Review article
Use of commercial video games to improve postural balance in patients with multiple sclerosis:a systematic review and meta-analysis of randomised controlled clinical trials
Efectos de la terapia con videojuegos comerciales sobre el equilibrio postural en pacientes con esclerosis múltiple: revisión sistemática y metaanálisis de ensayos clínicos controlados aleatorizados
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A-B) Haematoxylin-eosin staining showed intense polymorphous inflammatory infiltrate containing lymphocytes, plasma cells, and histiocytes, intermingled with large, atypical cells (B, arrows), some of which were close to blood vessels (B, arrowheads). C) The Ki67 proliferation index was > 40%. These cells tend to form aggregates of >50 cells (B) and present an angiocentric and angiodestructive growth pattern (D). Immunohistochemical studies (E, F, G, H) revealed that these atypical cells express CD20 (present in B-cells) and EBER (Epstein-Barr virus–encoded RNA, which indicates Epstein-Barr virus infection). A comparison of histology sections revealed a nearly complete overlap between EBER-expressing and CD20-expressing cells (G, H). All these findings are diagnostic of an EBV-associated B-cell lymphoproliferative disorder, compatible with lymphomatoid granulomatosis grade 3.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Moreno-Estébanez, T. González-Pinto, G. 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Parra-Moreno, J.J. Rodríguez-Juan, J.D. Ruiz-Cárdenas" "autores" => array:3 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Parra-Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "J.J." "apellidos" => "Rodríguez-Juan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "J.D." "apellidos" => "Ruiz-Cárdenas" "email" => array:1 [ 0 => "jdruiz@ucam.edu" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Facultad de Ciencias de la Salud, Universidad Católica de Murcia, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "GI. ECOFISTEM, Facultad de Ciencias de la Salud, Universidad Católica de Murcia, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efectos de la terapia con videojuegos comerciales sobre el equilibrio postural en pacientes con esclerosis múltiple: revisión sistemática y metaanálisis de ensayos clínicos controlados aleatorizados" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1861 "Ancho" => 2361 "Tamanyo" => 436071 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Forest plots: differences between patients receiving exergame therapy and controls for the Berg Balance Scale (A), the Four Step Square Test (B), and the Timed 25-Foot Walk (C). 95% CI: 95% confidence interval; df: degrees of freedom; IV: inverse variance; SD: standard deviation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Multiple sclerosis (MS) is a chronic, inflammatory demyelinating disease of unknown, probably multifactorial origin. The disease is associated with a wide range of symptoms, including depression, fatigue, pain, muscle weakness, and gait and balance alterations.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> Postural imbalance is one of the most disabling symptoms of MS, affecting approximately 80% of patients.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Commercial video games constitute a promising tool for improving postural balance in various populations.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3–5</span></a> They are inexpensive and widely accessible, and increase patient motivation and satisfaction with treatment, which makes them a useful tool both in clinical practice and in the home environment.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> “Exergames” involve such activities as dancing, running, throwing, cycling, boxing, or playing tennis; players use their arms and legs to activate commands in order to accomplish objectives. This stands in contrast with traditional video games, which are usually played in a seated position.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> Despite increasing evidence on the use of exergames in different populations,<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3–5</span></a> their benefits for MS are not clear and further research is required.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This systematic review and meta-analysis aims to analyse the available evidence on the effects of exergames on postural balance in patients with MS.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Design</span><p id="par0020" class="elsevierStylePara elsevierViewall">We performed a systematic review of randomised controlled clinical trials using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Search strategy and databases</span><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a literature search on 11 electronic databases: Academic Search Complete, Allied and Complementary Medicine Database (AMED), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Web of Science Core Collection, IBECS, LILACS, PubMed/Medline, Scielo, SPORTDiscus, and ScienceDirect.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We used the following search terms: multiple sclerosis, videogames, video games, exergam*, postural balance, posturography, postural control, and balance. These were combined using the Boolean operators AND and OR. We also reviewed the references cited in the studies identified in the literature search. The last search was conducted on 9 October 2017. Additional information on the search strategy used is provided in the Supplementary Material.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Eligibility criteria</span><p id="par0035" class="elsevierStylePara elsevierViewall">We gathered randomised controlled clinical trials evaluating the effects of commercial video games on postural balance in patients with MS and published in full-text format in international, peer-reviewed journals. Studies combining video games with other types of therapy were excluded from our review.