Wii Fit-Based Exergaming Plus Conventional Physiotherapy in Older Adults With Parkinson Disease: Randomized Controlled Trial (Preprint)

BACKGROUND Exercise-based rehabilitation is central to Parkinson disease care. Exergaming may increase practice intensity and engagement, but evidence remains limited for patient-reported health status and nonmotor outcomes in older adults receiving supervised rehabilitation. OBJECTIVE This study aimed to evaluate whether Wii Fit-based exergaming added to conventional physiotherapy improved patient-reported health status at 2-month follow-up compared with conventional physiotherapy alone and to examine mobility, daily motor experiences, falls-related self-efficacy, fatigue, and depressive symptoms. METHODS In this single-center, assessor-blinded, parallel-group randomized controlled trial at a geriatric outpatient clinic in Egypt, 64 adults aged 60-85 years with mild-to-moderate idiopathic Parkinson disease were randomized 1:1 to Wii Fit-based exergaming plus conventional physiotherapy or conventional physiotherapy alone. Both groups received 14 individual 60-minute sessions over 7 weeks during medication ON periods. The primary outcome was the 39-item Parkinson Disease Questionnaire summary index (PDQ-39 SI) at 2-month follow-up. Secondary outcomes were the Timed Up and Go test, Movement Disorder Society-Unified Parkinson Disease Rating Scale Part II, reverse-scored modified Falls Efficacy Scale-International, Parkinson Fatigue Scale-16, and Geriatric Depression Scale-15. Baseline-adjusted linear mixed-effects models estimated between-group mean differences. RESULTS All 64 randomized participants completed post-intervention and 2-month follow-up assessments. Baseline PDQ-39 SI was similar between groups, but mobility, falls-related self-efficacy, and fatigue imbalances favored the control group. At 2-month follow-up, baseline-adjusted PDQ-39 SI favored the intervention group over control (mean difference -3.29, 95% CI -3.55 to -3.04; P<.001). Baseline-adjusted differences also favored the intervention group for the Timed Up and Go test (-2.15 seconds, 95% CI -2.59 to -1.70; P<.001), Movement Disorder Society-Unified Parkinson Disease Rating Scale Part II (-3.38, 95% CI -3.99 to -2.77; P<.001), reverse-scored falls-related self-efficacy (2.99, 95% CI 1.94 to 4.04; P<.001), Parkinson Fatigue Scale-16 (-0.73, 95% CI -0.98 to -0.48; P<.001), and Geriatric Depression Scale-15 (-0.93, 95% CI -1.24 to -0.62; P<.001). No serious adverse events were reported, although non-serious transient symptoms were not prospectively classified. CONCLUSIONS Supervised Wii Fit-based exergaming added to conventional physiotherapy was associated with better short-term patient-reported health status and supportive functional and nonmotor outcomes than conventional physiotherapy alone in this sample of older adults with mild-to-moderate Parkinson disease. Findings should be interpreted in light of the single-center design, short follow-up, baseline imbalances, incomplete non-serious adverse event reporting, and limited screening-log information. Larger multicenter trials are needed before routine implementation in nurse-supported outpatient or home-based care. CLINICALTRIAL Pan African Clinical Trials Registry PACTR202601919185385