Self-directed usage of an in-home exergame after a supervised telerehabilitation training program for older adults with lower-limb amputation

Abstract

Background: While home-based exergames help overcome accessibility barriers to rehabilitation, it is unclear what constitutes effective intervention design in using exergames to support self-efficacy and engagement. Objective: Examine usage of an in-home exergame, compared to control, unsupervised after supervised training by older persons with lower-limb amputation. Study design: Secondary analysis of a multi-site parallel evaluator-masked randomized control trial. Methods: WiiNWalk uses the WiiFit and teleconferencing for in-home group-based exergame therapy with clinical supervision. Participants engaged in a 4-week supervised training phase followed by a 4-week unsupervised phase in experimental (WiiNWalk) and attention control groups. Usage between phases and between groups was compared using unsupervised/supervised ratio of session count (over 4 weeks) and session time (mean min/session over 4 weeks) for each phase. Results: Participants: n=36 experimental, n=28 control, unilateral lower-limb amputation, age > 50 years, prosthesis usage ≥ 2 hours/day. Session count ratio unsupervised/supervised, median and interquartile range (IQR), was less than parity ( p<0.01) for experimental (0.25, IQR 0.00 -0.68) and control (0.18, IQR 0.00 -0.67) groups, with no different between groups ( p=0.92). Experimental session time unsupervised/supervised showed consistency (1.12, IQR 0.80 -1.41) between phases ( p=0.24); control showed lower (0.76, IQR 0.57 -1.08) ratios compared to experimental ( p=0.027). Conclusions: Unsupervised exercise duration remained consistent with supervised, but frequency was reduced. Social and clinical guidance features may remain necessary for sustained lower-limb amputation exergame engagement at home. Clinical relevance This study provides context regarding when prosthesis users are more likely to use exergames such as Wii Fit for exercise therapy. Clinicians may consider our results when applying exergames in their practice or when developing new exergame intervention strategies.

COVID‐19: A catalyst for change in virtual health care utilization for persons with limb loss

“…In a feasibility study paired with this same framework, Tao et al compared supervised and unsupervised training in the home via telehealth. Similar to the results of Imam et al, researchers found that participants used the exergame less frequently when they were unsupervised in their home 45 . That being said, despite a decrease in frequency, the duration of this training was therapeutically sufficient 45 .…”

“…Similar to the results of Imam et al, researchers found that participants used the exergame less frequently when they were unsupervised in their home. 45 That being said, despite a decrease in frequency, the duration of this training was therapeutically sufficient. 45 Therefore, although there is promising evidence that telehealth can be used effectively in the home, participant adherence appears to be relatively low.…”

“…45 That being said, despite a decrease in frequency, the duration of this training was therapeutically sufficient. 45 Therefore, although there is promising evidence that telehealth can be used effectively in the home, participant adherence appears to be relatively low. Future studies should explore how to utilize telehealth to encourage active lifestyles and continued adherence.…”

Immersive virtual reality health games: a narrative review of game design

“…Beyond cardiovascular exercise, such games are of therapeutic interest for their involvement of psychomotor skills and even cognitive skills. Yet, the principal appeal behind using games for therapy, whether HMD-based or not, has been their potential to support sustained adherence to therapy [27][28][29]. As such, game-based therapy may be viewed as an approach to behavior change [30].…”

Sedentary conditions during the lockdown and movement opportunities for the Italian elderly

“…23 The Home exercise or the home training are experiences of motor activities widely used in the context of strategies for increasing physical activity levels: in fact, in the literature, it is possible to find numerous studies that analyze the motor activity carried out within the home. This activity is mainly carried out by subjects with pathologies, [26][27][28][29][30] by subjects who have undergone transplants or prostheses, 31,32 by subjects who have undergone amputations 33 or as a motor activity with specific prevention programs. 34,35 Until now in Italy, due to the cultural characteristics of the adult and elderly population, on the contrary, this type of activity has not had a significant diffusion, both for the home training modalities and for the modalities that included motor activities supervised by experts.…”