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While there has been wide uptake of the Nintendo Wii Fit as a therapy tool in hospital and aged care settings there is a lack of evidence regarding the effectiveness and safety of this approach when used with older people. This pilot study compared the effect of a physiotherapist providing activities from the Wii Fit with conventional therapy on mobility, activities of daily living and safety. The study used a randomized controlled design with masked outcome assessment. A total of 44 participants were recruited from a Geriatric Evaluation and Management (GEM) Unit and randomized to either therapy using the Wii Fit (n=22) or conventional physiotherapy (n=22). Therapy sessions were 25 minutes per workday for the duration of the participant's stay on the unit. Assessment measures were taken at baseline, post intervention (on discharge from the unit) and one month after discharge. The primary outcome used was the Timed Up and Go Test and additional measures included balance and activities of daily living function. Adverse events were recorded. Preliminary analyses of results showed that both groups improved however there was a small significant difference between groups on balance and the Timed Up and Go Test with the Wii Fit appearing to be a more effective approach to balance and mobility training in hospitalized older people.