Comparative Effectiveness of Digital Exercise-Based Interventions for Improving Balance in Older Adults: Systematic Review and Network Meta-Analysis With GRADE Certainty of Evidence.
Fangbo Li, Xuecheng Li, Qingfang Li et al.
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In 30 seconds
This systematic review and network meta-analysis compared five digital exercise-based approaches with conventional exercise (CE) and no treatment (NT) for balance in older adults. It included 60 randomized controlled trials (3469 participants); 57 trials contributed to the outcome networks. In the all-balance network, telerehabilitation, balance-platform exergaming, motion-capture exergaming, and CE each improved balance versus NT. No technology-based intervention was superior to CE in any network. Telerehabilitation ranked highest, but its ranking was preliminary and the evidence was mostly low or very low certainty.
Key findings
- Versus NT, telerehabilitation improved all-balance scores (SMD 0.69, 95% CI 0.08-1.29; P =.03); balance-platform exergaming and motion-capture exergaming also showed benefits.
- No technology-based intervention was superior to CE in any network.
- Telerehabilitation ranked first by SUCRA (76.3%), but its probability of being best was approximately 41%, based on 5 trials (n=198).
- Dropout did not differ between technology-based and control arms (odds ratio 1.10, 95% CI 0.87-1.40; P =.41); no included trial reported falls.
Why it matters
Digital exercise approaches may improve measured balance compared with no treatment, but the analysis does not show that they outperform conventional exercise. The distinction matters when interpreting rankings: a high probability-based ranking is not equivalent to established comparative superiority. Because trials did not report falls and most comparisons had low or very low certainty, balance-score improvements should not be taken as evidence of fall prevention.
What to keep in mind
Certainty was moderate only for balance-platform and motion-capture exergaming versus no treatment on the TUG test; the other 37 comparisons were low or very low certainty. Telerehabilitation estimates rested on 5 trials (n=198), and no included trial reported falls.