Group-based telerehabilitation intervention using Wii Fit to improve walking in older adults with lower limb amputation (WiiNWalk): A randomized control trial

Abstract

Objective Determine efficacy of the novel WiiNWalk intervention on walking-related outcomes in older adults with lower limb amputation. Design Multi-site, parallel, evaluator-masked randomized controlled trial. Setting Home-setting in three Canadian cities. Participants Community-dwelling lower limb prosthesis users over 50 years of age. Interventions The WiiNWalk group (n = 38) used modified Wii Fit activities for prosthetic rehabilitation. The attention control group (n = 33) used Big Brain Academy: Wii Degree, comprising of cognitive activities. Both groups completed a 4-week supervised phase with three 1-h sessions/week in groups of three overseen by a clinician via videoconferencing and a 4-week unstructured and unsupervised phase. Main Measures Primary outcome was walking capacity (2 min walk test); secondary outcomes were balance confidence (activities-specific balance confidence scale), dynamic balance (four-step square test), and lower limb functioning (short physical performance battery). Outcomes were compared across time points with repeated measures analysis of covariance, adjusting for baseline and age. Results Mean age was 65.0 (8.4) years, with 179.5 (223.5) months post-amputation and 80% transtibial amputation. No group difference in a 2 min walk test with an effect size: 1.53 95% CI [−3.17, 6.23] m. Activities balance confidence was greater in the WiiNWalk group by 5.53 [2.53, 8.52]%. No group difference in the four-step square test −0.16 [−1.25, 0.92] s, nor short physical performance battery 0.48 [−0.65, 1.61]. A post-hoc analysis showed the greatest difference in balance confidence immediately after an unsupervised phase. Conclusions The WiiNWalk intervention improved balance confidence, but not walking-related physical function in older adult lower limb prosthesis users. Future rehabilitation games should be specific to the amputation context. Clinical Trial Registration number, NCT 01942798.

Virtual Reality–Based Rehabilitation to Restore Motor Function in People With Amputation

“…However, walking capacity measured by timed walking distance tests demonstrated conflicting results among studies. Although a feasibility study 24 found a medium effect size on the 2-Minute Walk Test, the subsequent study 26 with a calculated sample size did not find a significant difference between the virtual reality and cognitive training group; another study 23 also reported insignificant results in the 6-Minute Walk Test. A common feature of these three studies is that none incorporated dedicated gait training components in virtual reality intervention protocol; rather, participants performed static and dynamic balance activities in front of a display.…”

“…A total of 174 participants were included in these studies: participants in seven studies 23,24,26,27,[30][31][32] had lower extremity amputation (transfemoral, knee disarticulation, transtibial, and Van Ness amputation) and, in three studies, 25,28,29 had upper extremity amputation (transhumeral, elbow disarticulation, transradial, wrist disarticulation, and partial hand amputation). Nine studies recruited adult participants, with two 24,26 of them restricted to age older than 50 yrs; one study 27 recruited children and adolescents aged 8-18 yrs. Three studies [29][30][31] were conducted at a military medical center, three at home 24,26,27 (two of them had initial supervised sessions in a rehabilitation facility), and four 23,25,28,32 at medical and rehabilitation facilities.…”

“…Among the 10 studies, four [23][24][25][26] were randomized controlled trials, three [27][28][29] were pre-post single-arm studies, and three [30][31][32] were case studies. A total of 174 participants were included in these studies: participants in seven studies 23,24,26,27,[30][31][32] had lower extremity amputation (transfemoral, knee disarticulation, transtibial, and Van Ness amputation) and, in three studies, 25,28,29 had upper extremity amputation (transhumeral, elbow disarticulation, transradial, wrist disarticulation, and partial hand amputation). Nine studies recruited adult participants, with two 24,26 of them restricted to age older than 50 yrs; one study 27 recruited children and adolescents aged 8-18 yrs.…”

“…Nine studies recruited adult participants, with two 24,26 of them restricted to age older than 50 yrs; one study 27 recruited children and adolescents aged 8-18 yrs. Three studies [29][30][31] were conducted at a military medical center, three at home 24,26,27 (two of them had initial supervised sessions in a rehabilitation facility), and four 23,25,28,32 at medical and rehabilitation facilities. For virtual reality-based rehabilitation interventions, two case studies 30,31 used the Computer Assisted Rehabilitation Environment to deliver virtual reality-based gait training on a moving multidirectional treadmill platform.…”

Categorization and recommendations for outcome measures for lower limb absence by an expert panel

“…To date, 60 outcome measures have had their psychometric properties evaluated with people with LLA. 11 Other outcome measures, including the 5 times sit-to-stand test, 12,13 the Wiifit, 14,15 and the EuroQol 5D, 16,17 which has subsequently had some validation, 18 have been used in both clinical and research settings but have not had their psychometric properties studied in this population. "…”