Frontiers in Physiology · Oct 31, 2026
The effects of gamification interventions on non-surgical knee osteoarthritis: a systematic review and meta-analysis
By Wei Luo, Xin Chu, Xueyang Yi et al.
Background: Knee osteoarthritis (KOA) is a leading cause of disability in older adults, representing a significant and growing health burden in this population. While long-term exercise therapy can delay disease progression, conventional exercise programs are frequently hampered by poor patient adherence, often attributable to a lack of engagement and interactivity. Gamified interventions, which enhance motivation and participation, have emerged as a promising alternative for KOA rehabilitation; however, conclusive evidence re-garding their efficacy is still lacking. Methods: A comprehensive literature search was conducted in Embase, Web of Science, PubMed, CINAHL, Cochrane Library, CNKI, Wanfang, and VIP databases for randomized controlled trials (RCTs) from inception to October 19, 2026. Meta-analysis was performed using Stata 18.0 (and risk of bias plots were generated using Robvis). The protocol has been registered with PROSPERO (CRD420251078746). Results: Eleven RCTs involving 709 patients with non-surgical KOA were included. Gamified interventions significantly reduced pain intensity (SMD = -0.75, 95% CI: -1.21 to -0.28) and improved joint function (SMD = -1.13, 95% CI: -2.11 to -0.15). However, the effects on physical performance (TUG), balance (BBS), and quality of life (QoL) were highly heterogeneous and fragile, with TUG and QoL losing statistical significance in sensitivity analyses, and BBS showing no significant difference in the primary analysis. Conclusion: Gamified interventions show promising effects in alleviating pain. However, the effects on joint function, physical performance, balance, and quality of life remain uncertain due to high heterogeneity and statistical fragility.