Video games often demand physical exertion and are more effective in treating multiple sclerosis patients. Some studies have concluded that they are even better than conventional rehabilitation methods. Frontiers in Neurology compiles published literature in their systematic review and meta-analysis to study the efficacy of exergames and virtual reality games. It compares them against conventional balance rehabilitation for improving balance in patients suffering from MS.
Human Balance Control
The result of multiple sensory system inputs integrated with complex mechanisms of constant adjustments and reweight is defined as human balance control. It does so by using visual, proprioception, and vestibular signals for correcting motor actions. Thus, multisensorial augmented reality is expected to be a practical rehabilitation approach for treating MS balance impairments.
VR Games and Exergaming
Virtual Reality Games in recent years were integrated with various neurological disease rehabilitative protocols, which included patients suffering from MS. Such integrations also showed promising results. Exergaming has also been used with multiple rehabilitative programs and clinical studies.
Microsoft Kinect and Nintendo Wii are commercially available exergames that have transformed living spaces into training environments in the last several years. Home and clinical trials investigating the effectiveness of such games and rehab processes for neurological conditions have been limited and yielded conflicting results.
Investigators searched three different databases for articles published in English before 14th May 2021. Including them required:
- Experimental and control groups
- Evaluation of Virtual Games and exergames effectiveness alongside conventional rehabilitation
- Assessment of VR or exergames in comparison to conventional rehabilitation
- Evaluation of the impact of such interventions on balance
- Including patients over 18 years and suffering from MS.
Over 93 studies were identified, out of which 7 RCTs were published between 2003 and 2020. After exclusion, they were included for review. Five of these were from Europe, while the other two were published in Eastern Mediterranean.
The study analyzed 209 patients, among which 97 performed exergames or virtual reality games. The remaining 112 were in the control group. The cohorts ranged between 11 to 47 patients, and the mean age ranged between 34.9 to 48.3 years. In total, two studies evaluated the effectiveness of VR while the other five evaluated exergaming and its effectiveness.
Derivations From The Study
Studies that assessed exergames compared to conventional training showed remarkable improvements in scores from the balance assessment. This was from the experimental groups compared to the control groups. In addition, another study found that exergaming using Xbox360 combined with conventional rehabilitation was very effective in improving balance compared to traditional rehabilitation.
A significant improvement in balance was seen in experimental groups in the study that compared VR with conventional training. But some studies produced non-statistically substantial results. Similar to exergames assessments, one study also found that Microsoft Kinect- based virtual reality games that combined conventional rehabilitation were more effective in improving balance than traditional rehabilitation.
Results from the meta-analysis showed a significant overall effect size of 4.25 and 4.49 (P<.0001 for both) for virtual reality games and exergames about BBS improvement.
According to subgroup analysis, there was a nonsignificant effect size of 1.85 (P=.39) for virtual reality and a significant effect size of 4.49 (P<.0001) in the case of exergames concerning BBS improvement. According to potential bias, six studies revealed that their randomization was correct and 5 showed excluded performance bias. Also, 6 guaranteed the binding of outcomes assessment, while six assessed attrition bias properly.
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