The effect of gamification-based exercises on foot posture in children and adolescents with flatfoot: A systematic review and meta-analysis.

BackgroundGamification has emerged as a novel approach in rehabilitation. This systematic review and meta-analysis aimed to evaluate the effectiveness of gamification-based exercises on foot posture in children and adolescents with flatfoot.MethodsA systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, utilizing the PubMed, Scopus, Web of Science, and Google Scholar databases to search for original and peer-reviewed articles with selected keywords from inception to July 2025. The quality of the included studies was assessed using the Joanna Briggs Institute checklist. Statistical analysis was conducted with Comprehensive Meta-Analysis software version 3. To evaluate data heterogeneity, the Q-test and I2 statistic were applied. Egger's test was used to assess publication bias.ResultsAfter searching the mentioned databases, 2160 articles were found. Finally, seven articles were included in the current review. It was shown that gamification-based exercise had a significant effect, leading to a reduction in navicular drop (95% CI = -1.796 to -0.516, p = 0.000) and an increase in balance scores (95% CI = -1.647 to -0.462, p = 0.000), compared to the passive control groups that did not receive any intervention. However, no significant differences were seen in the Staheli index (95% CI = -3.298 to 0.023, p = 0.053). High heterogeneity was noted in the navicular drop test (95% CI = -2.412 to -0.603, p = 0.001). Egger's test indicated no statistically significant publication bias for either navicular drop (p = 0.080) or Staheli index (p = 0.210).ConclusionThe results showed that exercise with gamification may be effective in improving foot alignment in children and adolescents. Specifically, positive effects were evident when using the navicular drop test, whereas no significant changes were detected with the Staheli index. However, interpretation should be made cautiously due to the limited number of studies and lack of age or gender stratification.