Clinician Article

Play-based interventions improve physical function for people with adult-acquired brain injury: a systematic review and meta-analysis of randomised controlled trials.

  • Saywell N
  • Taylor N
  • Rodgers E
  • Skinner L
  • Boocock M
Clin Rehabil. 2017 Feb;31(2):145-157. doi: 10.1177/0269215516631384. Epub 2016 Jul 10. (Review)
PMID: 26869595
Read abstract Read evidence summary
  • Physical Medicine and Rehabilitation
    Relevance - 6/7
    Newsworthiness - 6/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 5/7
  • Neurology
    Relevance - 5/7
    Newsworthiness - 5/7


OBJECTIVE: To undertake a systematic review and meta-analysis of the effectiveness of play-based interventions compared to traditional therapy in rehabilitation of adults with adult-acquired brain injury.

DATA SOURCES: The search was performed using Medline; Cinahl Plus; Health Source (Nursing/Academic Edition); Psychology and behavioural sciences collection; Biomedical reference collection (basic).

REVIEW METHODS: Studies included were randomised controlled trials that investigated the effect of play-based interventions on physical function of adults with adult acquired brain injury. Two independent reviewers identified eligible studies and assessed methodological quality using a modified Downs and Black. Meta-analysis compared standardised differences in means, to determine effect sizes for grouped functional outcome measures. The GRADE scoring system was used to determine the level of clinical evidence.

RESULTS: Thirty studies met the inclusion criteria, 13 were considered high quality and 17 moderate quality. Studies predominantly involved post-stroke participants, with only three studies including participants with traumatic brain injury. When compared to traditional therapy, dose-matched studies of play-based interventions showed a significant effect on independence (Effect size (ES) = 0.6) and physical performance (ES = 0.43), as measured using the Fugl -Meyer. For non-dose matched studies, play-based interventions showed a significant improvement for balance (ES = 0.76) compared with traditional therapy. In all studies that measured participant enjoyment, play-based therapy was rated as more enjoyable than traditional therapy.

CONCLUSION: Play-based interventions for people with adult acquired brain injury are more effective in improving balance and independence, which may be due to them being more enjoyable than traditional therapy.

Clinical Comments

General Internal Medicine-Primary Care(US)

This is a well done meta-analysis of play interventions mostly performed in a post-stroke population. Although all included studies were randomized controlled trials, almost all were limited by a sample size of less than 20 participants in each group. As a result, a consistent effect was not noted across out once measures. Play interventions were modestly more effective than standard care for improving balance and independence, but they were no different for upper limb measures or lower limb gait measures. Overall, as most would predict, play based interventions seem to be more enjoyable, but evidence is limited on objective outcomes.

General Internal Medicine-Primary Care(US)

As a geriatrician, I see this in practice. Making rehab and therapy play-based allows for more familiar activities averting the focus from acquired deficits. Fun may avoid boredom and keep one's interest.


Definitely, adult-acquired brain injury is one of the most important issues in the field of rehabilitation. We always see these kinds of small sized reports in the field of rehabilitation. It might be unavoidable problem. However, those efforts could show us some important viewpoints and make our clinical practice rich and more flexible. The weak point might be the different consequences between the dose-matched study and non-dose matched one in some domains.

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