title: Commercially available gaming systems as clinical assessment tools to improve value in the orthopaedic setting: a systematic review.
abstract: BACKGROUND
  Commercially available gaming systems (CAGS) such as the Wii Balance Board (WBB) and Microsoft Xbox with Kinect (Xbox Kinect) are increasingly used as balance training and rehabilitation tools. The purpose of this review was to answer the question, "Are commercially available gaming systems valid and reliable instruments for use as clinical diagnostic and functional assessment tools in orthopaedic settings?" and provide a summary of relevant studies, identify their strengths and weaknesses, and generate conclusions regarding general validity/reliability of WBB and Xbox Kinect in orthopaedics.
  
  
  METHODS
  A systematic search was performed using MEDLINE (1996-2013) and Scopus (1996-2013). Inclusion criteria were minimum of 5 subjects, full manuscript provided in English or translated, and studies incorporating investigation of CAG measurement properties. Exclusion criteria included reviews, systematic reviews, summary/clinical commentaries, or case studies; conference proceedings/presentations; cadaveric studies; studies of non-reversible, non-orthopaedic-related musculoskeletal disease; non-human trials; and therapeutic studies not reporting comparative evaluation to already established functional assessment criteria. All studies meeting inclusion and exclusion criteria were appraised for quality by two independent reviewers. Evidence levels (I-V) were assigned to each study based on established methodological criteria.
  
  
  RESULTS
  3 Level II, 7 level III, and 1 Level IV studies met inclusion criteria and provided information related to the use of the WBB and Xbox Kinect as clinical assessment tools in the field of orthopaedics. Studies have used the WBB in a variety of clinical applications, including the measurement of center of pressure (COP), measurement of medial-to-lateral (M/L) or anterior-to-posterior (A/P) symmetry, assessment anatomic landmark positioning, and assessment of fall risk. However, no uniform protocols or outcomes were used to evaluate the quality of the WBB as a clinical assessment tool; therefore a wide range of sensitivities, specificities, accuracies, and validities were reported.
  
  
  CONCLUSIONS
  Currently it is not possible to make a universal generalization about the clinical utility of CAGS in the field of orthopaedics. However, there is evidence to support using the WBB and the Xbox Kinect as tools to obtain reliable and valid COP measurements. The Wii Fit Game may specifically provide reliable and valid measurements for predicting fall risk.
authors.affiliation: Department of Orthopaedics The Ohio State University Wexner Medical Center 725 Prior Hall, Columbus, OH 43201, United States of America.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ruff
authors.affiliation: Department of Orthopaedics The Ohio State University Wexner Medical Center 725 Prior Hall, Columbus, OH 43201, United States of America.
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics The Ohio State University Wexner Medical Center 725 Prior Hall, Columbus, OH 43201, United States of America.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Quatman-Yates
authors.affiliation: Department of Orthopaedics The Ohio State University Wexner Medical Center 725 Prior Hall, Columbus, OH 43201, United States of America.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Phieffer
authors.affiliation: Department of Orthopaedics The Ohio State University Wexner Medical Center 725 Prior Hall, Columbus, OH 43201, United States of America. Electronic address: carmen.quatman@osumc.edu.
authors.forename: Carmen E
authors.initials: CE
authors.lastname: Quatman
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D009460:Neurologic Examination / Q000295:instrumentation*; D015588:Observer Variation; D009985:Orthopedics / Q000639:trends*; D004856:Postural Balance / Q000502:physiology*; D015203:Reproducibility of Results; D012984:Software; D018910:Video Games / Q000639:trends
keywords: Balance; Clinical assessment; Falls; Gaming tools; Kinect; Orthopaedics; Wii