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      Serious games for upper limb rehabilitation after stroke: a meta-analysis

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          Abstract

          Background

          Approximately two thirds of stroke survivors maintain upper limb (UL) impairments and few among them attain complete UL recovery 6 months after stroke. Technological progress and gamification of interventions aim for better outcomes and constitute opportunities in self- and tele-rehabilitation.

          Objectives

          Our objective was to assess the efficacy of serious games, implemented on diverse technological systems, targeting UL recovery after stroke. In addition, we investigated whether adherence to neurorehabilitation principles influenced efficacy of games specifically designed for rehabilitation, regardless of the device used.

          Method

          This systematic review was conducted according to PRISMA guidelines (PROSPERO registration number: 156589). Two independent reviewers searched PubMed, EMBASE, SCOPUS and Cochrane Central Register of Controlled Trials for eligible randomized controlled trials (PEDro score ≥ 5). Meta-analysis, using a random effects model, was performed to compare effects of interventions using serious games, to conventional treatment, for UL rehabilitation in adult stroke patients. In addition, we conducted subgroup analysis, according to adherence of included studies to a consolidated set of 11 neurorehabilitation principles.

          Results

          Meta-analysis of 42 trials, including 1760 participants, showed better improvements in favor of interventions using serious games when compared to conventional therapies, regarding UL function (SMD = 0.47; 95% CI = 0.24 to 0.70; P < 0.0001), activity (SMD = 0.25; 95% CI = 0.05 to 0.46; P = 0.02) and participation (SMD = 0.66; 95% CI = 0.29 to 1.03; P = 0.0005). Additionally, long term effect retention was observed for UL function (SMD = 0.42; 95% CI = 0.05 to 0.79; P = 0.03). Interventions using serious games that complied with at least 8 neurorehabilitation principles showed better overall effects. Although heterogeneity levels remained moderate, results were little affected by changes in methods or outliers indicating robustness.

          Conclusion

          This meta-analysis showed that rehabilitation through serious games, targeting UL recovery after stroke, leads to better improvements, compared to conventional treatment, in three ICF-WHO components. Irrespective of the technological device used, higher adherence to a consolidated set of neurorehabilitation principles enhances efficacy of serious games. Future development of stroke-specific rehabilitation interventions should further take into consideration the consolidated set of neurorehabilitation principles.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12984-021-00889-1.

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          The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

          Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
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            David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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              Meta-analysis in clinical trials

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                Author and article information

                Contributors
                thierry.lejeune@uclouvain.be
                Journal
                J Neuroeng Rehabil
                J Neuroeng Rehabil
                Journal of NeuroEngineering and Rehabilitation
                BioMed Central (London )
                1743-0003
                15 June 2021
                15 June 2021
                2021
                : 18
                : 100
                Affiliations
                [1 ]GRID grid.7942.8, ISNI 0000 0001 2294 713X, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, , Université Catholique de Louvain, ; Avenue Mounier 53, 1200 Brussels, Belgium
                [2 ]GRID grid.48769.34, ISNI 0000 0004 0461 6320, Service de Médecine Physique et Réadaptation, , Cliniques Universitaires Saint-Luc, ; Avenue Hippocrate 10, 1200 Brussels, Belgium
                [3 ]GRID grid.7942.8, ISNI 0000 0001 2294 713X, Université Catholique de Louvain, ; Louvain Bionics, 1348 Louvain-la-Neuve, Belgium
                Author information
                http://orcid.org/0000-0001-5741-7753
                Article
                889
                10.1186/s12984-021-00889-1
                8204490
                34130713
                f85627c3-d04b-471a-be1f-cd3bd728bd49
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 14 September 2020
                : 31 May 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100002661, Fonds De La Recherche Scientifique - FNRS;
                Award ID: 40001631
                Award Recipient :
                Funded by: Région Wallone - Win2Wal Program
                Award ID: 1810108
                Award Recipient :
                Categories
                Review
                Custom metadata
                © The Author(s) 2021

                Neurosciences
                stroke,upper extremity,serious games,virtual reality,robotics
                Neurosciences
                stroke, upper extremity, serious games, virtual reality, robotics

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