The Utilization of Nintendo Wii The Utilization of Nintendo Wii FitFitTMTM in the Rehabilitation of in the Rehabilitation of Outpatients Following Total Outpatients Following Total
Knee Replacements:Knee Replacements:A Randomized Controlled TrialA Randomized Controlled Trial
Vera Fung, Aileen Ho, Jennifer Shaffer,
Esther Chung, Manuel Gomez
2
St. John’s Rehab St. John’s Rehab HospitalHospital
• Patient populations– Burn–Orthopedic– Neurological– Trauma– Amputation–Oncology– Cardiac–Organ Transplant
3
Research StudyResearch Study
• Title: The Utilization of Nintendo Wii FitTM in the Rehabilitation of Outpatients Following Total Knee Replacement
• Design: Randomized controlled trial
• Population: Outpatients following TKR
4
Rationale for StudyRationale for Study
• Trends in physical rehabilitation favor the use of video games as therapeutic modalities
• Supporting literature was not strong
• WiiTM was already in use within hospital
• OT & PT support WiiTM as therapy adjunct
• Innovative and fun treatment option
5
Research QuestionResearch Question
Is there a difference in rehabilitation outcomes of total knee replacement
outpatients using Wii FitTM as a therapy adjunct versus those who do not?
Research ObjectiveResearch Objective
To determine whether Nintendo Wii FitTM is an acceptable adjunct to
outpatient rehabilitation following total knee
replacement6
7
Sample PopulationSample Population
Included• Medically cleared for
outpatient therapy
• Weight bearing as tolerated
• Able to stand and weight shift with supervision
• 2 therapy sessions/week
• 60 minute sessions
Excluded• Painful osteoarthritis
of the contralateral knee
• Unable to understand or follow instruction
• Condition aggravated by repetitive activity
• Seizure disorder
8
RandomizationRandomization
• Study Group– Standard PT session +15 minutes of Nintendo Wii FitTM activity
• Control Group– Standard PT session +15 minutes of additional PT exercise
9
Outcome MeasuresOutcome Measures
• Knee range of motion• 2 Minute Walk Test• Standing balance• Pain• Lower Extremity Functional Scale (LEFS)• Activities-specific Balance Confidence
scale (ABC)• Patient satisfaction• Demographics• Length of stay• Gait aids
10
Wii FitWii FitTMTM Intervention Intervention
Deep Breathing• Visual feedback regarding stability
and weight distribution
11
Wii FitWii FitTMTM Intervention Intervention
Ski Slalom & Penguin Slide• Encourages lateral weight shifting
grading and control
12
Wii FitWii FitTMTM Intervention Intervention
Table Tilt & Balance Bubble• Encourages multi-directional weight
shifting control
13
Wii FitWii FitTMTM Intervention Intervention
Tightrope Walk• Encourages lateral weight shifting
control and unilateral stance
14
Wii FitWii FitTMTM Intervention Intervention
Half Moon & Torso Twist• Challenges postural control while
engaging in dynamic movement
Wii FitTM Intervention
Body Test• Provides user with measurable evidence
of imbalances in weight distribution
16
Data Collection & Data Collection & AnalysisAnalysis
• Participants assessed–On admission– Every 2 weeks until discharge
• Assessor blinded to participant allocation
• Assessment in lieu of intervention
• Comparing change from assessment to discharge between groups– Chi-square and t-test analyses– P values <0.05 were considered
significant
17
ResultsResults
•n = 50
•Recruitment rate = 58.1%
•Mean Age: 68.0 ± 11.1 years
•Females: 33 (66%) Males: 17 (34%)
•Control: 23 (46%) Study: 27 (54%)
18
ResultsResults
Outcome Study (% ∆)
Control (% ∆)
P value
Passive Knee Flexion 16.03 15.37 0.899
Passive Knee Extension
0.61 1.39 0.326
2 Minute Walk Test 4.43 4.16 0.855
Standing Balance 8.35 0.35 0.347
Pain 3.25 1.56 0.220
LEFS 7.34 4.15 0.079
ABC 4.82 3.41 0.523
Results
• Cohen’s d calculated to determine effect size
• Cohen’s d = 58: Moderate effect size
• Potential for larger effect size with larger sample
20
DiscussionDiscussion
• No clinically significant difference between control and study group in:–Demographics–Outcomes
• Qualitative component might reveal difference, if exists
• Patient satisfaction questionnaire may have been completed with differing perspectives
21
ConclusionConclusion
• The Wii FitTM is an acceptable adjunct to PT intervention for Outpatient TKR population
• Comparable outcomes between control and study groups
• Moderate effect size of Wii FitTM on LEFS results
• Can be an innovative treatment option to:
–Address balance–Standing tolerance
–Postural control–Lower extremity function
22
Wii FitWii FitTMTM Applications in Applications in RehabRehab
• Exercise standing tolerance
• Weight distribution measurement
• Weight distribution & postural control feedback
• Lower extremity coordination training
• Core strengthening
23
Patient PopulationsPatient Populations
•Total hip or knee replacement
•Lower extremity trauma•Amputation •Burns•Stroke•Post-op deconditioning
24
Areas for Future Areas for Future ResearchResearch
• RCTs with other patient populations
• Other motion detection video game systems
• Investigating Wii FitTM on LEFS with a larger sample
• Qualitative studies to capture experience
Top Related