To assess the effects on functional outcomes and treatment adherence of wearable technology and serious games (ie, interactive computer applications with specific purposes useful in the “real world”) currently used in physical rehabilitation of patients after traumatic bone and soft tissue injuries.
PubMed, EMBASE, Cochrane Library, and Current Index to Nursing and Allied Health Literature were searched without publication date restrictions for the terms wearable, serious game, videogame or mobile application, and rehabilitation, exercise therapy, and physiotherapy.
The search yielded 2704 eligible articles, which were screened by 2 independent reviewers. Studies comparing serious games to standard therapy were included.
Methodology and results of the studies were critically appraised in conformity with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Twelve articles were included, all of which tested “off-the-shelf” games. No studies on “wearable-controlled” games or games specifically developed for rehabilitation could be included. Medical conditions included postoperative rehabilitation and acute traumatic injuries. All studies were of low to moderate quality. Only 2 studies found beneficial effects of serious games compared to conventional therapy. One of 3 studies reporting pain scores found beneficial effects of serious games compared to physiotherapy. One of 5 trials reporting treatment adherence found a statistically significant advantage in the game group compared to conventional physiotherapy. Because of heterogeneity in study design and outcome measures, pooling of data was not possible.
Serious games seem a safe alternative or addition to conventional physiotherapy after traumatic bone and soft tissue injuries. Future research should determine their validity and effectiveness in rehabilitation therapy, next to their cost-effectiveness and effect on treatment adherence.
List of abbreviations:MeSH (Medical Subject Headings)
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- Correlates of exercise compliance in physical therapy.Phys Ther. 1993; 73: 771-782
- Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review.Man Ther. 2010; 15: 220-228
- The challenge of patient adherence.Ther Clin Risk Manag. 2005; 1: 189-199
- Developing serious games.1st ed. Charles River Media, Hingham2006: xviip
- Virtual reality for stroke rehabilitation.Cochrane Database Syst Rev. 2015; : CD008349
- Gaming for health: a systematic review of the physical and cognitive effects of interactive computer games in older adults.J Appl Gerontol. 2015; 34: NP166-NP189
- Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians.Stroke. 2011; 42: 1380-1386
- A systematic review of serious games in training health care professionals.Simul Healthc. 2016; 11: 41-51
- Origins of serious games.in: Ma M. Oikonomou A. Jain L.C. Serious games and edutainment applications. Springer, New York2011: 25-43
- Wearable sensors/systems and their impact on biomedical engineering.IEEE Eng Med Biol Mag. 2003; 22: 18-20
- What is wearable tech? Everything you need to know explained.(Available at:)Accessed September 17, 2016)
- Optimising engagement for stroke rehabilitation using serious games.Vis Comput. 2009; 25: 1085-1099
- Duckneglect: video-games based neglect rehabilitation.Technol Health Care. 2013; 21: 97-111
- Wii-habilitation: is there a role in trauma?.Injury. 2010; 41: 883-885
- Clinical feasibility of the Nintendo Wii for balance training post-stroke: a phase II randomized controlled trial in an inpatient setting.Clin Rehabil. 2014; 28: 912-923
- Clinical feasibility of interactive motion-controlled games for stroke rehabilitation.J Neuroeng Rehabil. 2015; 12: 63
- Epidemiology of trauma-related disability.in: Hurley R. Trauma rehabilitation. Lippincott Williams & Wilkins, Philadelphia2006: 11-17
- Strategies for stroke rehabilitation.Lancet Neurol. 2004; 3: 528-536
- Preliminary evaluation of a commercially available videogame system as an adjunct therapeutic intervention for improving balance among children and adolescents with lower limb amputations.Arch Phys Med Rehabil. 2012; 93: 358-366
- How to systematically assess serious games applied to health care.JMIR Serious Games. 2014; 2: e11
- Validation of virtual reality simulators: key to the successful integration of a novel teaching technology into minimal access surgery.Minim Invasive Ther Allied Technol. 2005; 14: 244-246
- Rehabilitation. Oxford Advanced Learner's Dictionary.(Available at:)Accessed September 15, 2015)
- Cochrane handbook for systematic reviews of interventions. Version 5.1.0.(Available at:)Accessed October 12, 2016)
- Methodological Index for Non-Randomized Studies (MINORS): development and validation of a new instrument.ANZ J Surg. 2003; 73: 712-716
- Testing the feasibility and safety of the Nintendo Wii gaming console in orthopedic rehabilitation: a pilot randomized controlled study.Arch Med Sci. 2016; 12: 1273-1278
- The utilization of Nintendo® Wii™ during burn rehabilitation: a pilot study.J Burn Care Res. 2012; 33: 36-45
- Comparison between Nintendo Wii Fit and conventional rehabilitation on functional performance outcomes after hamstring anterior cruciate ligament reconstruction: prospective, randomized, controlled, double-blind clinical trial.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 880-887
- A randomized controlled trial to evaluate the feasibility of the Wii Fit for improving walking in older adults with lower limb amputation.Clin Rehabil. 2017; 31: 82-92
- Wii Fit™ exercise therapy for the rehabilitation of ankle sprains: its effect compared with physical therapy or no functional exercises at all.Scand J Med Sci Sports. 2016; 26: 816-823
- A pilot prospective randomized control trial comparing exercises using videogame therapy to standard physical therapy: 6 months follow-up.J Burn Care Res. 2015; 36: 534-544
- Xbox KinectTM based rehabilitation as a feasible adjunct for minor upper limb burns rehabilitation: a pilot RCT.Burns. 2016; 42: 1797-1804
- Advancement of physical process by mental activation: a prospective controlled study.J Rehabil Res Dev. 2012; 49: 1221-1228
- Nintendo Wii Fit as an adjunct to physiotherapy following lower limb fractures: preliminary feasibility, safety and sample size considerations.Physiotherapy (United Kingdom). 2016; 102: 217-220
- Interactive virtual reality Wii in geriatric day hospital: a study to assess its feasibility, acceptability and efficacy.Geriatr Gerontol Int. 2012; 12: 714-721
- Use of Nintendo Wii Fit™ in the rehabilitation of outpatients following total knee replacement: a preliminary randomised controlled trial.Physiotherapy. 2012; 98: 183-188
- Interactive gaming consoles reduced pain during acute minor burn rehabilitation: a randomized, pilot trial.Burns. 2016; 42: 91-96
- Comparing outcomes of Kinect videogame-based occupational/physical therapy versus usual care.Games Health J. 2014; 3: 157-161
- Using commercial video games for upper limb stroke rehabilitation: is this the way of the future?.Top Stroke Rehabil. 2014; 21: 152-162
- Serious games for home-based stroke rehabilitation.Stud Health Technol Inform. 2015; 213: 157-160
- The use of commercial video games in rehabilitation: a systematic review.Int J Rehabil Res. 2016; 39: 277-290
- A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation.Disabil Rehabil. 2009; 31: 427-447
- Using smartphone applications as hand therapy interventions.J Hand Ther. 2014; 27 (quiz 57): 254-256
- Advances in wearable technology and applications in physical medicine and rehabilitation.J Neuroeng Rehabil. 2005; 2: 2
Published online: November 11, 2017
Supported by the Growing Games consortium (Dutch Game Garden, iMMovator, Dutch Games Association and Economic Board Utrecht; grant no. CB_WP200018) and the CZ (Centraal Ziekenfonds) Fund.
© 2017 by the American Congress of Rehabilitation Medicine