A systematic review on the effect of serious games and wearable technology used in rehabilitation of patients with traumatic bone and soft tissue injuries

To determine the effects on functional outcomes and treatment adherence of wearable technology and serious games (i.e., interactive computer applications with specific purposes useful in the 'real world') currently applied in physical rehabilitation of patients after traumatic bone and soft tissue injuries. PubMed, Embase, the Cochrane Library and CINAHL were searched without publication date restrictions for the terms 'wearable', 'serious game', 'videogame' or 'mobile application', and 'rehabilitation', 'exercise therapy' or 'physiotherapy'. The search yielded 2704 eligible articles, which were screened by two independent reviewers. Studies comparing a serious game to standard therapy were included. Methodology and results of the studies were critically appraised in conformity with PRISMA guidelines. Twelve articles were included, all of which tested 'off-the-shelf' games. No studies on 'wearable-controlled' games, or games specifically developed for rehabilitation could be included. Medical conditions included post-operative rehabilitation and acute traumatic injuries. All studies were of low to moderate quality. Only two studies found beneficial effects of serious games over conventional therapy. One of three studies reporting pain scores found beneficial effects of a serious game compared to physiotherapy. One out of five trials reporting treatment adherence found a statistically significant advantage in the game-group compared to conventional physiotherapy. Due to heterogeneity in study design and outcome measures, pooling of data was not possible. Serious games seem a safe alternative or addition to conventional physiotherapy after traumatic bone and soft tissue injury. Future research should determine their validity and effectiveness in rehabilitation therapy, next to their cost-effectiveness and effect on treatment adherence