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Study selection and data collection process</span><p id="par0040" class="elsevierStylePara elsevierViewall">Studies were selected by 2 independent reviewers, who first read the titles and abstracts of the studies gathered during the electronic search, and then read the full texts of those articles potentially relevant to our review.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We used the PICO approach<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> to gather data on participant characteristics (sample size, age, sex, level of disability), type of intervention (type of exercise; video game used; session intensity, frequency, and duration; duration of the intervention), characteristics of the control group, and impact on postural balance. We also gathered data on study characteristics (author, year of publication) and the tools used by the authors to evaluate balance.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Risk of bias</span><p id="par0050" class="elsevierStylePara elsevierViewall">We assessed the risk of bias of the studies reviewed using the tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> which evaluates sequence generation, allocation sequence concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective outcome reporting, and other potential threats to validity. Two independent reviewers evaluated the risk of bias; disagreements were resolved by a third reviewer.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">A meta-analysis was conducted in cases where 2 or more studies measured the same outcome variable. We calculated the difference in means (DM) and the 95% confidence interval (CI) for each relevant outcome from each of the studies selected. The results of the meta-analysis are presented in the form of forest plots; statistical significance was set at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>.05. The <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span> index was used to assess the heterogeneity of the studies included.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The fixed-effects model was applied when the <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span> index detected no significant heterogeneity (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05); otherwise, the random-effects model was used. Egger's regression test was used to assess publication bias. A non-zero intercept indicated publication bias (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>.05).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Statistical analysis was performed with RevMan 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) and a Microsoft® Excel 2010 template.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Study selection</span><p id="par0070" class="elsevierStylePara elsevierViewall">We identified a total of 230 studies in the electronic databases used. We excluded duplicate articles and selected 6 potentially eligible studies, which were read in full text format. One of these was excluded as it combined Wii Fit with balance board exercises. Five studies were included in the qualitative analysis, and 4 were selected for the meta-analysis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Study characteristics and risk of bias</span><p id="par0075" class="elsevierStylePara elsevierViewall">We included randomised controlled clinical trials published between 2013 and 2015.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10–14</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In general terms, the articles included show a low risk of bias for all domains, except for blinding of participants and personnel, which had a high risk of bias (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10–14</span></a> Eighty percent of studies showed adequate sequence generation and allocation sequence concealment.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10,11,13,14</span></a> Assessors were blinded in 60% of studies.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10,11,13</span></a> The domains “selective outcome reporting” and “incomplete outcome data” presented a low risk of bias in all studies.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10–14</span></a> Additional information on the risk of bias assessment is provided in the Supplementary Material.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Patient characteristics</span><p id="par0085" class="elsevierStylePara elsevierViewall">A total of 259 patients (176 women, 86 men) with MS and moderate disability (Expanded Disability Status Scale scores 3-6) were included in our systematic review. Patient ages ranged from 35.3 to 53.9 years.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Characteristics of the intervention</span><p id="par0090" class="elsevierStylePara elsevierViewall">Experimental groups used different commercial video game systems, including the Nintendo Wii® for the videogames Wii Fit® and Wii Fit Plus®,<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10,12–14</span></a> and the Xbox 360® for the videogames Kinect Sports®, Kinect Joy Ride®, and Kinect Adventures®.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In some studies, controls received conventional physical therapy with strength, proprioception, and gait exercises, as well as stretching or balance board exercises,<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10,11,14</span></a> whereas in others they received no treatment.