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Huber SK, Manser P, de Bruin ED. PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke-a methodological paper with an application example. Front Sports Act Living 2024; 6:1397949. [PMID: 38915297 PMCID: PMC11194322 DOI: 10.3389/fspor.2024.1397949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/27/2024] [Indexed: 06/26/2024] Open
Abstract
Background Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke. Methods The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the "Framework for Developing and Evaluating Complex Interventions" by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed. Results A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2-3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept. Conclusion We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.
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Affiliation(s)
- Simone K. Huber
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Patrick Manser
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST—Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Parsaei M, Amanollahi M, TaghaviZanjani F, Khanmohammadi S, Jameie M, Naser Moghadasi A. Effects of non-pharmacological interventions on gait and balance of persons with Multiple Sclerosis: A narrative review. Mult Scler Relat Disord 2024; 82:105415. [PMID: 38211505 DOI: 10.1016/j.msard.2023.105415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Multiple Sclerosis (MS) is among the most common reasons for disability in young adults. Mobility impairment, primarily related to gait and balance, is ranked as the preeminent concern among persons with MS (PwMS). Gait and balance dysfunction can directly affect the quality of life and activities of daily life in PwMS, hence the importance of effective treatment strategies. Previous studies have demonstrated the positive effect of various non-pharmacological rehabilitation methods, including physiotherapy and electrical stimulation, on gait and mobility in PwMS. Non-pharmacological methods can be tailored to the individual needs and abilities of each patient, allowing healthcare providers to create personalized training programs. Furthermore, these methods typically result in minimal or no side effects. PURPOSE This review provides a comprehensive overview of an array of non-pharmacological treatment approaches aimed at enhancing ambulatory performance in PwMS. METHODS We performed a narrative review of the original papers available in PubMed, investigating the effects of different nonmedical approaches on the gait and balance performance of the PwMS. Reviewed treatment approaches include "exercise, physical rehabilitation, dual-task (DT) rehabilitation, robot-assisted rehabilitation, virtual reality-assisted rehabilitation, game training, electrical stimulation devices, auditory stimulation, visual feedback, and shoe insoles". RESULTS AND CONCLUSIONS Eighty articles were meticulously reviewed. Our study highlights the positive effects of non-pharmacological interventions on patients' quality of life, reducing disability, fatigue, and muscle spasticity. While some methods, including exercise and physiotherapy, showed substantial promise, further research is needed to evaluate whether visual biofeedback and auditory stimulation are preferable over conventional approaches. Additionally, approaches such as functional electrical stimulation, non-invasive brain stimulation, and shoe insoles demonstrate substantial short-term benefits, prompting further investigation into their long-term effects. Non-pharmacological interventions can serve as a valuable complement to medication-based approaches.
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Affiliation(s)
- Mohammadamin Parsaei
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mobina Amanollahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Melika Jameie
- Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran; Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Schrempf MC, Zanker J, Arndt TT, Vlasenko D, Anthuber M, Müller G, Sommer F, Wolf S. Immersive Virtual Reality Fitness Games to Improve Recovery After Colorectal Surgery: A Randomized Single Blind Controlled Pilot Trial. Games Health J 2023; 12:450-458. [PMID: 37428543 DOI: 10.1089/g4h.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Introduction: Early mobilization after surgery is crucial for reducing postoperative complications and restoring patients' fitness and ability to care for themselves. Immersive, activity-promoting fitness games in virtual reality (VR) can be used as a low-cost motivational adjunct to standard physiotherapy to promote recovery after surgery. In addition, they have potentially positive effects on mood and well-being, which are often compromised after colorectal surgery. The purpose of this pilot study was to evaluate the feasibility and clinical outcomes of a VR-based intervention that provides additional mobilization. Methods: Patients undergoing curative surgery for colorectal cancer were randomly assigned to an intervention group or a control group. Participants in the intervention group (VR group) received daily bedside fitness exercises using immersive, activity-promoting, virtual reality fitness games in addition to standard care during their postoperative hospital stay. Results: A total of 62 patients were randomized. The feasibility outcomes were in line with the predefined goals. In the VR group, an improvement in overall mood (+0.76 points; 95% confidence interval [CI] 0.39 to 1.12; P < 0.001) and a shift toward positive feelings were observed. The median length of hospital stay was 7.0 days in the VR group compared with 9.0 days in the control group, but the difference (2.0 days) did not reach statistical significance (95% CI -0.0001 to 3.00; P = 0.076). Surgical outcomes, health status, and measures of distress did not differ between groups. Conclusions: The study demonstrated the feasibility of a VR intervention that improved overall mood and showed a desirable effect on feelings and length of hospital stay after colorectal surgery. The results should stimulate further research investigating the potential of VR as an adjunct to physiotherapy to enhance mobilization after surgery.
