title: Play-based interventions improve physical function for people with adult-acquired brain injury: a systematic review and meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  To undertake a systematic review and meta-analysis of the effectiveness of play-based interventions compared to traditional therapy in rehabilitation of adults with adult-acquired brain injury.
  
  
  METHODS
  The search was performed using Medline; Cinahl Plus; Health Source (Nursing/Academic Edition); Psychology and behavioural sciences collection; Biomedical reference collection (basic).
  
  
  METHODS
  Studies included were randomised controlled trials that investigated the effect of play-based interventions on physical function of adults with adult acquired brain injury. Two independent reviewers identified eligible studies and assessed methodological quality using a modified Downs and Black. Meta-analysis compared standardised differences in means, to determine effect sizes for grouped functional outcome measures. The GRADE scoring system was used to determine the level of clinical evidence.
  
  
  RESULTS
  Thirty studies met the inclusion criteria, 13 were considered high quality and 17 moderate quality. Studies predominantly involved post-stroke participants, with only three studies including participants with traumatic brain injury. When compared to traditional therapy, dose-matched studies of play-based interventions showed a significant effect on independence (Effect size (ES) = 0.6) and physical performance (ES = 0.43), as measured using the Fugl -Meyer. For non-dose matched studies, play-based interventions showed a significant improvement for balance (ES = 0.76) compared with traditional therapy. In all studies that measured participant enjoyment, play-based therapy was rated as more enjoyable than traditional therapy.
  
  
  CONCLUSIONS
  Play-based interventions for people with adult acquired brain injury are more effective in improving balance and independence, which may be due to them being more enjoyable than traditional therapy.
authors: 1 Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
authors: Nicola
authors: N
authors: Saywell
authors: 2 Hand Institute, Auckland, New Zealand.
authors: Nick
authors: N
authors: Taylor
authors: 3 Southern Physiotherapy, Auckland, New Zealand.
authors: Emma
authors: E
authors: Rodgers
authors: 4 Waitemata District Health Board, Auckland, New Zealand.
authors: Luke
authors: L
authors: Skinner
authors: 1 Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
authors: Mark
authors: M
authors: Boocock
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis* / Q000534:rehabilitation*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010988:Play and Playthings; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome
keywords: Brain injury; rehabilitation interventions; systematic review