games for health 2011 - may 18
DESCRIPTION
The Utilization of Nintendo Wii Fit in the Rehabilitation of Outpatients Following Total Knee Replacement: A Randomized Controlled Trial-presented at Games for Health 2011TRANSCRIPT
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The Utilization of Nintendo Wii The Utilization of Nintendo Wii FitFitTMTM in the Rehabilitation of in the Rehabilitation of Outpatients Following Total Outpatients Following Total
Knee Replacements:Knee Replacements:A Randomized Controlled TrialA Randomized Controlled Trial
Vera Fung, Aileen Ho, Jennifer Shaffer,
Esther Chung, Manuel Gomez
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St. John’s Rehab St. John’s Rehab HospitalHospital
• Patient populations– Burn–Orthopedic– Neurological– Trauma– Amputation–Oncology– Cardiac–Organ Transplant
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Research StudyResearch Study
• Title: The Utilization of Nintendo Wii FitTM in the Rehabilitation of Outpatients Following Total Knee Replacement
• Design: Randomized controlled trial
• Population: Outpatients following TKR
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Rationale for StudyRationale for Study
• Trends in physical rehabilitation favor the use of video games as therapeutic modalities
• Supporting literature was not strong
• WiiTM was already in use within hospital
• OT & PT support WiiTM as therapy adjunct
• Innovative and fun treatment option
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Research QuestionResearch Question
Is there a difference in rehabilitation outcomes of total knee replacement
outpatients using Wii FitTM as a therapy adjunct versus those who do not?
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Research ObjectiveResearch Objective
To determine whether Nintendo Wii FitTM is an acceptable adjunct to
outpatient rehabilitation following total knee
replacement6
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Sample PopulationSample Population
Included• Medically cleared for
outpatient therapy
• Weight bearing as tolerated
• Able to stand and weight shift with supervision
• 2 therapy sessions/week
• 60 minute sessions
Excluded• Painful osteoarthritis
of the contralateral knee
• Unable to understand or follow instruction
• Condition aggravated by repetitive activity
• Seizure disorder
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RandomizationRandomization
• Study Group– Standard PT session +15 minutes of Nintendo Wii FitTM activity
• Control Group– Standard PT session +15 minutes of additional PT exercise
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Outcome MeasuresOutcome Measures
• Knee range of motion• 2 Minute Walk Test• Standing balance• Pain• Lower Extremity Functional Scale (LEFS)• Activities-specific Balance Confidence
scale (ABC)• Patient satisfaction• Demographics• Length of stay• Gait aids
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Wii FitWii FitTMTM Intervention Intervention
Deep Breathing• Visual feedback regarding stability
and weight distribution
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Wii FitWii FitTMTM Intervention Intervention
Ski Slalom & Penguin Slide• Encourages lateral weight shifting
grading and control
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Wii FitWii FitTMTM Intervention Intervention
Table Tilt & Balance Bubble• Encourages multi-directional weight
shifting control
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Wii FitWii FitTMTM Intervention Intervention
Tightrope Walk• Encourages lateral weight shifting
control and unilateral stance
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Wii FitWii FitTMTM Intervention Intervention
Half Moon & Torso Twist• Challenges postural control while
engaging in dynamic movement
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Wii FitTM Intervention
Body Test• Provides user with measurable evidence
of imbalances in weight distribution
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Data Collection & Data Collection & AnalysisAnalysis
• Participants assessed–On admission– Every 2 weeks until discharge
• Assessor blinded to participant allocation
• Assessment in lieu of intervention
• Comparing change from assessment to discharge between groups– Chi-square and t-test analyses– P values <0.05 were considered
significant
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ResultsResults
•n = 50
•Recruitment rate = 58.1%
•Mean Age: 68.0 ± 11.1 years
•Females: 33 (66%) Males: 17 (34%)
•Control: 23 (46%) Study: 27 (54%)
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ResultsResults
Outcome Study (% ∆)
Control (% ∆)
P value
Passive Knee Flexion 16.03 15.37 0.899
Passive Knee Extension
0.61 1.39 0.326
2 Minute Walk Test 4.43 4.16 0.855
Standing Balance 8.35 0.35 0.347
Pain 3.25 1.56 0.220
LEFS 7.34 4.15 0.079
ABC 4.82 3.41 0.523
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Results
• Cohen’s d calculated to determine effect size
• Cohen’s d = 58: Moderate effect size
• Potential for larger effect size with larger sample
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DiscussionDiscussion
• No clinically significant difference between control and study group in:–Demographics–Outcomes
• Qualitative component might reveal difference, if exists
• Patient satisfaction questionnaire may have been completed with differing perspectives
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ConclusionConclusion
• The Wii FitTM is an acceptable adjunct to PT intervention for Outpatient TKR population
• Comparable outcomes between control and study groups
• Moderate effect size of Wii FitTM on LEFS results
• Can be an innovative treatment option to:
–Address balance–Standing tolerance
–Postural control–Lower extremity function
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Wii FitWii FitTMTM Applications in Applications in RehabRehab
• Exercise standing tolerance
• Weight distribution measurement
• Weight distribution & postural control feedback
• Lower extremity coordination training
• Core strengthening
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Patient PopulationsPatient Populations
•Total hip or knee replacement
•Lower extremity trauma•Amputation •Burns•Stroke•Post-op deconditioning
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Areas for Future Areas for Future ResearchResearch
• RCTs with other patient populations
• Other motion detection video game systems
• Investigating Wii FitTM on LEFS with a larger sample
• Qualitative studies to capture experience
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