Gamification for Distal Radius Fracture Rehabilitation: A Randomized Controlled Pilot Study

Abstract

IntroductionGamification is a novel interventional approach to functional recovery and rehabilitation. A significant impact has been observed with the application of gamification on non-traumatic conditions and chronic neurological and musculoskeletal illnesses; however, the implication of gamification on the functional recovery of patients with distal radius fractures (DRF) is yet to be explored. MethodologyThis pilot study included 20 post-DRF patients aged 18-65 years with unilateral DRF, managed with closed reduction and K-wire internal fixation. The patients were assigned to group A (gamification) and group B (conventional rehabilitation) in a 1:1 ratio. Group A patients played Racket: NX game, Until you fall game, and Holofit game on Oculus Quest head-mounted display (HMD) (Oculus, USA), while group B patients received a conventional rehabilitation program. Both groups underwent a rehabilitation program for 60 min/day, five days a week, for four weeks. The visual analogue scale (VAS), universal goniometer, Jamar dynamometer, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire were used as outcome measures at baseline, at the end of the second week, and at the end of treatment. ResultsThere were significant improvements in pain, range of motion (ROM), grip strength, and functional independence in both groups. However, improvements in hand function and functional independence were significantly greater in the gamification group than in the conventional physiotherapy rehabilitation group. ConclusionThe study concluded that gamification appears to have a significant impact on post-DRF rehabilitation in terms of pain, ROM, grip strength, and functional independence. Further research with larger sample sizes is required to confirm the preliminary findings.

Rehabilitation after Distal Radius Fractures: Opportunities for Improvement

“…In addition, “gamification” principles have shown in previous studies to increase treatment adherence 27 60 and seem promising in improving functional outcomes in wrist rehabilitation. 51 Recent trials show a positive effect of active games compared with regular physiotherapy interventions. 61 62…”

“…As shown in one trial included in the review, gamification can be a method to support patient self-efficacy and facilitate support during rehabilitation exercises. 51 After successful validation, the use of novel technologies such as gamification and mobile applications may be promising in improving rehabilitation, when complying with the relevant laws and regulations. [57][58][59] These technologies can provide monitoring, increase self-efficacy 20,24,27 , and may hereby improve outcomes in the near future.…”

“…Eleven studies provided patients with written instructions for exercises for home reference, 31,[36][37][38][39][40][41][42][43][44] two used videobased instructions, 30,35 and ten trials did not report using any form of support tools for patients. [32][33][34][45][46][47][48][49][50][51] Seven studies described the used exercise protocol in detail, and four articles included a complete graphical depicted homeexercise protocol [35][36][37]43 . While exercise understanding was checked at follow-up in almost all trials, none of the included studies specifically reported treatment adherence or described the use of monitoring tools.…”

“…[31][32][33][34][35][36]40 Six studies compared supervised physiotherapy to other interventions (►Table 4). [47][48][49][50][51][52] Of these studies, one described providing patients with written exercise instructions. 52 Two trials comparing home-based exercise or a single exercise session to a control group receiving no exercise instructions found statistically significant advantages of exercise over no exercises.…”

“…48 Patients receiving additional mirror therapy, gamification, and robot-assisted arm training showed only a beneficial effect of gamification in pain scores, active ROM, and DASH scores, compared with patients receiving only regular supervised exercises. 47,50,51 Exercise Protocols, Support Tools and Treatment Adherence…”