Comparative Effectiveness of Digital Exercise-Based Interventions for Improving Balance in Older Adults: A Network Meta-Analysis With GRADE Certainty of Evidence
ABSTRACT
Background:
Technology-based rehabilitation is increasingly used for balance training in older adults. A 2023 network meta-analysis (NMA) found only exergaming with motion capture significantly superior to no treatment, but the evidence has since expanded and no GRADE certainty appraisal had been applied.
Objective:
To update comparative effectiveness of five technology categories (exergaming with balance platforms [EBP], exergaming with motion capture [EMC], other serious games [OSG], wearable devices [IW], telerehabilitation [Tele]) versus conventional exercise (CE) and no treatment (NT), applying GRADE adapted for NMA.
Methods:
Systematic search (through April 2025) identified 60 RCTs (n=3,469; mean age 73.4 years). Random-effects NMA covered four networks (balance, functional scales, TUG, gait speed). RoB 2 and SUCRA ranking were used.
Results:
In the balance network, Tele (SMD=0.69), EBP (0.63), and EMC (0.58) significantly outperformed NT. For TUG, similar significant effects were seen for EBP (0.81), EMC (0.79), and Tele (0.82). Tele ranked first in SUCRA (76.3%). No technology significantly exceeded CE. GRADE certainty was moderate for EBP and EMC vs. NT in the TUG network only; all other comparisons were low or very low. Dropout rates did not differ between technology and control arms (OR=1.10).
Conclusions:
Telerehabilitation, EBP, and EMC improve balance in older adults, with telerehabilitation as the highest-ranked modality. Evidence certainty remains moderate at best, warranting larger, rigorous trials. Clinical Trial: PROSPERO with the registration number CRD420261380567
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