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">12–14</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Exergaming training was performed between 2 and 5 times per week, with sessions lasting 30-60<span class="elsevierStyleHsp" style=""></span>minutes; the duration of the intervention ranged from 4 to 12 weeks. Session intensity was adjusted by progressively increasing the game's difficulty level.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">11–14</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Patient assessment tools</span><p id="par0105" class="elsevierStylePara elsevierViewall">Dynamic balance was assessed with a wide range of functional tests and scales: the Timed Up and Go test, Cognitive Timed-Up-and-Go dual-task test, Timed Chair Stand test, Four Step Square Test (FSST), Timed 25-Foot Walk (T25-FW), Dynamic Gait Index (DGI), Activities-Specific Balance Confidence Scale, Berg Balance Scale (BBS), and Tinetti Balance and Gait Assessment Scale.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10–13</span></a> Some authors used stabilometric parameters to assess static balance with the eyes open and closed, including centre of pressure (CoP) displacement, CoP sway area, CoP velocity, and CoP displacement range in the anteroposterior and mediolateral axes.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10,13,14</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Effects of exergaming on postural balance</span><p id="par0110" class="elsevierStylePara elsevierViewall">The studies included generally reported improvements in the short term (4 to 12 weeks) in all balance variables analysed in patients receiving exergame therapy as compared to controls receiving no treatment<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> or performing strength and proprioception exercises<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10,11,13</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Exergaming improved dynamic balance by 9%-16%, as measured with the BBS (+5 to +7.6 points), the Tinetti scale (+7.5 points), the T25-FW (−0.8<span class="elsevierStyleHsp" style=""></span>s), and the FSST (−2.8<span class="elsevierStyleHsp" style=""></span>s).<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10,11,13</span></a> Static balance also improved in terms of CoP displacement (−88<span class="elsevierStyleHsp" style=""></span>mm), CoP velocity (−1<span class="elsevierStyleHsp" style=""></span>m/s), and CoP displacement range in the mediolateral (−12 to −18<span class="elsevierStyleHsp" style=""></span>mm) and anteroposterior axes (−13 to −14<span class="elsevierStyleHsp" style=""></span>mm).<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">13,14</span></a> Furthermore, CoP sway area decreased by 44% (−46.3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>) and 38% (−97<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>) during open-eye and closed-eye stabilometry, respectively.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Two of the studies included report no differences in any of the variables analysed between the intervention group and controls receiving no treatment<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> or traditional balance training (e.g., standing with feet together after perturbations, straight line walking, wobble board).<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Meta-analysis</span><p id="par0125" class="elsevierStylePara elsevierViewall">We performed 3 meta-analyses to assess the effects of exergaming on BBS, FSST, and T25-FW scores. We used the fixed-effects model, as the heterogeneity analysis revealed no significant differences between studies for any of the variables analysed (BBS: <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.96, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.33, <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%; FSST: <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.44, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.51, <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%; T25-FW: <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.96, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.33, <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%).</p><p id="par0130" class="elsevierStylePara elsevierViewall">Improvements in BBS scores were more marked in patients receiving exergame therapy than in controls performing strength, proprioception, and postural balance exercises (DM: 5.30; 95% CI, 3.39-7.21; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001; <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). However, no significant differences were observed between patients in the intervention group and controls receiving no treatment in FSST (DM: −0.74; 95% CI, −2.79 to 1.32; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.48; <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B) or T25-FW scores (DM: −0.15; 95% CI, −1.06 to 0.76; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.75; <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>C).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Egger's regression test showed no significant differences between studies for any of the variables analysed (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.10), which points to an absence of publication bias; we should nonetheless bear in mind that our study analysed a small sample of articles.</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Our systematic review and meta-analysis analysed the available evidence on the impact of exergames on postural balance in patients with MS.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In the studies analysed, FSST and T25-FW scores and CoP displacement, velocity, and displacement range improved in patients using exergames as compared to those receiving no treatment.