, and SAN drafted the manuscript and made critical revisions to the manuscript. All authors read and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author.*

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The effect of gamification-based exercises on foot posture in children and adolescents with flatfoot: A systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusion

Keywords

Introduction

Methods

Search strategy and keywords

Inclusion and exclusion criteria

Study selection

Data extraction and quality assessment

Data analysis

Results

Study characteristics

Data synthesis

Gamification effect on navicular drop

Gamification effect on the Staheli index

Gamification effect on balance

Risk of bias

Discussion

Conclusion

Footnotes

ORCID iDs

Author contributions

Funding

Declaration of conflicting interests

Data Availability Statement

References