Sana: A Gamified Rehabilitation Management System for Anterior Cruciate Ligament Reconstruction Recovery

Abstract

The anterior cruciate ligament (ACL) provides stabilization support for the back and forth motion of the knee joint. ACL ruptures account for 50% of all sports-related knee injuries with approximately 76.6% of them requiring reconstructive surgery, necessitating long-term patient rehabilitation. Compliance with rehabilitation management programs, following ACL reconstruction, is fundamental for the successful restoration of the knee’s kinematics and reducing the risk of secondary osteoarthritis. Existing recovery programs are often paper-based and require patients to perform exercises at home, unsupervised, resulting in a low level of self-efficacy; by promoting self-efficacy in home-based settings, rehabilitation outcomes can improve. This paper reports the design development of the Sana system, a mobile and wearable application that adopts behavioral design principles and gamification theory to improve long-term post-operative outcomes for ACL reconstruction recovery. A feasibility study was conducted from 15 October 2019–13 May 2020, employing the double diamond framework and a human-centered design approach (BS EN ISO 9241-210: 2019). Eighteen participants were recruited, including eight domain experts (in fields such as user experience design, human factors, and physiotherapy), and ten representative users who had undergone long-term rehabilitation for musculoskeletal injuries.

Special Issue “New Trends in Sport and Exercise Medicine”

“…The failure of rehabilitation programs increases the onset of secondary pathologies in the years after surgery. In this paper, Kungwengwe and Evans [1] studied a mobile application, called Sana, based on gamification theory, to improve the results of post-operative physiotherapy after ACL reconstruction. The program content is based on the Royal National Orthopedic Hospital guidelines for ACL rupture reconstruction.…”

“…Sixteen papers have been published, which are briefly described below. They range from mobile applications in physiotherapy to changes in bioactive lipids in half-marathoners [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

Exergames to improve Rehabilitation after Anterior Cruciate Ligament Injury: Systematic review and GRADE evidence synthesis

“…The knee is one of the joints that present a high incidence of injuries, with the most frequent injury affecting the anterior cruciate ligament (ACL) (Cordeiro et al, 2017;Kungwengwe et al, 2020). The ACL provides stabilisation support for knee movement (Kungwengwe et al, 2020;Ahmed et al, 2020;Atkinson et al, 2014), as well as passive restriction for anterior translation of the tibia into the femur and rotational stability in the frontal and transverse planes (Raines et al, 2017).…”

“…Many of these injuries result in reconstructive surgery, leading to a long period of rehabilitation (Kungwengwe et al, 2020). The ACL is one of the most common reconstructions of the knee ligaments (Cheecharern, 2018) and ACL reconstruction has become a standard surgical procedure attempting to prevent the development of musculoskeletal consequences of the injury (Atkinson et al, 2014).…”

“…The market for digital healthcare interventions for rehabilitation has grown exponentially in recent years (Kungwengwe et al, 2020). They allow patients to practice their own exercises, provide direct feedback during their performance, and motivate them to train more (Ficklscherer et al, 2016).…”