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">13,14</span></a> Exergame therapy also achieved more marked improvements in BBS and Tinetti scale scores and in CoP sway area with open and closed eyes than conventional therapy with proprioceptive, strength, and stretching exercises.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">However, the magnitude of change for FSST and T25-FW scores (+2.8<span class="elsevierStyleHsp" style=""></span>s and +0.9<span class="elsevierStyleHsp" style=""></span>s, respectively) was below the minimal detectable change (MDC) reported in the literature for patients with MS (4.6<span class="elsevierStyleHsp" style=""></span>s and 12.6<span class="elsevierStyleHsp" style=""></span>s, respectively)<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">15,16</span></a>; MDC refers to the smallest amount of change required to distinguish a true change after an intervention from a change due to variability or measurement error.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> Furthermore, meta-analysis detected no intergroup differences in any of the variables analysed except for BBS scores, with a magnitude of change of +5.3<span class="elsevierStyleHsp" style=""></span>points in the exergame therapy group; this is below the MDC reported in the literature for this variable in patients with MS (7 points).<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> Our results suggest that the magnitude of change for each variable cannot be interpreted as a true change in patients’ clinical status but rather is due to variability in the assessment tool. To our knowledge, the MDC for Tinetti scale scores and static stabilometry variables has not been established for patients with MS; our results for these variables should therefore be interpreted with caution.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Future studies should use assessment tools whose sensitivity to change has been analysed in patients with MS, in order to be able to determine whether changes are attributable to the intervention or to measurement errors.</p><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Limitations</span><p id="par0160" class="elsevierStylePara elsevierViewall">Despite rigorous data collection and analysis, our study is not without limitations. Despite increasing interest in treatment with commercially available exergames for balance training in patients with MS, few studies have analysed the effects of this type of intervention.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10–14</span></a> In any case, the studies analysed show a low risk of bias for most domains.</p><p id="par0165" class="elsevierStylePara elsevierViewall">This review identifies methodological issues that may be accounted for in future research into the effects of exergame therapy on postural balance in patients with MS.</p></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conclusions</span><p id="par0170" class="elsevierStylePara elsevierViewall">Few data are available on the effectiveness of commercial exergames on postural balance in patients with MS. Future studies should use appropriate assessment tools to analyse the effects of this type of intervention on postural balance in MS before it can be recommended in clinical practice.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conflicts of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1586732" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and method" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1427599" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1586733" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1427598" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Search strategy and databases" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Eligibility criteria" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Study selection and data collection process" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Risk of bias" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Study selection" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Study characteristics and risk of bias" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Patient characteristics" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Characteristics of the intervention" ] 4 => array:2 [ "identificador" => "sec0070" "titulo" => "Patient assessment tools" ] 5 => array:2 [ "identificador" => "sec0075" "titulo" => "Effects of exergaming on postural balance" ] 6 => array:2 [ "identificador" => "sec0080" "titulo" => "Meta-analysis" ] ] ] 7 => array:3 [ "identificador" => "sec0085" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0090" "titulo" => "Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0095" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0100" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-10" "fechaAceptado" => "2017-12-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1427599" "palabras" => array:6 [ 0 => "Demyelinating diseases" 1 => "Postural balance" 2 => "Video games" 3 => "Multiple sclerosis" 4 => "Proprioception" 5 => "Stability" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1427598" "palabras" => array:6 [ 0 => "Enfermedades desmielinizantes" 1 => "Equilibrio postural" 2 => "Videojuegos" 3 => "Esclerosis múltiple" 4 => "Propiocepción" 5 => "Estabilidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Commercial video ga<span class="elsevierStyleItalic"><span class="elsevierStyleInf">me</span></span><span class="elsevierStyleItalic"><span class="elsevierStyleInf"><span class="elsevierStyleBold"><span class="elsevierStyleSup">s are considered an effective tool to improve postural balance in different populations. Howe</span></span></span></span><span class="elsevierStyleItalic"><span class="elsevierStyleInf"><span class="elsevierStyleBold">ver, t</span></span></span><span class="elsevierStyleItalic"><span class="elsevierStyleInf">he effectivenes</span></span><span class="elsevierStyleItalic">s o</span>f these video games for patients with multiple sclerosis (MS) is unclear.