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Affiliation(s)
- Matthias C Schrempf
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Johannes Zanker
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Tim Tobias Arndt
- Department of Computational Statistics and Data Analysis, Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Dmytro Vlasenko
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Matthias Anthuber
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Gernot Müller
- Department of Computational Statistics and Data Analysis, Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Florian Sommer
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Sebastian Wolf
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
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Moeinzadeh AM, Calder A, Petersen C, Hoermann S, Daneshfar A. Comparing virtual reality exergaming with conventional exercise in rehabilitation of people with multiple sclerosis: A systematic review. Neuropsychol Rehabil 2023; 33:1430-1455. [PMID: 35929897 DOI: 10.1080/09602011.2022.2107021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
Abstract
This systematic review aimed to present the comparison of the impacts of conventional exercise and virtual reality (VR) exergaming on the physical and cognitive abilities of people with multiple sclerosis (PwMS). The literature search was conducted in the EMBASE, PubMed, Scopus, CINAHL, and Cochrane Library databases. Eligible studies were identified by independent reviewers based on the title, abstract and full-texts. Studies were limited to randomized clinical trials published in peer-reviewed journals in English that compared conventional exercise with VR-exergaming for improving the physical and cognitive abilities of PwMS. Selected studies were assessed for their risk of bias and the major findings of the reviewed studies were analyzed descriptively. The search identified 239 articles of which 10 studies met the eligibility criteria. Despite these studies employing strategies to control biases, some risks of bias remain. Various gaming platforms and conventional exercises were used based on the extent of technologies and therapy regimens. The selected studies used measures of physical and cognitive abilities to compare VR-exergaming with conventional exercise. This review suggests positive impacts of both VR-exergaming and conventional exercise in MS rehabilitation. We also found that VR-exergaming generally exceeded conventional exercise for improving physical and cognitive abilities, psychosocial status, and fatigue.
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Affiliation(s)
| | - Allyson Calder
- School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research (CHARR), University of Otago, Christchurch, New Zealand
| | - Carl Petersen
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Simon Hoermann
- School of Product Design, University of Canterbury, Christchurch, New Zealand
| | - Amin Daneshfar
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
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Almarwani M, Alosaimi B. Exercise Self-Efficacy and Fatigue as Predictors of Adherence to Home-Based Exercise Among Patients with Multiple Sclerosis. Patient Prefer Adherence 2023; 17:1441-1449. [PMID: 37342492 PMCID: PMC10278867 DOI: 10.2147/ppa.s414884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
Background Adherence to home-based exercise programs can be improved by determining the factors associated with exercise adoption and maintenance in patients with multiple sclerosis. However, the factors that influence adherence to home-based exercise have been poorly studied among patients with multiple sclerosis in Saudi Arabia. This study aimed to examine predictors of adherence to home-based exercise programs among patients with multiple sclerosis in Saudi Arabia. Methods This was a cross-sectional observational study. A total of forty individuals (mean age = 38.65 ± 8.16 years) diagnosed with multiple sclerosis participated in the study. Outcome measures were self-reported exercise adherence, the Arabic version of exercise self-efficacy, the Arabic version of patient-determined disease steps, and the Arabic version of the fatigue severity scale. All outcome measures were assessed at baseline, except for self-reported adherence to exercise, which was measured after 2 weeks. Results Our results showed that the adherence to home-based exercise programs was significantly positively correlated with exercise self-efficacy and negatively correlated with fatigue and disability. Exercise self-efficacy (β = 0.62, p < 0.01) and fatigue (β = -0.24, p = 0.04) were significant predictors of adherence to home-based exercise programs. Conclusion These findings suggest that exercise self-efficacy and fatigue should be considered by physical therapists when designing a tailored exercise program for patients with multiple sclerosis. This may facilitate greater adherence to the home-based exercise programs and improve functional outcomes.
