Review Article Is Nintendo Wii an Effective Intervention for Individuals With Stroke? A Systematic Review and Meta-Analysis Gary Cheok MSc a, b , Dawn Tan ClinDocPT a, *, Aiying Low MSc a , Jonathan Hewitt PhD c a Department of Physiotherapy, Singapore General Hospital, Singapore b School of Medicine, University of Cardiff, Cardiff, United Kingdom c Department of Geriatric Medicine, Llandough Hospital, Cardiff, United Kingdom Keywords: Video games stroke rehabilitation review meta-analysis abstract Objective: To investigate the effectiveness of Nintendo Wii compared with no intervention or other ex- ercise interventions in the rehabilitation of adults with stroke. Data Sources: Seven electronic databases were systematically searched to source for full-text studies published in peer-reviewed journals up to July 2014. Hand searches of reference lists were performed. Study Selection: Randomized controlled trials (RCTs) comparing Wii with no intervention or other ex- ercise interventions, in patients with stroke, were selected. Data Extraction: Methodological quality was assessed by 2 independent reviewers. Data pertaining to participants, interventions, outcomes, and clinical effectiveness were independently extracted by 2 re- viewers using a standardized form and compared for accuracy. We calculated mean or standardized mean differences for analysis of continuous variables. Risk ratios were derived and 95% confidence in- tervals (CIs) calculated. Data Synthesis: Six studies were included. Three trials (64 participants) compared Wii and conventional rehabilitation versus conventional rehabilitation alone. Three trials (102 participants) compared Wii with other exercise interventions. The addition of Wii to conventional rehabilitation resulted in significant mean differences in favor of additional Wii compared with standard care for Timed Up and Go test (TUG) (0.81 points, CI 0.29e1.33, P ¼ .002), but not for other mobility and functional outcomes: Functional Independence Measure (FIM) score (0.45, CI À0.21e1.11, P ¼ .18), Berg Balance Score (À0.64, CI À3.66 e2.39, P ¼ .68), anteroposterior postural sway (0.23, CI À0.38e0.84, P ¼ .46). No serious adverse events were reported, and when Wii was compared with exercise alone, we demonstrated a decreased risk of participants dropping out of follow-up (RR 0.40, CI 0.20e0.78, P ¼ .007). Conclusions: The addition of Wii gaming to conventional rehabilitation in patients with chronic stroke significantly improved performance in TUG and not in the other physical measures. The pooled effect was small and not beyond the minimal detectable change. However, Wii can be used safely in patients with stroke and participants were less likely to drop out in the Wii group. This review highlights the need for further high-quality studies to demonstrate the efficacy of Wii in stroke rehabilitation. Ó 2015 AMDA e The Society for Post-Acute and Long-Term Care Medicine. Stroke is the main cause of long-term disability. Upper and lower limb paresis, 1 postural instability, falls, and immobility are common features. 2 Physical rehabilitation approaches that are intensive, re- petitive, and task-oriented are effective in improving motor function in patients with stroke through promoting motor learning and neuroplasticity. 3 Repetitive task training, which involves performing functionally relevant tasks at high levels of intensity, has been shown to improve transfer ability, balance, lower limb function, and walking speed in stroke survivors. 4,5 Using Wii technology (Nintendo, Kyoto, Japan) in stroke rehabil- itation provides an alternative form of repetitive task training in an interactive enriched environment. Peters et al 6 demonstrated that patients with stroke performed an average of 61.9 upper extremity movements and 109.7 weight shifts during a Wii game over a dura- tion of a standard physiotherapy session. This is considerably higher than the 32 repetitions achieved during a traditional physiotherapy The authors declare no conflicts of interest. * Address correspondence to Dawn Tan, ClinDocPT, Department of Physiotherapy, Singapore General Hospital, Singapore 169608. E-mail address: dawn.tan.m.l@sgh.com.sg (D. Tan). JAMDA journal homepage: www.jamda.com http://dx.doi.org/10.1016/j.jamda.2015.06.010 1525-8610/Ó 2015 AMDA e The Society for Post-Acute and Long-Term Care Medicine. JAMDA xxx (2015) 1e10