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To analyse existing evidence on the effects of commercial video games on postural balance in patients with MS.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material and method</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We conducted a systematic literature search on 11 databases (Academic-Search Complete, AMED, CENTRAL, CINAHL, WoS, IBECS, LILACS, Pubmed/Medline, Scielo, SPORTDiscus, and Science Direct) using the following terms: “multiple sclerosis”, videogames, “video games”, exergam*, “postural balance”, posturography, “postural control”, balance. Risk of bias was analysed by 2 independent reviewers. We conducted 3 fixed effect meta-analyses and calculated the difference of means (DM) and the 95% confidence interval (95% CI) for the Four Step Square Test, Timed 25-Foot Walk, and Berg Balance Scale (BBS).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Five randomised controlled trials were included in the qualitative systematic review and 4 in the meta-analysis. We found no significant differences between the video game therapy group and the control group in Four Step Square Test (DM: −.74; 95% CI, −2.79 to 1.32; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.48; <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%) and Timed 25-Foot Walk scores (DM: .15; 95% CI, −1.06 to .76; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.75; <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%). We did observe intergroup differences in BBS scores in favour of video game therapy (DM: 5.30; 95% CI, 3.39–7.21; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001; <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%), but these were not greater than the minimum detectable change reported in the literature.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The effectiveness of commercial video game therapy for improving postural balance in patients with MS is limited.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and method" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El uso de videojuegos comerciales ha sido considerado una herramienta eficaz para mejorar el equilibrio postural en diferentes poblaciones. Sin embargo, los beneficios reportados en pacientes con esclerosis múltiple (PEM) no están claros.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analizar la evidencia existente sobre los efectos de las terapias con videojuegos comerciales en el equilibrio postural en PEM.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y método</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realizó una búsqueda en las bases de datos Academic-Search-Complete, AMED, CENTRAL, CINAHL, WoS, IBECS, LILACS, Pubmed/Medline, Scielo, SPORTDiscus, ScienceDirect utilizando los términos <span class="elsevierStyleItalic">multiple sclerosis</span>, <span class="elsevierStyleItalic">videogames</span>, <span class="elsevierStyleItalic">video games</span>, <span class="elsevierStyleItalic">exergam</span>*, <span class="elsevierStyleItalic">postural balance</span>, <span class="elsevierStyleItalic">posturography,</span><span class="elsevierStyleItalic">postural control</span>, <span class="elsevierStyleItalic">balance</span>. El riesgo de sesgo fue analizado por 2 revisores independientes. Se realizaron 3 metaanálisis modelos de efectos fijos calculando la diferencia de medias (DM) y el intervalo de confianza (IC) del 95% para las variables <span class="elsevierStyleItalic">Four-Step-Square-Test</span>, <span class="elsevierStyleItalic">Timed-25-Foot-Walk</span> y <span class="elsevierStyleItalic">Berg-Balance-Scale</span>.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cinco ensayos clínicos controlados aleatorizados fueron incluidos en la síntesis cualitativa, mientras que 4 fueron incluidos en el metaanálisis. No se observaron diferencias entre las terapias con videojuegos y los grupos controles para la variable <span class="elsevierStyleItalic">Four-Step-Square-Test</span> (DM: –0,74; IC 95%: –2,79 a 1,32; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,48; I<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%) y <span class="elsevierStyleItalic">Timed-25-Foot-Walk</span> (DM: –0,15; IC 95%: –1,06 a 0,76; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,75; I<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%). Sin embargo, la variable <span class="elsevierStyleItalic">Berg-Balance-Scale</span> mostró diferencias a favor del grupo de videojuegos (DM: 5,30; IC 95%: 3,39 a 7,21; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001; I<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%), aunque estos resultados no fueron superiores al mínimo cambio detectable reportado en la literatura científica.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La eficacia de las terapias con videojuegos comerciales sobre el equilibrio postural en PEM es escasa.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Parra-Moreno M, Rodríguez-Juan JJ, Ruiz-Cárdenas JD. Efectos de la terapia con videojuegos comerciales sobre el equilibrio postural en pacientes con esclerosis múltiple: revisión sistemática y metaanálisis de ensayos clínicos controlados aleatorizados. Neurología. 2019. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.nrl.2017.12.001">https://doi.org/10.1016/j.nrl.2017.12.001</span></p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0190" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0115" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2129 "Ancho" => 1333 "Tamanyo" => 212070 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Flow chart illustrating the article selection process.