- Design
- Systematic review and network meta-analysis with GRADE
- Population
- 60 randomised trials, 3469 older adults (mean age 73)
- Primary outcome
- Balance measures, Timed Up and Go and gait speed
- Effect
- Versus no treatment: telerehabilitation SMD 0.69 (0.08–1.29); balance-platform exergaming 0.63 (0.31–0.95); none superior to conventional exercise
A network meta-analysis in JMIR Aging, published on 28 October, pooled 60 randomised trials with about 3500 older adults, mean age 73. It compared telerehabilitation, exergaming with balance platforms or motion capture, other serious games and wearables against conventional exercise and no treatment.
Telerehabilitation and both forms of exergaming improved balance compared with no treatment, with moderate effect sizes. Conventional exercise also did. None of the technology-based options beat conventional exercise. Certainty was moderate for only two comparisons; most were low or very low. No trial measured falls.
For a family physician, the message is that the best balance intervention is the one an older patient will do. Technology may help with adherence or reach, but it is not superior to standard strength and balance exercise.
- Recommend structured strength and balance exercise to older adults at risk of falls.
- Offer home-based or remote programmes when travel is a barrier; they improved balance.
- Do not present exergaming as better than ordinary exercise; it was not.
- Balance scores are not falls; these trials did not measure falls.
Why it matters
It frees clinicians to choose by preference and access rather than chasing devices.
Don't overread it
No trial reported falls, so these results are not direct evidence of fall prevention.
The statistics, in plain English
A standardised mean difference of about 0.6 to 0.7 against no treatment is a moderate effect. Telerehabilitation ranked first, but on only five trials and 198 people, and its chance of truly being best was about 41%: rankings in network meta-analyses are fragile.
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