Elsevier

Physiotherapy

Volume 98, Issue 3, September 2012, Pages 183-188
Physiotherapy

Use of Nintendo Wii Fit™ in the rehabilitation of outpatients following total knee replacement: a preliminary randomised controlled trial

https://doi.org/10.1016/j.physio.2012.04.001Get rights and content

Abstract

Objectives

To determine whether Nintendo Wii Fit™ is an acceptable adjunct to physiotherapy treatment in the rehabilitation of balance, lower extremity movement, strength and function in outpatients following total knee replacement.

Design

Preliminary randomised controlled trial.

Setting

Outpatient department of a rehabilitation hospital.

Participants

Adult outpatients following total knee replacement.

Interventions

The study group received a physiotherapy session followed by 15 minutes of Wii Fit gaming activities. The games encouraged lateral and multidirectional weight shifting, and provided visual feedback regarding postural balance. The control group received a physiotherapy session followed by 15 minutes of lower extremity strengthening and balance training exercises.

Main outcome measures

Length of outpatient rehabilitation, 2-minute walk test, knee range of motion, timed standing, Activity-specific Balance Confidence Scale, Lower Extremity Functional Scale and Numeric Pain Rating Scale, all measured on admission and every 2 weeks until discharge. A patient satisfaction survey was completed at discharge.

Results

Seventeen males (34%) and 33 females (66%) with a mean age of 68 (standard deviation 11) years participated in the study. No significant differences in age, gender, days since surgery or length of outpatient rehabilitation were found between the groups. In addition, there were no significant differences in pain (P = 0.220), knee flexion (P = 0.951), knee extension (P = 0.492), walking speed (P = 0.855), timed standing tasks (P = 0.289), Lower Extremity Functional Scale (P = 0.079), Activity-specific Balance Confidence Scale (P = 0.523) or patient satisfaction with therapy services (P = 0.201) between the groups.

Conclusions

Wii Fit is potentially acceptable as an adjunct to physiotherapy intervention for outpatients following total knee replacement, provided the games chosen challenge balance and postural control, and use the lower extremities. Further research is needed to establish whether video games as a therapy adjunct increase patient motivation and compliance with rehabilitation goals.

ClinicalTrials.gov ID: NCT01548664.

Introduction

In recent years, there has been increasing interest in the role of commercially available video game systems in the rehabilitation of various patient populations, as well as increasing availability of clinical literature describing their use. Such video game systems have been applied as a therapeutic intervention option that is considered to be more fun and interesting than conventional exercise [1], [2], [3], [4]. Video game therapy has been applied in the rehabilitation of upper extremity [5], lower extremity [6], neurological [7], [8], [9], [10] and burn injury patient populations [11], [12], [13]. However, few studies have described the use of video games in the rehabilitation of orthopaedic conditions.

Between 2006 and 2007, 37 943 knee replacement operations were performed in Canada, demonstrating a 140% increase in such procedures compared with 1996 to 1997 [14]. Within this 10-year period, the greatest increase in patients electing to undergo total knee replacement (TKR) was seen in 45 to 54 year olds: 271% in males and 337% in females [14]. The use of a novel, technology-based intervention in rehabilitation is more likely to be viewed as acceptable and valuable in this age group compared with older populations. In addition, video games can offer ways to simulate sport, recreational and functional activities without the intensity or risk associated with performing the actual activity. The Nintendo Wii™ is a commercially available motion controlled video game system (Nintendo of America, Redmond, WA, USA) [15]. Wii Fit™ includes a balance board similar in concept to a force plate. This balance board measures and interprets the pressure distribution of weight applied by the player, and subsequently provides feedback on exercises performed or games played on the accompanying software. This system is marketed to the general public as a method of achieving fitness goals at home using a video game. However, there is potential for this technology to be beneficial in a physical rehabilitation setting. There is a need for randomised controlled trials to compare the benefits of Wii Fit use with traditional rehabilitation therapy [4]. Wii Fit games encourage lower extremity movement, challenge balance, and require the player to remain in a standing position during play. These activities have the potential to address rehabilitation goals involving recovery of lower extremity function. This preliminary randomised controlled study investigated whether Wii Fit use is an acceptable adjunct to physiotherapy treatment in the rehabilitation of balance, lower extremity movement, strength and function in outpatients following TKR.

Section snippets

Participants

This study was approved by St. John's Rehab Hospital Research Ethics Board, and informed consent was obtained from all participants. The study was conducted between May 2009 and September 2010 in an outpatient department of a rehabilitation hospital in Toronto, Canada. All outpatients with full lower extremity weight bearing, requiring twice-weekly physiotherapy treatment for TKR rehabilitation were eligible for inclusion in the study. Individuals with active painful osteoarthritis in the

Results

The recruitment rate was 58% (50/86), and all 50 subjects completed the study (Fig. 1, see supplementary online material). Within this sample, there were 17 (34%) males and 33 (66%) females between the ages of 38 and 81 years, with a mean age of 68 (SD 11) years. There were 27 (54%) participants in the study group and 23 (46%) participants in the control group. Demographically, there was no significant difference in mean age, gender, number of days since surgery or LOR between the two groups (

Discussion

The mean age of the study participants was the same as the mean age for the Canadian population that underwent TKR surgery from 2006 to 2007 (68 years) [14]. Also reflective of the Canadian TKR population were the percentage of males (34%) and females (66%) in this study compared with the overall percentage of males (39%) and females (61%) who underwent TKR in 2006 to 2007 [14]. Assuming that such statistics are also reflective for the TKR population of 2009 to 2010, it is expected that the

Conclusions

This preliminary randomised controlled trial suggests that Wii Fit has potential for use as an adjunct to physiotherapy treatment in the rehabilitation of balance and lower extremity function in outpatients following TKR. Additional studies with larger samples will help to determine the extent to which use of Wii Fit as a physiotherapy adjunct contributes to an improvement in LEFS scores. Further research is required to establish the role of Wii Fit as a home therapy tool for this population,

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    This paper is based on a paper presented at WCPT in Amsterdam 2011.

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