Computer-Aided Physical Rehabilitation of Older People: A Pilot Non-Inferiority Randomized Clinical Trial

Abstract

Background: Developed countries are facing the challenge of aging societies, a high risk of dependence and high cost of care. Researchers attempted to address these issues by using cost-efficient, innovative technology to promote healthy aging and to regain functionality. After an injury, efficient rehabilitation is crucial to promote returning home and to prevent institutionalization. However, there is often a lack of motivation to carry out physical therapies. Consequently, there is a growing interest in testing new approaches like computer-aided rehabilitation to achieve functional targets and prevent re-hospitalization. Trial design: Pilot multicenter non-inferiority randomized clinical trial. Objectives: To assess the efficacy of a personal mobility device compared with standard of care in the rehabilitation treatment of patient with musculoskeletal issues. Methods: 57 patients aged 67-95 years were randomly assigned to the intervention group (n=35) using the gamified rehabilitation equipment 3 times a week or to a control group (n=22) receiving usual standard care. Outcome measures included SPPB (Short Physical Performance Battery), IHGS (Isometric Hand Grip Strength), FIM (Functional Independence Measure) and number of steps. Results: There were no significant differences between the control and the intervention groups for the primary outcome (SPPB) or any of the secondary outcomes (IHGS, FIM and steps), which demonstrates the non-inferiority effect of the serious game-based intervention. The analysis by mixed-effects regression on SPPB showed no indication of a group x time interaction (SPPB_I_t1=-0.76, p=0.26; SPPB_I_t2=0.21, p=0.74). Although not significant, a positive IHGS improvement of more than 2kg (Right: 2.52kg; Left: 2.43kg) for the patient from the intervention group was observed. In addition, patients who received the intervention exhibited stronger engagement in the rehabilitation process and a higher motivation to being more active. Conclusions: Serious game-based rehabilitation could be an effective alternative for older patients to regain their functional capacities.