Development and Assessment of a Physiotherapy System Based on Serious Games

JMIR Rehabil Assist Technol

et al. 2021

Background Health-enabling technologies (HETs) are information and communication technologies that promote individual health and well-being. An important application of HETs is telerehabilitation for patients with musculoskeletal shoulder disorders. Currently, there is no overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. Objective This scoping review provides a broad overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. It focuses on concepts and components of HETs, exercise program strategies, development phases, and reported outcomes. Methods The search strategy used Medical Subject Headings and text words related to the terms upper extremity, exercises, and information and communication technologies. The MEDLINE, Embase, IEEE Xplore, CINAHL, PEDro, and Scopus databases were searched. Two reviewers independently screened titles and abstracts and then full texts against predefined inclusion and exclusion criteria. A systematic narrative synthesis was performed. Overall, 8988 records published between 1997 and 2019 were screened. Finally, 70 articles introducing 56 HETs were included. Results Identified HETs range from simple videoconferencing systems to mobile apps with video instructions to complex sensor-based technologies. Various software, sensor hardware, and hardware for output are in use. The most common hardware for output are PC displays (in 34 HETs). Microsoft Kinect cameras in connection with related software are frequently used as sensor hardware (in 27 HETs). The identified HETs provide direct or indirect instruction, monitoring, correction, assessment, information, or a reminder to exercise. Common parameters for exercise instructions are a patient’s range of motion (in 43 HETs), starting and final position (in 32 HETs), and exercise intensity (in 20 HETs). In total, 48 HETs provide visual instructions for the exercises; 29 HETs report on telerehabilitation aspects; 34 HETs only report on prototypes; and 15 HETs are evaluated for technical feasibility, acceptance, or usability, using different assessment instruments. Efficacy or effectiveness is demonstrated for only 8 HETs. In total, 18 articles report on patients’ evaluations. An interdisciplinary contribution to the development of technologies is found in 17 HETs. Conclusions There are various HETs, ranging from simple videoconferencing systems to complex sensor-based technologies for telerehabilitation, that assist patients with musculoskeletal shoulder disorders when exercising at home. Most HETs are not ready for practical use. Comparability is complicated by varying prototype status, different measurement instruments, missing telerehabilitation aspects, and few efficacy studies. Consequently, choosing an HET for daily use is difficult for health care professionals and decision makers. Prototype testing, usability, and acceptance tests with the later target group under real-life conditions as well as efficacy or effectiveness studies with patient-relevant core outcomes for every promising HET are required. Furthermore, health care professionals and patients should be more involved in the product design cycle to consider relevant practical aspects.

Section: Resultsmentioning

confidence: 99%

Health-Enabling Technologies to Assist Patients With Musculoskeletal Shoulder Disorders When Exercising at Home: Scoping Review

Elgert¹,

Steiner²,

JMIR Rehabil Assist Technol

et al. 2021

“…All 27 application systems assist in the execution of exercises, mostly physiotherapeutic self-exercises. Of them, 5 were explicitly described as telerehabilitation systems [ 25 , 29 - 32 ]. These application systems provide additional functionalities for creating and adjusting individual exercises and training plans or for monitoring training progress by a therapist or physician; however, only Rahman et al [ 33 ] and Luchessi et al [ 30 ] describe possibilities for monitoring patients’ adherence.…”

Section: Resultsmentioning

confidence: 99%

“…Whereas 11 publications focus on the implementation of a single, sometimes incredibly broad game [ 22 , 23 , 29 , 37 , 38 , 43 - 48 ], just as many publications provide several games [ 24 , 28 , 32 , 36 , 39 - 42 , 49 - 51 ]. By implementing different games, a higher variability is gained.…”

Section: Resultsmentioning

confidence: 99%

“…In addition to simple tasks such as picking fruits [ 25 , 47 , 50 , 53 ], placing dishes [50‑51], or fishing [ 44 ], there are more complex, and therefore, possibly more exciting and less fatiguing tasks. Examples are destroying submarines by cleverly dropping bombs [ 41 ] and controlling objects (eg, aircrafts, storks, rays) along a course with or without obstacles [ 23 , 25 , 32 , 38 ]. Probably the most extensive game in terms of implemented tasks and game components is The Sorcerer’s Apprentice [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…Encouraging motivation, as well as enhancing engagement, is one of several goals of gamification [ 56 , 57 ]. Certain publications describe their application systems as motivating (6 of the 27), without mentioning specific factors for this effect [ 23 , 25 , 32 , 36 , 39 , 46 ]. Furthermore, motivational effects are often based on general, superficial aspects, such as interactivity (12 of the 27), fun, enjoyment, and entertainment (13 of the 27).…”

Section: Resultsmentioning

confidence: 99%

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Gamification in Rehabilitation of Patients With Musculoskeletal Diseases of the Shoulder: Scoping Review

