Effectiveness of various dosage parameters of Wii Fit Plus exergames for enhancing balance and postural control among people post-stroke: a systematic review protocol

OBJECTIVE: The objective of this review is to synthesize the evidence on the effectiveness of various dosage parameters (session duration, frequency, and total intervention period), including their potential dose-response impact (if meta-analysis is feasible), on postural control and balance using Wii Fit Plus balance exergaming in patients post-stroke. INTRODUCTION: Wii Fit Plus is an innovative exergaming tool that consists of interactive standing balance exercises to improve balance and postural control in patients with stroke. However, the optimal treatment effects and dosage response for achieving these outcomes remain unclear. ELIGIBILITY CRITERIA: This review will consider randomized controlled trials, quasi-experimental studies, and other types of experimental studies evaluating preliminary efficacy or effectiveness of Wii Fit Plus balance exergames for adults and older adults post-stroke. The comparators will include standard-care physiotherapy and alternative exergaming interventions. The outcomes of interest will be postural control and balance, quality of life, functional independence, gait performance, and functional mobility. METHODS: A systematic search will be conducted across PubMed, Embase, Scopus, PEDro, Web of Science, and CINAHL (EBSCOhost) for studies published from 2010 onward. The review will follow the JBI methodology for systematic reviews of effectiveness. Study selection, data extraction, and critical appraisal will be independently performed by 2 reviewers. Dose-response meta-analysis using a random effects model will be used to estimate pooled effect size, with subgroup analyses exploring dosing variations. If meta-analysis is not feasible, a narrative synthesis will be conducted. The overall strength of the evidence will be determined using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. REVIEW REGISTRATION: PROSPERO CRD42025641558.