The review concluded that there was a potential promise for video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. Due to a lack of good quality studies and the significant variation across trials, this conclusion should be considered tentative.

To determine the effectiveness of video games in improving health-related outcomes.

Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to February 2010. Search terms were reported. Relevant reference lists were screened for additional studies.

Randomised controlled trials (RCTs) that compared video games as an intervention with control groups (no video games or different video game) in participants of any age, gender, race or ethnicity were eligible for inclusion. Only RCTs that tested the effect of video games on health-promoting clinically relevant health outcomes were considered. The term "video game" had to meet criteria described by the American Heritage Dictionary; the game had to have a system of reward and/or objective, be interactive and competitive and be designed for recreational use. Studies that involved video game interventions of any dose, intensity and/or length were included. Studies were excluded if they assessed outcomes only at follow-up and not at baseline. Studies that tested the effect of a video game on improving hand-eye coordination in healthy participants were excluded.

The mean age of participants ranged from six years to 78 years. Mean duration of interventions was nine weeks and ranged from one-time intervention to 52 weeks. For interventions that were delivered more than once, the frequency of delivery ranged from once weekly to seven days per week.

The commonly addressed health topics in the included trials were asthma, age-related morbidity, physical activity, stroke and cancer. Other less commonly addressed health topics were dyslexia, cerebral palsy, type I diabetes, burns and self-esteem. In over half of the included studies the video games were developed for specific therapeutic purposes; the other studies used games already commercially available for entertainment.

Two reviewers independently performed study selection and any disagreements were resolved by consensus.

Study quality was assessed with criteria that included randomisation, allocation concealment, blinding, drop-out rate and intention-to-treat analysis.

Two reviewers were involved in the quality assessment.

The authors classed each outcome as positive or negative based on whether or not there was a statistically significant between-group difference for that outcome in favour of the video game intervention. This was based on the significance threshold of individual studies.

Two reviewers independently extracted the data.

One outcome from each study was classed as the primary outcome. When the primary outcome was not stated clearly, the most frequently mentioned outcome or the first outcome within a composite score or the first outcome described in the results section was used. The remaining outcomes were classified as secondary outcomes. An outcome was considered positive if the video game intervention was superior to the control group; otherwise the outcome was classified as negative. Superiority was based on the statistical significance threshold of the individual studies. Studies were grouped based on the main purpose of the intervention: physical therapy, psychological therapy, disease self-management, distraction from discomfort, physical activity and skills training for clinicians. Studies were divided by group (≤19 years, 20 to 49 years and 50 to 80 years). A funnel plot consisting of the primary outcomes was inspected to assess publication bias.

Thirty-eight studies were included in the review (2,662 participants, range 10 to 371). Study quality was generally poor: five studies reported blinding, eight studies explicitly described the method of randomisation, four studies reported allocation concealment and four studies reported intention-to-treat analyses. Funnel plot suggested no publication bias.

The video game intervention was superior to control for 69% of outcomes in psychological therapy trials, 59% of outcomes in physical therapy trials, 50% of outcomes in physical activity trials, 46% of outcomes in clinician skills trials, 42% of outcomes in health education trials, 42% of outcomes in pain distraction trials and for 37% of outcomes in disease self-management trials.

There was potential promise for video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy.

The review addressed a clear question and was supported by broad inclusion criteria. Although several sources were searched, attempts to identify unpublished studies were limited so relevant studies may have been missed. Appropriate methods were used to reduce reviewer error and bias in the review processes. Included studies were quality assessed. No publication bias was found.

The approach to the narrative synthesis had some limitations. Simply counting the number of statistically significant results for each category of intervention meant that factors such as effect size and studies being too small to be able to detect a statistically significant effect were not taken into consideration. The included studies were very diverse and there was limited exploration of diversity within each of the six intervention groups.

The authors' conclusions should be considered as tentative especially regarding physical and psychologically focused interventions showing particular promise. Several factors may have led to these studies having a higher proportion of positive outcomes and adverse consequences were not investigated. There was substantial variability across the trials and a lack of good quality studies.

Practice: The authors did not state any implications for practice.

Research: The authors stated that further studies should consider using randomised controlled trials and have longer follow-up, improve the measures of quality (such as randomisation and blinding), use standardised measurement tools and give careful attention to the quality of outcome measures.

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.