Exergaming as a Viable Therapeutic Tool to Improve Static and Dynamic Balance among Older Adults and People with Idiopathic Parkinson's Disease: A Systematic Review and Meta-Analysis.

Timo Rantalainen,Dale M. Harris,Wei-Peng Teo,Liam Johnson,Makii Muthalib

doi:10.3389/fnagi.2015.00167

Abstract

The use of virtual reality games (known as “exergaming”) as a neurorehabilitation tool is gaining interest. Therefore, we aim to collate evidence for the effects of exergaming on the balance and postural control of older adults and people with idiopathic Parkinson’s disease (IPD). Six electronic databases were searched, from inception to April 2015, to identify relevant studies. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were used to calculate effect sizes between experimental and control groups. I2 statistics were used to determine levels of heterogeneity. 325 older adults and 56 people with IPD who were assessed across 11 studies. The results showed that exergaming improved static balance (SMD 1.069, 95% CI 0.563–1.576), postural control (SMD 0.826, 95% CI 0.481–1.170), and dynamic balance (SMD −0.808, 95% CI −1.192 to −0.424) in healthy older adults. Two IPD studies showed an improvement in static balance (SMD 0.124, 95% CI −0.581 to 0.828) and postural control (SMD 2.576, 95% CI 1.534–3.599). Our findings suggest that exergaming might be an appropriate therapeutic tool for improving balance and postural control in older adults, but more large-scale trials are needed to determine if the same is true for people with IPD.

Highlights

Idiopathic Parkinson’s disease (IPD) is the second most common neurological disease worldwide, affecting approximately 1% of all older adults aged 65 years or older (Moore et al, 2005; Lees et al, 2009)
Five studies reported a measurement of static balance (BBS) (Bateni, 2012; Franco et al, 2012; Pompeu et al, 2012; Bieryla and Dold, 2013; Lai et al, 2013) (Figure 2), and five studies reported a measurement of dynamic balance (TUG) (Rendon et al, 2012; Bieryla and Dold, 2013; Lai et al, 2013; Singh et al, 2013; Park et al, 2015) (Figure 3)
Of the randomized control trials (RCTs) included in our meta-analysis, the methodologies are not comprehensive enough to definitively elucidate if exergaming affects the balance of older adults or people with idiopathic Parkinson’s disease (IPD)

Summary

Introduction

Idiopathic Parkinson’s disease (IPD) is the second most common neurological disease worldwide, affecting approximately 1% of all older adults aged 65 years or older (Moore et al, 2005; Lees et al, 2009). Lindholm et al (2015) found 31% people with IPD reported nearly falling in the previous 12 months Medications, such as levodopa, are often the first line of treatment for IPD and have shown promise in improving motor function in the early stages of the disease (Singh et al, 2007; Lees et al, 2009). The long-term efficacy of these treatments are poor, and levodopa therapy does little to preserve balance during the more advanced stages of the disease when balance is typically most affected (Bloem et al, 1996; Hely et al, 2005) Exergaming, in this instance, is a term used to describe computer games that require players to physically move in response to game demands and/or an on-screen avatar (usually constructed from a sensor that records the player’s physical characteristics). Exergaming has the potential to facilitate balance improvements, including reducing standing center of pressure (CoP) variability (Rendon et al, 2012; Toulotte et al, 2012; Bieryla and Dold, 2013; Wuest et al, 2014), in a home-based setting for older adults (Miller et al, 2014) and for people recovering from spinal cord injury, brain injury (Betker et al, 2007 or stroke (Hung et al, 2014) who have severe balance impairments

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