Steiner¹,

Elgert²,

et al. 2020

JMIR Serious Games

Background Gamification has become increasingly important both in research and in practice. Particularly in long-term care processes, such as rehabilitation, playful concepts are gaining in importance to increase motivation and adherence. In addition to neurological diseases, this also affects the treatment of patients with musculoskeletal diseases such as shoulder disorders. Although it would be important to assist patients during more than one rehabilitation phase, it is hypothesized that existing systems only support a single phase. It is also unclear which game design elements are currently used in this context and how they are combined to achieve optimal positive effects on motivation. Objective This scoping review aims to identify and analyze information and communication technologies that use game design elements to support the rehabilitation processes of patients with musculoskeletal diseases of the shoulder. The state of the art with regard to fields of application, game design elements, and motivation concepts will be determined. Methods We conducted a scoping review to identify relevant application systems. The search was performed in 3 literature databases: PubMed, IEEE Xplore, and Scopus. Following the PICO (population, intervention, comparison, outcome) framework, keywords and Medical Subject Headings for shoulder, rehabilitation, and gamification were derived to define a suitable search term. Two independent reviewers, a physical therapist and a medical informatician, completed the search as specified by the search strategy. There was no restriction on year of publication. Data synthesis was done by deductive-inductive coding based on qualitative content analysis. Results A total of 1994 articles were screened; 31 articles in English, published between 2006 and 2019, were included. Within, 27 application systems that support patients with musculoskeletal diseases of the shoulder in exercising, usually at home but also in inpatient or outpatient rehabilitation clinics, were described. Only 2 application systems carried out monitoring of adherence. Almost all were based on in-house developed software. The most frequently used game components were points, tasks, and avatars. More complex game components, such as collections and teams, were rarely used. When selecting game components, patient-specific characteristics, such as age and gender, were only considered in 2 application systems. Most were described as motivating, though an evaluation of motivational effects was usually not conducted. Conclusions There are only a few application systems supporting patients with musculoskeletal diseases of the shoulder in rehabilitation by using game design elements. Almost all application systems are exergames for supporting self-exercising. Application systems for multiple rehabilitation phases seem to be nonexistent. It is also evident that only a few complex game design elements are used. Patient-specific characteristic are generally neglected when selecting and implementing game components. Consequently, a holistic approach to enhance adherence to rehabilitation is required supporting patients during the entire rehabilitation process by providing motivational game design elements based on patient-specific characteristics.

Gamification in Rehabilitation of Patients With Musculoskeletal Diseases of the Shoulder: Scoping Review (Preprint)

Steiner¹,

Elgert²,

et al. 2020

Preprint

BACKGROUND Gamification has become increasingly important both in research and practice. Particularly in long-term care processes, such as rehabilitation, playful concepts are gaining in importance to increase motivation and adherence. In addition to neurological diseases, this also affects the treatment of patients with musculoskeletal diseases (MSD), such as shoulder disorders. Although it would be important to assist patients during more than one rehabilitation phase, it is hypothesized that existing systems only support a single phase. It is also unclear which game design elements are currently used in this context and how they are combined to achieve optimal positive effects on motivation. OBJECTIVE This scoping review aims to identify and analyze information and communication technologies using game design elements to support rehabilitation processes of patients with MSD of the shoulder. The state of the art with regard to fields of application, used game design elements, and addressed motivation concepts will be determined. METHODS We conducted a scoping review to identify relevant application systems. The search was performed in three literature databases: PubMed, IEEE Xplore, and Scopus. Following the PICO-framework, keywords and Medical Subject Headings for the aspects shoulder, rehabilitation and gamification were derived to define a suitable search term. Two independent reviewers, a physical therapist and a medical informatician, completed the search as specified in the search strategy. There was no restriction on years of publication. Data synthesis was done by a deductive-inductive coding based on a qualitative content analysis. RESULTS A total of 1994 articles were screened. 31 articles in English, published between 2006 and 2019 were included. All 27 described applications support patients with MSD of the shoulder in exercising, usually at home, but also in inpatient or outpatient rehabilitation clinics. Only two applications carry out a monitoring of adherence. Almost all applications are based on in-house developed software. The most frequently used game-components are points, tasks, and avatars. More complex game-components, such as collections and teams, are rarely used. When selecting game-components, patient-specific characteristics, here age and gender, are only considered in two applications. Most applications are described as motivating, an evaluation of motivation is, however, nearly not performed at all. CONCLUSIONS There are only a few applications supporting patients with MSD of the shoulder in rehabilitation by using game design elements. Almost all applications are exergames for supporting self-exercising. Applications for multiple rehabilitation phases seem to be non-existent. It is also evident that only a few complex game design elements are used. Patient-specific characteristic are generally neglected when selecting and implementing game-components. Consequently, a holistic approach to enhance adherence to rehabilitation is required supporting patients during the entire rehabilitation process by providing motivational game design elements based on patient-specific characteristics.