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Affiliation(s)
- Maha Almarwani
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Bashaier Alosaimi
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Physical Therapy Department, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
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Alanko D. The Health Effects of Video Games in Children and Adolescents. Pediatr Rev 2023; 44:23-32. [PMID: 36587018 DOI: 10.1542/pir.2022-005666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Play has always been an essential part of childhood, but it looks different for modern children, who increasingly engage in virtual play. More than 90% of children older than 2 years play video games, and three-quarters of American households own a video game console. Children 8 to 17 years of age spend an average of 1.5 to 2 hours daily playing video games. Recent developments framed by decades of research have provided insight into how games influence children's physical health, mental health, social behaviors, and cognitive development. Anticipatory guidance surrounding media use is often centered on screen time, but pediatricians should have some knowledge of the unique benefits and risks associated with this nearly ubiquitous activity. In light of the recent addition of gaming disorder to the International Classification of Diseases, 11th Revision, this review includes a discussion of the epidemiology, clinical features, and diagnosis of gaming disorder, including the use of existing screening tools. As games become more popular while ever-increasing in scope and complexity, this review aims to educate the modern pediatric provider about what is known, what is uncertain, and how to use this knowledge in the management of both healthy and unhealthy video gaming in children.
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Affiliation(s)
- Daniel Alanko
- Hasbro Children's Hospital and Alpert School of Medicine at Brown University, Providence, Rhode, Island
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Brincks J, Dalgas U, Franzén E, Callesen J, Wallin A, Johansson S. Unwrapping the "black box" of balance training in people with multiple sclerosis - A descriptive systematic review of intervention components, progression, and intensity. Mult Scler Relat Disord 2023; 69:104412. [PMID: 36399965 DOI: 10.1016/j.msard.2022.104412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Delineating the specific components of the existing balance training interventions in people with multiple sclerosis (PwMS) may contribute to a framework for future design and reporting of such interventions. Thus, we aimed to systematically synthesize how balance training frequency, intensity, time, type, duration, and progression are reported in balance training interventions for PwMS. METHODS A systematic literature search was conducted in Medline, Embase, Web of Science, and Cinahl. Search terms were MS, postural balance, walking, gait, and randomized/quasi-randomized controlled or clinical trials. Articles including ambulatory PwMS and interventions designed to challenge the balance control system were eligible. Two investigators screened, selected, and extracted data independently. Data on study characteristics such as design, population, and balance training content were extracted. Categorization of balance training based on balance control components was performed. RESULTS We included 40 studies grouped under five balance training categories. Balance interventions were well described regarding frequency, session time, and duration, but only two interventions described training intensity, and no systematic, gradual progression approach was reported for balance training adaptation over time. However, the balance training interventions included many sensory and motor components of the balance control system. Still, little focus was on reactive motor strategies, vestibular sense, and cognitive dual-tasking. CONCLUSIONS Existing balance training interventions in PwMS primarily consist of practicing sensory and motor strategies. Future balance training interventions are encouraged to systematically monitor individual advancements in balance training adaptations and to apply the progressive overload principle (i.e. continuous increase in balance exercise stimulus over time). Furthermore, we suggest that balance training in PwMS is performed with high intensity near an individual's balance capacity limits. Finally, individualized balance training is recommended to cover all relevant components of balance control using the proposed framework.
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Affiliation(s)
- John Brincks
- Faculty of Health Science, Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Hedeager 2, Aarhus N 8200, Denmark.
| | - Ulrik Dalgas
- Department of Public Health - Exercise Biology, Aarhus University, Dalgas Avenue 4, Aarhus 8000, Denmark
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Jacob Callesen
- Faculty of Health Science, Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Hedeager 2, Aarhus N 8200, Denmark
| | - Andreas Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Rehab Station Stockholm, Research and Development Unit, Solna, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Mobility and balance rehabilitation in multiple sclerosis: A systematic review and dose-response meta-analysis. Mult Scler Relat Disord 2023; 69:104424. [PMID: 36473240 DOI: 10.1016/j.msard.2022.104424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the benefits of neurological rehabilitation and the dose-response relationship for the treatment of mobility and balance in multiple sclerosis. METHODS We included studies investigating the effects of neurological rehabilitation on mobility and balance with the following eligibility criteria for inclusion: Population, People with Multiple Sclerosis (PwMS); Intervention, method of rehabilitation interventions; Comparison, experimental (specific balance intervention) vs control (no intervention/no specific balance intervention); Outcome, balance clinical scales; Study Design, randomised controlled trials. We conducted a random effects dose-response meta-analysis to assess linear trend estimations and a one stage linear mixed effects meta-regression for estimating dose-response curves. RESULTS We retrieved 196 studies from a list of 5020 for full text review and 71 studies (n subjects=3306) were included. One study was a cross-over and 70 studies were randomized controlled trials and the mean sample size per study was 46.5 ± 28.6 (mean±SD) with a mean age of 48.3 ± 7.8years, disease duration of 11.6 ± 6.1years, and EDSS of 4.4 ± 1.4points. Twenty-nine studies (40.8%) had the balance outcome as the primary outcome, while 42 studies (59.1%) had balance as secondary outcome or did not specify primary and secondary outcomes. Thirty-three trials (46.5%) had no active intervention as comparator and 38 trials (53.5%) had an active control group. Individual level data from 20 studies (n subjects=1016) were analyzed showing a medium pooled effect size for balance interventions (SMD=0.41; 95% CIs 0.22 to 0.59). Moreover, we analyzed 14 studies (n subjects=696) having balance as primary outcome and BBS as primary endpoint yielding a mean difference of 3.58 points (95% CIs 1.79 to 5.38, p<0.0001). Finally, we performed meta regression of the 20 studies showing an association between better outcome, log of intensity defined as minutes per session (β=1.26; SEβ=0.51; p = 0.02) and task-oriented intervention (β=0.38; SEβ=0.17; p = 0.05). CONCLUSION Our analyses provide level 1 evidence on the effect of balance intervention to improve mobility. Furthermore, according to principles of neurological rehabilitation, high intensity and task-specific interventions are associated with better treatment outcomes.
