Critically appraised paper: Gamified rehabilitation enhances upper limb function in stroke survivors synopsis

Yvonne C Learmonth

doi:10.1016/j.jphys.2025.06.012

Summary of: Ali AS, Kumaran DS, Unni A, Sardesai S, Prabhu V, Nirmal P, et al. Effectiveness of an Intensive, Functional, and Gamified Rehabilitation Program on Upper Limb Function in People With Stroke (EnteRtain): A Multicenter Randomized Clinical Trial. Neurorehabil Neural Repair. 2024;38:243–256. Question: Does a gamified upper limb training program improve upper limb function and activity after stroke compared with a task-based training program? Design: Randomised controlled trial with concealed allocation and blinded assessment. Setting: Three rehabilitation centres in India. Participants: Adults aged < 80 years with unilateral stroke and haemodynamic stability. Exclusion criteria were: global or receptive aphasia; complex regional pain syndrome; major medical issues or comorbidities that restricted study participation; and sensory loss that limited computer use. Randomisation of 120 participants allocated 64 to the gamified training group and 56 to a task-based comparator group. Interventions: Participants in both groups received conventional training consisting of mobilisation of limbs, facilitatory/inhibitory techniques, muscle strengthening, balance training and gait training. In addition to this, the intervention group received an intensive, functional, gamified upper limb program using the portable ArmAble™ device, while the comparator group received an upper limb task-based program, which included daily functional tasks. The intervention and comparator were delivered for 45 to 60 minutes, 6 days/week, under therapist supervision for 2 weeks. Participants in both groups then received an identical home-based program of 30 minutes, 6 days/week for 4 weeks, and this was supported by weekly phone calls to encourage adherence. Outcome measures: The primary outcomes were change in upper limb function via the Fugl-Meyer Assessment-Upper Extremity tool (FM-UE, 0 to 66) and upper limb activity via the Action Research Arm Test (ARAT, 0 to 55) from baseline to 2 and 6 weeks. Results: 115 participants (96%) completed the 2-week follow-up and 98 (82%) the 6-week follow-up. The gamified training program was superior for improving FM-UE scores at 2 weeks (MD –3.9, 95% CI –6.5 to –1.3) and 6 weeks (MD −3.9, 95% CI –6.5 to –1.3) but not ARAT scores at 2 weeks (MD −2.9, 95% CI −5.8 to 0.0) and 6 weeks (MD –3.0, 95% CI –5.9 to –0.0). Conclusion: In adult stroke survivors, a 2-week gamified upper limb training program, supplemented with a 4-week home-based program, improved upper limb function but not activity, compared with a 2-week task-based training program supplemented with a 4-week home program. Provenance: Invited. Not peer reviewed.

Critically appraised paper: Gamified rehabilitation enhances upper limb function in stroke survivors synopsis

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