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 874 "Ancho" => 2226 "Tamanyo" => 181296 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Risk of bias of the studies included.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1861 "Ancho" => 2361 "Tamanyo" => 436071 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Forest plots: differences between patients receiving exergame therapy and controls for the Berg Balance Scale (A), the Four Step Square Test (B), and the Timed 25-Foot Walk (C). 95% CI: 95% confidence interval; df: degrees of freedom; IV: inverse variance; SD: standard deviation.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Data are expressed as means (SD) or number (%).</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ABC: Activities-specific Balance Confidence; BBS: Berg Balance Scale; CoP: centre of pressure; DGI: Dynamic Gait Index; EDSS: Expanded Disability Status Scale; FSST: Four Step Square Test; CG: control group; EG: experimental group; MSIS: Multiple Sclerosis Impact Scale; min: minutes; n.d.: no data; TCS: Timed Chair Stands test; T25-FW: Timed 25-Foot Walk test; TUG: Timed Up and Go test; cogTUG: Cognitive Timed-Up-and-Go dual-task test.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Author (year) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Sample \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Task \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Results \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intensity \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nilsagård et al.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> (2013)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>42 (10 men, 32 women)50 (11.5) years oldMSIS: 72 (19.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nintendo Wii® – Wii Fit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increasing game difficulty level \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 sessions/week (30<span class="elsevierStyleHsp" style=""></span>min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6–7 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG: improvements of 0.8<span class="elsevierStyleHsp" style=""></span>s (6%) in TUG, 1.9<span class="elsevierStyleHsp" style=""></span>s (12%) in cogTUG, 1.6<span class="elsevierStyleHsp" style=""></span>s (9%) in FSST, 3.2<span class="elsevierStyleHsp" style=""></span>s (9%) in TCS, 5.0 points (7.6%) in ABC, and 1.8 points (10%) in DGI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CG: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>42 (10 men, 32 women)49 (11.1) years oldMSIS: 74 (21.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No intervention</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CG: improvements of 0.8<span class="elsevierStyleHsp" style=""></span>s (6%) in cogTUG and 2<span class="elsevierStyleHsp" style=""></span>s (11.3%) in FSSTEG vs CG: no difference in any variable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Brichetto et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> (2013)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18 (8 men, 10 women)41 (11.5) years oldEDSS: ≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nintendo Wii® – Wii Fit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n.d. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 sessions/week (60<span class="elsevierStyleHsp" style=""></span>min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG: improvements of 5 points (10%) in BBS, 36.3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> (38%) in open-eye stabilometry, and 117<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> (42.7%) in closed-eye stabilometry \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CG: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18 (6 men, 12 women)43 (10.6) years oldEDSS: ≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Single- and double-leg stance exercises with balance board \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n.d. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 sessions/week (60<span class="elsevierStyleHsp" style=""></span>min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CG: improvements of 1 point (2%) in BBS and 1.2<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> (1.1%) in open-eye stabilometry; worsening of 2.9<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> (4.4%) in closed-eye stabilometryEG vs CG: improvements of 5 points (9.8%) in BBS, 46.3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> (44%) in open-eye stabilometry, and 97<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> (38%) in closed-eye stabilometry \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gutiérrez et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> (2013)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>24 (11 men, 13 women)40 (8.1) years oldEDSS: 3.7 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Xbox 360® – Kinect Sports, Joy Ride, Adventures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increasing game difficulty level \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 sessions/week (20<span class="elsevierStyleHsp" style=""></span>min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG: improvements of 5.8 points (6.9%) in BBS and 7.9 points (10.9%) in Tinetti test \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CG: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>23 (9 men, 14 women)43 (7.4) years oldEDSS: 3.9 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strength, proprioception, gait, and stretch exercises \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low