Effects of game-based rehabilitation on upper limb motor function following acute and sub-acute stroke: a systematic review, meta-analyses, and GRADE evidence synthesis

Abstract Despite the strong theoretical basis for driving neuroplasticity, there is a lack of consensus over the effectiveness of game-based therapies for improving upper limb (UL) function within six-months post-stroke. Therefore, this review synthesized the certainty of evidence underpinning the immediate, short-term and long-term effects of game-based rehabilitation on UL function within the first six months following stroke. Eight electronic and three grey literature databases were searched from their inception to 30th April 2024 for relevant articles. The Cochrane ROB 2 tool for risk of bias assessment and the GRADE approach for evidence synthesis for each outcome of interest were used. Forty-eight randomized controlled trials with a total of 2809 participants were included in the qualitative analysis, whereas data from only 41 studies were used in the meta-analyses. Significant improvements in UL function (Fugl-Meyer assessment-upper extremity), UL motor recovery (Brunnstrom motor recovery stage), independence in day-to-day activities (Barthel index), and cognitive function (Montreal cognitive assessment) in patients with acute and sub-acute stroke were found. A non-significant improvement was noted in the quantitative analysis for grip strength, hand dexterity (Box and block test), independence in day-to-day activities (Functional independence measure, Korean version of modified Barthel index), arm and hand motor ability (action research arm test, manual function test) and quality of life (European quality of life—5 dimension- 3 levels). The certainty of evidence was found to be low or very low for these outcomes. Although a positive immediate, short-term and long-term effect of game-based rehabilitation on improving UL function and an immediate effect on motor recovery and cognitive function were evident, there are concerns about the risk of bias in the included studies. Furthermore, heterogeneity of interventions, inconsistency, imprecision of findings, indirectness of outcomes, and low or very low quality of evidence preclude the recommendation of a specific game-based rehabilitation program over conventional therapy for improving UL function following acute and sub-acute stroke. Further robust clinical trials with homogenous methods and outcome measures are warranted to substantiate the effects of game-based rehabilitation on UL function post-stroke. Systematic review registration number: PROSPERO CRD42020190100.