Use of Nintendo Wii Fit™ in the rehabilitation of outpatients following total knee replacement: a preliminary randomised controlled trial☆
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,
References (27)
- et al.
Video game-based exercises for balance rehabilitation: a single-subject design
Arch Phys Med Rehabil
(2006) - et al.
The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: a randomized controlled trial
BMC Pediatr
(2005) - et al.
Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies
Arch Phys Med Rehabil
(2007) - et al.
Validity and reliability comparison of 4 mobility measures in patients presenting with neurological impairment
Arch Phys Med Rehabil
(2001) - et al.
Comparative study of methods measuring acute pain intensity in an ED
Am J Emerg Med
(1998) - et al.
Assisting people with multiple disabilities actively correct abnormal standing posture with a Nintendo Wii balance board through controlling environmental stimulation
Res Dev Disabil
(2010) - et al.
Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance
Gait Posture
(2010) - et al.
The contribution of upper limb and total body movement to adolescents’ energy expenditure whilst playing Nintendo Wii
Eur J Appl Physiol
(2008) - et al.
The health benefits of interactive video game exercise
Appl Physiol Nutr Metab
(2007) - et al.
Is the Wii Fit a new-generation tool for improving balance, health and well-being? A pilot study
Climateric
(2010)
EXercising with Computers in Later Life (EXCELL) – pilot and feasibility study of the acceptability of the Nintendo® WiiFit in community-dwelling fallers
BMC Res Notes
“Playstation eyetoy games” improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial
Eur J Phys Rehabil Med
Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy
Phys Ther
Cited by (144)
The use of technology to support lifestyle interventions in knee osteoarthritis: A scoping review
2023, Osteoarthritis and Cartilage OpenEffect of balance training using virtual reality-based serious games in individuals with total knee replacement: A randomized controlled trial
2022, Annals of Physical and Rehabilitation MedicineEffects of Wii Fit Rehabilitation on Lower Extremity Functional Status in Adults With Severe Burns: A Randomized Controlled Trial
2022, Archives of Physical Medicine and Rehabilitation
- ☆
This paper is based on a paper presented at WCPT in Amsterdam 2011.