Acceptability and outcomes of an individualized exergaming telePT program for veterans with multiple sclerosis: a pilot study

Abstract

Background Physical rehabilitation services are an important component of treatment for persons with multiple sclerosis (PwMS) to improve and maintain physical mobility. However, PwMS often have significant barriers to outpatient physical therapy (PT) services including mobility deficits and lack of transportation. The integration of exercise gaming (exergaming) and telehealth into clinical PT practices may overcome these barriers. The overarching purpose of this pilot study was to evaluate the acceptability and effects of an individualized telePT intervention using exergaming. Methods Ten individuals with multiple sclerosis (MS) completed a 12-week exergaming (Jintronix®) telerehabilitation intervention. In order to measure the acceptability of the telerehabilitation intervention, adherence was measured through the tablet-based rehabilitation software and each participant completed a satisfaction questionnaire. Clinical outcome measures were assessed at baseline and post-intervention. To evaluate the efficacy of this intervention, the following measures of physical function and fatigue were included; the Short Physical Performance Battery (SPPB), 25-Foot Walk (25FW), Modified Fatigue Impact Scale (MFIS), Multiple Sclerosis Walking Scale-12 (MSWS), and the 2-Minute Walk Test (2MWT). Clinical outcomes were analyzed using the Sign test and Wilcoxon signed rank test. All other data were evaluated using descriptive statistics. Results After the intervention, participants demonstrated significant improvements in ambulation speed during the 25FW (p = 0.04) and ambulation distance during the 2MWT (p = 0.002). Statistically significant increases of SPPB total score (p = .04) and sub-scores were also found. Participants did not demonstrate significant changes in the MFIS (p = 0.31) or MSWS-12 (p = 0.06) after the intervention. Participants had a 58.3% adherence rate during the intervention and performed their exercise program an average of 2.5 times per week. All participants reported that they were either ‘satisfied or ‘very satisfied’ with their telerehabilitation experience, would use telerehabilitation again, and would recommend telerehabilitation to others. Conclusion This individualized telerehabilitation intervention which integrates exergaming and clinical video teleconferencing is acceptable to patients and may offer a viable alternative to traditional PT for PwMS. Trial registration NCT03655431, retrospectively registered on August 31st, 2018.

Feasibility and safety of an immersive virtual reality-based vestibular rehabilitation programme in people with multiple sclerosis experiencing vestibular impairment: a protocol for a pilot randomised controlled trial

“…123 A recent study with 10 participants with MS showed satisfactory results in balance and gait, but not for fatigue, after a telerehabilitation intervention based on Nintendo Wii exergames. 124 With regard to our protocol, because Oculus Quest is wireless and portable, exercises can be performed at the laboratory, in public, in private clinics and at home. In addition, this HMD has two features to ensure safety.…”

Is telehealth an effective and feasible option for improving falls-related outcomes in community-dwelling adults with neurological conditions? A systematic review and meta-analysis

“…Six studies were randomised controlled trials, 50,51,56,60,63,67 four were two-group prospective non-randomised controlled trials, 55,57,61,66 and seven were single-group pre-post designs. 45,52,58,59,62,64,65 Stroke was the focus in nine studies, 45,50,56,57,59,61,62,64,67 multiple sclerosis in four 55,58,60,63 and Parkinson's disease in three. 51,52,66 One study included a mix of conditions (i.e., multiple sclerosis, Parkinson's disease and supranuclear palsy).…”

“…Whilst several studies conducted an initial assessment and/or training in-person, 50,52,58,59,62,63 all utilised synchronous videoconferencing to deliver interventions with clinicians based remotely. Four studies were not based in participants’ homes, instead using telehealth at community centres, 61,64,66 or a simulated home environment situated in a hospital outpatient room.…”

“…Four studies were not based in participants’ homes, instead using telehealth at community centres, 61,64,66 or a simulated home environment situated in a hospital outpatient room. 57 Additional technology included gaming systems, 51,55,57,58 wearable devices, 51,55,58 and ‘store and forward’ applications whereby participant exercise performance data were collected for clinician review. 50,56,58,59 Fourteen (82%) of the interventions predominantly involved clinician-supervised exercises.…”

Telemedicine in neurology: advances and possibilities

“…There is evidence showing benefits of telerehabilitation specially in patients after stroke [34][35][36] , but also in other neurological conditions, such as Parkinson disease 37 , vestibular disorders 38 and multiple sclerosis 39 . Telerehabilitation is characterized not only by video contact between patient and physical therapist, but can include virtual reality and applications for self-managed exercises 36,38 , without therapist guidance.…”