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

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St. John’s Rehab St. John’s Rehab HospitalHospital

• Patient populations– Burn–Orthopedic– Neurological– Trauma– Amputation–Oncology– Cardiac–Organ Transplant

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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

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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

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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

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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

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RandomizationRandomization

• Study Group– Standard PT session +15 minutes of Nintendo Wii FitTM activity

• Control Group– Standard PT session +15 minutes of additional PT exercise

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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

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Wii FitWii FitTMTM Intervention Intervention

Deep Breathing• Visual feedback regarding stability

and weight distribution

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Wii FitWii FitTMTM Intervention Intervention

Ski Slalom & Penguin Slide• Encourages lateral weight shifting

grading and control

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Wii FitWii FitTMTM Intervention Intervention

Table Tilt & Balance Bubble• Encourages multi-directional weight

shifting control

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Wii FitWii FitTMTM Intervention Intervention

Tightrope Walk• Encourages lateral weight shifting

control and unilateral stance

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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

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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

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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%)

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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

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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

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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

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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

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Patient PopulationsPatient Populations

•Total hip or knee replacement

•Lower extremity trauma•Amputation •Burns•Stroke•Post-op deconditioning

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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