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.

Background: 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.