Exercise-based gaming in patients with multiple sclerosis: A systematic review and meta-analysis

Amal Mohamed Elhusein (Nursing Department, College of Applied Medical Sciences, University of Bisha, Bisha, Saudi Arabia)
Hammad Ali Fadlalmola (Nursing College, Department of Community Health Nursing, Taibah University, Saudi Arabia)
Eltayeb Mohammed Awadalkareem (Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Saudi Arabia)
Ekram Yahia Mahmowd Alhusain (Faculty of Nursing, Obstetric and Gynecological Nursing, Shendi University, Sudan)
Soad Mohamed Alnassry (Nursing College, Jazan University, Jazan, Saudi Arabia)
Mukhlid Alshammari (College of Applied Medical Science, University of Hafr Al Batin, Saudi Arabia)
Elsadig Eltahir Abdulrahman (Faculty of Nursing, Najran University, Saudi Arabia)
Doaa El Sayed Fadila (Nursing College, Department of Community Health Nursing, Taibah University, Saudi Arabia | Gerontological Nursing Department, Faculty of Nursing, Mansoura University, Egypt)
Fatma M. Ibrahim (Community Health Nursing, RAK Medical and Health Sciences University, United Arab Emirates)
Abdalrahman Abdallatif Mohmmed Saeed (Nursing Department, College of Applied Medical Science, King Faisal University, Saudi Arabia)
Adel Abdalla (Prince Sultan Military College of Health Sciences, Nursing Department, Al Dhahran, Saudi Arabia)
Hassan N Moafa (Department of Epidemiology, College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia | Department of Tropical Medicine, College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia)
Ehab I. El-Amin (Department of Epidemiology, College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia)
Daniel Mon Mamanao (Nursing College, Department of Community Health Nursing, Taibah University, Saudi Arabia)

Belitung Nursing Journal
Vol. 10 No. 1 (2024): January - February

Background: Multiple sclerosis presents a significant burden, with balance disturbances impacting patients’ daily living. Conventional therapies have been supplemented with technological advancements like virtual reality (VR) and exergaming, providing engaging, multisensory rehabilitation options. Objective: This study aimed to synthesize evidence on exergaming’s role in multiple sclerosis treatment, particularly to evaluate the impact of exergaming on cognitive, motor, and psychological outcomes in patients with multiple sclerosis. Methods: A systematic review and subsequent meta-analysis design were employed. An extensive search was conducted up to June 2023 across five electronic databases - Web of Science, Scopus, PubMed, Cochrane, and EMBASE. The data extraction process from the selected studies was conducted independently. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool 1 (ROB1) and the National Institutes of Health (NIH) assessment tool. Continuous outcomes were consolidated as mean differences (MD) with 95% confidence intervals (CIs). Meta-analyses were performed using RevMan ver. 5.4. Results: Out of 1,029 studies, 27 were included for meta-analysis. There were no significant differences in cognitive outcomes between the exergaming and the no-intervention group or the Conventional Physiotherapy and Rehabilitation interventions (CPRh) subgroups. However, the Symbol Digit Modalities Test (SDMT) showed a statistically significant difference in favor of exergaming in the no-intervention subgroup (MD = 5.40, 95% CI [0.08, 10.72], p = 0.05). In motor outcomes, exergaming only demonstrated better results in the 6-minute walking test compared to the no-intervention group (MD = 25.53, 95% CI [6.87, 44.19], p = 0.007). The Berg Balance Scale score in both studied subgroups and the Timed Up and Go (TUG) test in the no-intervention group favored exergaming. In terms of psychological outcomes, the Beck Depression Inventory did not reveal any significant differences, while the Modified Fatigue Impact Scale (MFIS) score favored exergaming in the CPRh subgroup. Conclusion: Exergaming shows promise for enhancing cognitive and motor functions, motivation, adherence, and quality of life in MS patients, which is beneficial for nurses. It can be tailored to individual preferences and easily conducted at home, potentially serving as a viable alternative to traditional rehab programs, especially during relapses. However, further research is necessary to fully understand its optimal and lasting benefits.