load \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 sessions/week (40<span class="elsevierStyleHsp" style=""></span>min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CG: improvements of 1 point (1.4%) in BBS and 1.9 points (2.7%) in Tinetti testEG vs CG: improvements of 7.6 points (9.2%) in BBS and 7.5 points (10%) in Tinetti test \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prosperini et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> (2013)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18 (5 men, 13 women)35 (8.6) years oldEDSS: ≤5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nintendo Wii® – Wii Fit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increasing game difficulty level \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 sessions/week (30<span class="elsevierStyleHsp" style=""></span>min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG: no difference vs baseline results in any of the variables analysed \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CG: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18 (6 men, 12 women)37 (8.8) years oldEDSS: ≤5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No intervention</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CG: no difference vs baseline results in any of the variables analysedEG vs CG: improvements of 88<span class="elsevierStyleHsp" style=""></span>mm (15%) in CoP displacement, 2.8<span class="elsevierStyleHsp" style=""></span>s (16%) in FSST, and 0.9<span class="elsevierStyleHsp" style=""></span>s (10%) in T25-FW \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Robinson et al.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> (2015)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20 (6 men, 14 women)52.6 (6.1) years oldEDSS: 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nintendo Wii® – Wii Fit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increasing game difficulty level \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 sessions/week (40–60<span class="elsevierStyleHsp" style=""></span>min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG vs CG2: improvements of 13<span class="elsevierStyleHsp" style=""></span>mm in CoP displacement range on the anteroposterior axis, 12<span class="elsevierStyleHsp" style=""></span>mm in CoP displacement range on the mediolateral axis, and 1<span class="elsevierStyleHsp" style=""></span>m/s in CoP velocity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CG1: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19 (7 men, 12 women)53.9 (6.5) years oldEDSS: 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Traditional balance training \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n.d. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 sessions/week (40–60<span class="elsevierStyleHsp" style=""></span>min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG vs CG1: no difference in any variable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CG2: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>17 (5 men, 12 women)51.9 (4.7) years oldEDSS: ≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No intervention</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EG vs CG2: improvements of 14<span class="elsevierStyleHsp" style=""></span>mm in CoP displacement range on the anteroposterior axis, 18<span class="elsevierStyleHsp" style=""></span>mm in CoP displacement range on the mediolateral axis, and 1<span class="elsevierStyleHsp" style=""></span>m/s in CoP velocity \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2717903.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the studies included.</p>" ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 36082 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0090" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P.N. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 26 | 8 | 34 |
| 2024 September | 64 | 24 | 88 |
| 2024 August | 40 | 5 | 45 |
| 2024 July | 26 | 11 | 37 |
| 2024 June | 28 | 6 | 34 |
| 2024 May | 37 | 7 | 44 |
| 2024 April | 38 | 18 | 56 |
| 2024 March | 30 | 10 | 40 |
| 2024 February | 37 | 4 | 41 |
| 2024 January | 21 | 14 | 35 |
| 2023 December | 30 | 10 | 40 |
| 2023 November | 29 | 7 | 36 |
| 2023 October | 26 | 13 | 39 |
| 2023 September | 21 | 3 | 24 |
| 2023 August | 10 | 5 | 15 |
| 2023 July | 28 | 9 | 37 |
| 2023 June | 42 | 20 | 62 |
| 2023 May | 53 | 6 | 59 |
| 2023 April | 33 | 10 | 43 |
| 2023 March | 20 | 16 | 36 |
| 2023 February | 11 | 9 | 20 |
| 2023 January | 22 | 23 | 45 |
| 2022 December | 14 | 6 | 20 |
| 2022 November | 40 | 15 | 55 |
| 2022 October | 19 | 12 | 31 |
| 2022 September | 25 | 8 | 33 |
| 2022 August | 26 | 16 | 42 |
| 2022 July | 15 | 5 | 20 |
| 2022 June | 15 | 7 | 22 |
| 2022 May | 58 | 10 | 68 |
| 2022 April | 30 | 7 | 37 |
| 2022 March | 38 | 17 | 55 |
| 2022 February | 26 | 7 | 33 |
| 2022 January | 24 | 8 | 32 |
| 2021 December | 22 | 14 | 36 |
| 2021 November | 19 | 23 | 42 |
| 2021 October | 24 | 21 | 45 |
| 2021 September | 8 | 9 | 17 |
| 2021 August | 6 | 15 | 21 |
| 2021 July | 7 | 15 | 22 |
| 2021 June | 10 | 10 | 20 |
| 2021 May | 16 | 8 | 24 |
| 2021 April | 17 | 30 | 47 |
| 2021 March | 10 | 6 | 16 |
| 2021 February | 11 | 6 | 17 |
| 2021 January | 8 | 9 | 17 |
| 2020 December | 10 | 7 | 17 |
| 2020 November | 10 | 9 | 19 |
| 2020 October | 8 | 9 | 17 |
| 2020 September | 8 | 11 | 19 |
| 2020 August | 6 | 10 | 16 |
| 2020 July | 11 | 11 | 22 |
| 2020 June | 6 | 6 | 12 |
| 2020 May | 6 | 12 | 18 |
| 2020 April | 7 | 6 | 13 |
| 2020 March | 4 | 7 | 11 |
| 2020 February | 9 | 7 | 16 |
| 2020 January | 6 | 9 | 15 |
| 2019 December | 9 | 7 | 16 |
| 2019 November | 5 | 5 | 10 |
| 2019 October | 6 | 13 | 19 |
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