Games For Health 2011 - May 18

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The Utilization of Nintendo Wii Fit in the Rehabilitation of Outpatients Following Total Knee Replacement: A Randomized Controlled Trial
-presented at Games for Health 2011

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Games For Health 2011 - May 18

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

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