A systematic review and meta-analysis of the efficacy of custom game based virtual rehabilitation in improving physical functioning of patients with acquired brain injury

BACKGROUND: There have been several reviews examining the effectiveness of VR in rehabilitation. However, its effectiveness remains inconclusive in most review articles. OBJECTIVE: To explore the effectiveness of customized game based virtual rehabilitation on the physical recovery of patients with acquired brain injury. METHOD: We searched PubMed, MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO and AMED for articles published until 30th June 2017. Articles that met the study's inclusion/exclusion criteria were included in the review. RESULTS: A total of 31 studies were selected for review. Pooled analysis showed that customized game-based virtual rehabilitation was effective in improving balance, gait and upper limb functioning as assessed via Berg Balance Scale (BBS) (WMD: 3.31, 95% CI 0.79 to 5.82); Timed Up and Go test (WMD: -4.48, 95% CI -5.43 to -3.52); walk tests (SMD: 0.47, 95% CI 0.05 to 0.89), and Fugl-Meyer Assessment (SMD 0.46, 95% CI 0.20 to 0.72; P< 0.01). Generally, most studies reported that participants were more motivated and enjoyed the game based intervention although there were some mixed results. CONCLUSION: Customized game based virtual rehabilitation has potential to complement current rehabilitation programs. Participants' subjective reports of well-being, motivation and acceptance towards this intervention were generally positive.