Exergames to improve rehabilitation after knee arthroplasty: a systematic review and grade evidence synthesis

Objective: We aimed to systematically review and synthesise the impact of rehabilitation with games in people after knee arthroplasty. Methods: We conducted a systematic review following the Preferred Reporting Items for the declaration of Systematic Reviews (PRISMA – Preferred Reporting Items for Systematic Reviews and Meta- Analysis). The summary of evidence was developed using the Grading of Recommendations, Assessment, Development, and Assessment (GRADE). The review included randomised controlled trials that used characteristics of games in rehabilitation. Results: Eight articles from a total of 1289 identified articles were included after duplicates were removed. In total, 239 participants participated. There were no statistically significant changes between the groups using the exergames and control groups. The level of evidence was rated using GRADE and was very low or moderate. The difference in grouped means was not significant for Knee Flexion, Knee extension, Range of Motion, WOMAC (Western Ontario and McMaster Universities Arthritis Index), AKSS (American Knee Society Score), Self-Efficacy, Five Times Sit-to-Stand Test time, Pain, or Proprioception. Conclusions: The results of the different studies did not find significant changes in the intervention groups with exergames in the physical domains, especially in studies with shorter interventions. Therefore, further investment in future studies on developing and evaluating games is suggested to enhance training during the recovery process.