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Wolf S, Zanker J, Sommer F, Vlasenko D, Pinto DRM, Hoffmann M, Anthuber M, Schrempf MC. Immersive virtual reality fitness games for enhancement of recovery after colorectal surgery: study protocol for a randomised pilot trial. Pilot Feasibility Stud 2022; 8:256. [PMID: 36514093 PMCID: PMC9745969 DOI: 10.1186/s40814-022-01213-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Physical inactivity after surgery is an important risk factor for postoperative complications. Compared to conventional physiotherapy, activity-promoting video games are often more motivating and engaging for patients with physical impairments. This effect could be enhanced by immersive virtual reality (VR) applications that visually, aurally and haptically simulate a virtual environment and provide a more interactive experience. The use of VR-based fitness games in the early postoperative phase could contribute to improved mobilisation and have beneficial psychological effects. Currently, there is no data on the use of VR-based fitness games in the early postoperative period after colorectal surgery. METHODS This pilot trial features a single-centre, randomised, two-arm study design with a 1:1 allocation. Patients undergoing elective abdominal surgery for colorectal cancer or liver metastases of colorectal cancer will be recruited. Participants will be randomly assigned to an intervention group or a control group. Patients randomised to the intervention group will perform immersive virtual reality-based fitness exercises during their postoperative hospital stay. Feasibility and clinical outcomes will be assessed. DISCUSSION Early mobilisation after surgery is crucial for reducing many postoperative complications. VR-based interventions are easy to use and often inexpensive, especially compared to interventions that require more medical staff and equipment. VR-based interventions could serve as an alternative or complement to regular physiotherapy and enhance mobilisation after surgery. The proposed pilot study will be the first step to evaluate the feasibility of VR-based interventions in the perioperative period, with the aim of improving the postoperative rehabilitation of cancer patients. TRIAL REGISTRATION The trial has been registered in the German Clinical Trials Register (DRKS) Nr. DRKS00024888 , on April 13, 2021, WHO Universal Trial Number (UTN) U1111-1261-5968.
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Affiliation(s)
- Sebastian Wolf
- grid.419801.50000 0000 9312 0220Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Johannes Zanker
- grid.419801.50000 0000 9312 0220Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Florian Sommer
- grid.419801.50000 0000 9312 0220Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Dmytro Vlasenko
- grid.419801.50000 0000 9312 0220Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - David R. M. Pinto
- grid.419801.50000 0000 9312 0220Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Michael Hoffmann
- grid.419801.50000 0000 9312 0220Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Matthias Anthuber
- grid.419801.50000 0000 9312 0220Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Matthias C. Schrempf
- grid.419801.50000 0000 9312 0220Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
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Gaemelke T, Frandsen JJ, Hvid LG, Dalgas U. Participant characteristics of existing exercise studies in persons with multiple sclerosis - A systematic review identifying literature gaps. Mult Scler Relat Disord 2022; 68:104198. [PMID: 36257149 DOI: 10.1016/j.msard.2022.104198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exercise is a cornerstone in rehabilitation of persons with multiple sclerosis (pwMS), which is known to elicit beneficial effects on various symptoms and to have a potential disease-modifying effect. However, it remains to be elucidated if the existing MS exercise literature covers the full age and disability span of pwMS. OBJECTIVE To systematically review MS exercise studies and provide a detailed mapping of the demographic and clinical characteristics of the included pwMS. METHODS A systematic review of MS exercise studies were performed using MEDLINE and EMBASE. From the resulting MS exercise studies, mean sample characteristics were extracted. RESULTS 4576 records were identified, from which 202 studies were included. Of these, 166 studies (82.2%) enrolled pwMS aged 35-54 years, 10.9% enrolled pwMS <35 years, and 6.9% enrolled pwMS ≥55 years (only 1.5% enrolled pwMS ≥60 years). A total of 118 studies (58.4%) reported Expanded Disability Status Scale (EDSS), with 88.1% of included pwMS having an EDSS between 2.0 and 6.5, while only one study enrolled pwMS with an EDSS ≥7.0. Finally, 80% of the studies included pwMS having a disease duration of 5-14.5 years. CONCLUSION Exercise studies in pwMS included primarily middle-aged (35-54 years) pwMS having an EDSS of 2.0-6.5 and a disease duration of 5-14.5 years. Few exercise studies were identified in young and older pwMS, in pwMS with mild disability and severe disability, and in pwMS having shorter or longer disease durations. These findings highlight the need for further investigation of exercise in these specific subgroups of pwMS as benefits of exercise might not generalize across subpopulations.
