title: Is Nintendo Wii an Effective Intervention for Individuals With Stroke? A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To investigate the effectiveness of Nintendo Wii compared with no intervention or other exercise interventions in the rehabilitation of adults with stroke.
  
  
  METHODS
  Seven electronic databases were systematically searched to source for full-text studies published in peer-reviewed journals up to July 2014. Hand searches of reference lists were performed.
  
  
  METHODS
  Randomized controlled trials (RCTs) comparing Wii with no intervention or other exercise interventions, in patients with stroke, were selected.
  
  
  METHODS
  Methodological quality was assessed by 2 independent reviewers. Data pertaining to participants, interventions, outcomes, and clinical effectiveness were independently extracted by 2 reviewers using a standardized form and compared for accuracy. We calculated mean or standardized mean differences for analysis of continuous variables. Risk ratios were derived and 95% confidence intervals (CIs) calculated.
  
  
  RESULTS
  Six studies were included. Three trials (64 participants) compared Wii and conventional rehabilitation versus conventional rehabilitation alone. Three trials (102 participants) compared Wii with other exercise interventions. The addition of Wii to conventional rehabilitation resulted in significant mean differences in favor of additional Wii compared with standard care for Timed Up and Go test (TUG) (0.81 points, CI 0.29-1.33, P = .002), but not for other mobility and functional outcomes: Functional Independence Measure (FIM) score (0.45, CI -0.21-1.11, P = .18), Berg Balance Score (-0.64, CI -3.66-2.39, P = .68), anteroposterior postural sway (0.23, CI -0.38-0.84, P = .46). No serious adverse events were reported, and when Wii was compared with exercise alone, we demonstrated a decreased risk of participants dropping out of follow-up (RR 0.40, CI 0.20-0.78, P = .007).
  
  
  CONCLUSIONS
  The addition of Wii gaming to conventional rehabilitation in patients with chronic stroke significantly improved performance in TUG and not in the other physical measures. The pooled effect was small and not beyond the minimal detectable change. However, Wii can be used safely in patients with stroke and participants were less likely to drop out in the Wii group. This review highlights the need for further high-quality studies to demonstrate the efficacy of Wii in stroke rehabilitation.
authors.affiliation: Department of Physiotherapy, Singapore General Hospital, Singapore; School of Medicine, University of Cardiff, Cardiff, United Kingdom.
authors.forename: Gary
authors.initials: G
authors.lastname: Cheok
authors.affiliation: Department of Physiotherapy, Singapore General Hospital, Singapore. Electronic address: dawn.tan.m.l@sgh.com.sg.
authors.forename: Dawn
authors.initials: D
authors.lastname: Tan
authors.affiliation: Department of Physiotherapy, Singapore General Hospital, Singapore.
authors.forename: Aiying
authors.initials: A
authors.lastname: Low
authors.affiliation: Department of Geriatric Medicine, Llandough Hospital, Cardiff, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hewitt
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D000071939:Stroke Rehabilitation; D014584:User-Computer Interface; D018910:Video Games
keywords: Video games; meta-analysis; rehabilitation; review; stroke