Game-based and gamification-enhanced telerehabilitation for physical therapy in people with multiple sclerosis: a scoping review

INTRODUCTION: People with multiple sclerosis (MS) commonly experience balance, gait, and upper-limb impairments that require long-term physical therapy (PT). Home-based telerehabilitation can improve access to therapy, and game-enhanced interventions (serious games/exergaming) and gamification elements may enhance engagement and adherence. METHODS: This scoping review examined the current evidence and explored the implementation considerations of gamification-based telerehabilitation (GBT) systems designed to deliver home-based PT for people with MS. Following PRISMA-ScR guidance, the databases OVID Medline, OVID EMBASE, CINAHL, and EBSCO were systematically searched between January 2010 and November 2024. Fifteen studies satisfied the inclusion criteria. Study quality was appraised using the Downs and Black checklist, and evidence levels were classified according to a modified Sackett scale. RESULTS: The majority of the 15 studies were of fair-to-good methodological quality, and all used a quantitative design with small sample sizes. The included studies mainly focused on whole-body physical rehabilitation. Eleven studies used commercial games, while others developed customized hardware or software modules. No serious adverse events were reported. High levels of participant satisfaction and adherence in home settings supported feasibility. The effectiveness of GBT for people with MS is still uncertain because the results are mixed. Across controlled trials, balance and postural control outcomes showed the most consistent improvements, whereas fatigue, QoL, and participation outcomes were mixed and often not significant between the groups. CONCLUSION: GBT solutions may serve as a therapeutic alternative to conventional therapy, particularly when access to traditional services is limited or when individuals with MS experience reduced motivation to maintain their exercise routines. More research is needed to find out which measures respond best, which subgroups benefit most, and to provide stronger evidence through the use of both within-group and between-group comparisons.