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Affiliation(s)
- Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark.
| | - Jens Jakob Frandsen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
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Aartolahti E, Janhunen M, Katajapuu N, Paloneva J, Pamilo K, Oksanen A, Keemu H, Karvonen M, Luimula M, Korpelainen R, Jämsä T, Mäkelä K, Heinonen A. Effectiveness of Gamification in Knee Replacement Rehabilitation: Protocol for a Randomized Controlled Trial With a Qualitative Approach. JMIR Res Protoc 2022; 11:e38434. [PMID: 36441574 DOI: 10.2196/38434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/03/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Exergames can provide encouraging exercise options. Currently, there is limited evidence regarding home-based exergaming in the postoperative phase of total knee replacement (TKR). OBJECTIVE This study aimed to investigate the effects of a 4-month postoperative home-based exergame intervention with an 8-month follow-up on physical function and symptoms among older persons undergoing TKR compared with home exercise using a standard protocol. In addition, a concurrent embedded design of a mixed methods study was used by including a qualitative component within a quantitative study of exergame effects. METHODS This was a dual-center, nonblinded, two-arm, parallel group randomized controlled trial with an embedded qualitative approach. This study aimed to recruit 100 patients who underwent their first unilateral TKR (aged 60-75 years). Participants were randomized to the exergame or standard home exercise arms. Participants followed a custom-made exergame program independently at their homes daily for 4 months. The primary outcomes at 4 months were function and pain related to the knee using the Oxford Knee Score questionnaire and mobility using the Timed Up and Go test. Other outcomes, in addition to physical function, symptoms, and disability, were game user experience, exercise adherence, physical activity, and satisfaction with the operated knee. Assessments were performed at the preoperative baseline and at 2, 4, and 12 months postoperatively. Exergame adherence was followed from game computers and using a structured diary. Self-reported standard exercise was followed for 4 months of intervention and physical activity was followed for 12 months using a structured diary. Qualitative data on patients' perspectives on rehabilitation and exergames were collected through laddering interviews at 4 and 12 months. RESULTS This study was funded in 2018. Data collection began in 2019 and was completed in January 2022. The COVID-19 pandemic caused an unavoidable situation in the study for recruitment, data collection, and statistical analysis. As of November 2020, a total of 52 participants had been enrolled in the study. Primary results are expected to be published by the end of 2022. CONCLUSIONS Our study provides new knowledge on the effects of postoperative exergame intervention among older patients with TKR. In addition, this study provides a new understanding of gamified postoperative rehabilitation, home exercise adherence, physical function, and physical activity among older adults undergoing TKR. TRIAL REGISTRATION ClinicalTrials.gov NCT03717727; https://clinicaltrials.gov/ct2/show/NCT03717727. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/38434.
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Affiliation(s)
- Eeva Aartolahti
- Institute of Rehabilitation, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Maarit Janhunen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Niina Katajapuu
- Faculty of Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Healthcare District and University of Eastern Finland, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Orthopedics, Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Airi Oksanen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Hannes Keemu
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko Karvonen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Mika Luimula
- Faculty of Business and Engineering, Turku University of Applied Sciences, Turku, Finland
| | - Raija Korpelainen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland.,Research Unit of Population Health, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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12
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Hortobágyi T, Ács P, Baumann P, Borbély G, Áfra G, Reichardt-Varga E, Sántha G, Tollár J. Comparative effectiveness of four exercise interventions followed by two years of exercise maintenance in multiple sclerosis: A randomized control trial. Arch Phys Med Rehabil 2022; 103:1908-1916. [PMID: 35584738 DOI: 10.1016/j.apmr.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/25/2022] [Accepted: 04/20/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine the effects of Exergaming on quality of life (QoL), motor, and clinical symptoms in Multiple Sclerosis. We compared the effects of exergaming (EXE), balance (BAL), cycling (CYC), proprioceptive neuromuscular facilitation (PNF), and a standard care wait-listed control group (CON) on clinical and motor symptoms and quality of life (QoL) in people with MS (PwMS) and determined the effects of subsequent maintenance programs for 2 years in a hospital setting. DESIGN A randomized clinical trial, using before-after test design. SETTINGS University Hospital Setting PARTICIPANTS: Of 82 multiple sclerosis outpatients, 70 were randomized, and 68 completed the study. INTERVENTIONS The initial high-intensity and -frequency interventions consisted of 25, 1-h sessions over 5 weeks. After the 5-wk-long initial intervention, the 2-year-long maintenance programs followed, consisting of 3 sessions per week, each for 1h. MAIN OUTCOME MEASURES The primary outcome: Multiple Sclerosis Impact Scale (MSIS-29). SECONDARY OUTCOMES Measures five aspects of health-related QoL (EQ-5D index), Beck Depression Inventory, six-minute walk test (6MWT), Berg Balance Scale (BBS), Tinetti Assessment Tool (TAT) and static balance (center of pressure, COP). RESULTS MSIS-29 improved most in EXE (11 points), BAL (6), and CYC (6, all p<0.05). QoL improved most in EXE (3 points) and CYC and BAL (2, all p<0.05). TAT and BBS improved significantly (p<0.05) but similarly (p>0.05) in EXE, BAL, and CYC. 6MWT improved most in EXE (57m), BAL (32m), and CYC (19m all p<0.001). Standing sway did not change. Maintenance programs further increased the initial exercise-induced gains, robustly in EXE. CONCLUSION 25 sessions of EXE, BAL, CYC, and PNF, in this order, improved clinical and motor symptoms and QoL and subsequent, 2-y-long thrice weekly maintenance programs further slowed symptom-worsening and improved QoL. EXE was the most and PNF was the least effective to improve clinical symptoms, motor function, and QoL in PwMS.
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Affiliation(s)
- Tibor Hortobágyi
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Hungary; Departments of Epidemiology and Neurosurgery, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Pongrác Ács
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - Petra Baumann
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Department of Dentistry, Oral and Maxillofacial Surgery, Pécs
| | - Gábor Borbély
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - György Áfra
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - Emese Reichardt-Varga
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - Gergely Sántha
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - József Tollár
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Hungary; Széchényi István University, Digital Development Center, Győr, Hungary.
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13
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THE EFFECT OF VIRTUAL REALITY-BASED THERAPY ON FEAR OF FALLING IN MULTIPLE SCLEROSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Mult Scler Relat Disord 2022; 63:103791. [DOI: 10.1016/j.msard.2022.103791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 11/19/2022]
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14
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Pérez-de la Cruz S. Use of Robotic Devices for Gait Training in Patients Diagnosed with Multiple Sclerosis: Current State of the Art. SENSORS 2022; 22:s22072580. [PMID: 35408195 PMCID: PMC9002809 DOI: 10.3390/s22072580] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023]
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease that produces alterations in balance and gait in most patients. Robot-assisted gait training devices have been proposed as a complementary approach to conventional rehabilitation treatment as a means of improving these alterations. The aim of this study was to investigate the available scientific evidence on the benefits of the use of robotics in the physiotherapy treatment in people with MS. A systematic review of randomized controlled trials was performed. Studies from the last five years on walking in adults with MS were included. The PEDro scale was used to assess the methodological quality of the included studies, and the Jadad scale was used to assess the level of evidence and the degree of recommendation. Seventeen studies met the eligibility criteria. For the improvement of gait speed, robotic devices do not appear to be superior, compared to the rest of the interventions evaluated. The methodological quality of the studies was moderate–low. For this reason, robot-assisted gait training is considered just as effective as conventional rehabilitation training for improving gait in people with MS.
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Affiliation(s)
- Sagrario Pérez-de la Cruz
- Department of Nursing, Physical Therapy and Medicine, University of Almería, Carretera de Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain
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15
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Abou L, Qin K, Alluri A, Du Y, Rice LA. The effectiveness of physical therapy interventions in reducing falls among people with multiple sclerosis: A systematic review and meta-analysis. J Bodyw Mov Ther 2022; 29:74-85. [DOI: 10.1016/j.jbmt.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/16/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
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16
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García-Muñoz C, Casuso-Holgado MJ, Hernández-Rodríguez JC, Pinero-Pinto E, Palomo-Carrión R, Cortés-Vega MD. Feasibility and safety of an immersive virtual reality-based vestibular rehabilitation programme in people with multiple sclerosis experiencing vestibular impairment: a protocol for a pilot randomised controlled trial. BMJ Open 2021; 11:e051478. [PMID: 34810187 PMCID: PMC8609940 DOI: 10.1136/bmjopen-2021-051478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Vestibular system damage in patients with multiple sclerosis (MS) may have a central and/or peripheral origin. Subsequent vestibular impairments may contribute to dizziness, balance disorders and fatigue in this population. Vestibular rehabilitation targeting vestibular impairments may improve these symptoms. Furthermore, as a successful tool in neurological rehabilitation, immersive virtual reality (VRi) could also be implemented within a vestibular rehabilitation intervention. METHODS AND ANALYSIS This protocol describes a parallel-arm, pilot randomised controlled trial, with blinded assessments, in 30 patients with MS with vestibular impairment (Dizziness Handicap Inventory ≥16). The experimental group will receive a VRi vestibular rehabilitation intervention based on the conventional Cawthorne-Cooksey protocol; the control group will perform the conventional protocol. The duration of the intervention in both groups will be 7 weeks (20 sessions, 3 sessions/week). The primary outcomes are the feasibility and safety of the vestibular VRi intervention in patients with MS. Secondary outcome measures are dizziness symptoms, balance performance, fatigue and quality of life. Quantitative assessment will be carried out at baseline (T0), immediately after intervention (T1), and after a follow-up period of 3 and 6 months (T2 and T3). Additionally, in order to further examine the feasibility of the intervention, a qualitative assessment will be performed at T1. ETHICS AND DISSEMINATION The study was approved by the Andalusian Review Board and Ethics Committee, Virgen Macarena-Virgen del Rocio Hospitals (ID 2148-N-19, 25 March 2020). Informed consent will be collected from participants who wish to participate in the research. The results of this research will be disseminated by publication in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT04497025.
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Affiliation(s)
| | | | | | | | - Rocío Palomo-Carrión
- Department of Nursery, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain
- GIFTO, Physiotherapy Research Group, Toledo, Spain
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17
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Sadeghi H, Jehu DA, Daneshjoo A, Shakoor E, Razeghi M, Amani A, Hakim MN, Yusof A. Effects of 8 Weeks of Balance Training, Virtual Reality Training, and Combined Exercise on Lower Limb Muscle Strength, Balance, and Functional Mobility Among Older Men: A Randomized Controlled Trial. Sports Health 2021; 13:606-612. [PMID: 33583253 PMCID: PMC8558995 DOI: 10.1177/1941738120986803] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Poor muscle strength, balance, and functional mobility have predicted falls in older adults. Fall prevention guidelines recommend highly challenging balance training modes to decrease falls; however, it is unclear whether certain modes are more effective. The purpose of this study was to determine whether traditional balance training (BT), virtual reality balance training (VR), or combined exercise (MIX) relative to a waitlist control group (CON) would provoke greater improvements in strength, balance, and functional mobility as falls risk factor proxies for falls in older men. HYPOTHESIS We hypothesized that 8 weeks of MIX will provoke the greatest improvements in falls risk factors, followed by similar improvements after BT and VR, relative to the CON. STUDY DESIGN Single-blinded randomized controlled trial NCT02778841 (ClinicalTrials.gov identifier). LEVEL OF EVIDENCE Level 2. METHODS In total, 64 community-dwelling older men (age 71.8 ± 6.09 years) were randomly assigned into BT, VR, MIX, and CON groups and tested at baseline and at the 8-week follow-up. The training groups exercised for 40 minutes, 3 times per week, for 8 weeks. Isokinetic quadriceps and hamstrings strength on the dominant and nondominant legs were primary outcomes measured by the Biodex Isokinetic Dynamometer. Secondary outcomes included 1-legged stance on firm and foam surfaces, tandem stance, the timed-up-and-go, and gait speed. Separate one-way analyses of covariance between groups were conducted for each outcome using baseline scores as covariates. RESULTS (1) MIX elicited greater improvements in strength, balance, and functional mobility relative to BT, VR, and CON; (2) VR exhibited better balance and functional mobility relative to BT and CON; and (3) BT demonstrated better balance and functional mobility relative to CON. CONCLUSION The moderate to large effect sizes in strength and large effect sizes for balance and functional mobility underline that MIX is an effective method to improve falls risk among older adults. CLINICAL RELEVANCE This study forms the basis for a larger trial powered for falls.
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Affiliation(s)
- Hassan Sadeghi
- Department of Biomechanics and Sports
Injuries, Faculty of Physical Education and Sports Sciences, Kharazmi University,
Tehran, Iran
- Department of Sports Studies, Faculty of
Educational Studies, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Deborah A. Jehu
- Aging, Mobility and Cognitive
Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine,
University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility,
Vancouver Coastal Health Research Institute, Vancouver, British Columbia,
Canada
- Djavad Mowafaghian Centre for Brain
Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia,
Canada
| | - Abdolhamid Daneshjoo
- Department of Sports Injuries and
Corrective Exercises, Faculty of Sports Sciences, Shahid Bahonar University of
Kerman, Kerman, Iran
| | - Elham Shakoor
- Department of Physical Education and
Sport Sciences, School of Education and Psychology, Shiraz University, Shiraz,
Iran
- Shiraz Geriatric Research Center,
Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- School of Rehabilitation Sciences,
Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Amani
- Faculty of Sports Science, Shomal
University, Amol, Iran
| | - Muhammad Nazrul Hakim
- Department of Biomedical Sciences,
Faculty of Medicine and Health Sciences, Universiti Putra, Serdang, Selangor,
Malaysia
| | - Ashril Yusof
- Centre for Sports and Exercise
Sciences, University of Malaya, Kuala Lumpur, Malaysia
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Ong DSM, Weibin MZ, Vallabhajosyula R. Serious games as rehabilitation tools in neurological conditions: A comprehensive review. Technol Health Care 2021; 29:15-31. [PMID: 32804107 DOI: 10.3233/thc-202333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of serious games (SG) in rehabilitation has been on the rise in recent years and they are used as either a main interventional tool, or as an adjunct alongside conventional therapies. This is largely due to its virtue of being an electronic platform hence possessing game characteristics that facilitates patient progress. OBJECTIVE The present study aimed to provide a comprehensive review of the impact of SG on neurorehabilitation therapies as well as patients' perspectives on rehabilitation. METHODS The literature search was conducted in PubMed and Cochrane databases. The study was conducted in four different phases, consisting of the generation of MeSH terms and keywords, screening of articles, and data analysis based on the study characteristics. RESULTS This review included 47 studies that explored the use of custom designed experimental serious games (ESG) or commercially designed serious games (CSG) for rehabilitation in a few neurological conditions. The majority of CSG used Nintendo Wii as an adjunct to conventional therapies. Significant improvement in the primary outcomes such as motor functioning, balance, executive and cognitive functions were reported in 35 studies. 17 studies also indicated patient perspectives on rehabilitation. There was no difference between the overall impact of either CSG or ESG. CONCLUSION Evidently, SG are efficient exergame tools. However, future studies should explore patient perspectives that could help to design evidence-based games for rehabilitation purposes.
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Hoang PD, Lord S, Gandevia S, Menant J. Exercise and Sports Science Australia (ESSA) position statement on exercise for people with mild to moderate multiple sclerosis. J Sci Med Sport 2021; 25:146-154. [PMID: 34538565 DOI: 10.1016/j.jsams.2021.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS), the most common chronic and progressive neurological condition of the central nervous system, affects 26,000 Australian adults. Exercise training has beneficial effects on MS-related impairments including reduced muscular strength, poor aerobic capacity and impaired mobility, and in consequence can improve quality of life. This Position Statement provides evidence-based recommendations for exercise prescription and delivery of exercise training for people with MS with mild to moderate disability. DESIGN AND METHODS Synthesis of published works within the field of exercise training in MS. RESULTS Exercise provides many benefits to people with MS. There is strong evidence that resistance and aerobic training, performed 2 to 3 times per week at a moderate intensity, are safe and can improve muscle strength, cardiorespiratory fitness, balance, fatigue, functional capacity, mobility and quality of life in people with MS with mild to moderate disability (Expanded Disease Severity Scale (EDSS) ≤ 6.5). However, the evidence for those with severe disability (EDSS >6.5) is less clear. The effects of exercise on MS pathogenesis, central nervous structures and other outcomes such as depression and cognitive impairment, have not been adequately investigated. Effective exercise interventions to improve balance, joint contractures and reduce falls in people with MS are also urgently needed as well as investigations of long-term (≥1 year) effects of exercise training. CONCLUSIONS Resistance and aerobic training exercises are effective to alleviate some characteristic signs and symptoms in MS and should be supplemented by balance exercise to prevent falls. Exercise training programs should be prescribed and delivered by qualified exercise professionals. It is important to recognise and accommodate exercise-associated complications such as fatigue and heat sensitivity.
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Affiliation(s)
- Phu D Hoang
- Neuroscience Research Australia (NeuRA), Australia; Australian Catholic University, Australia; Multiple Sclerosis Limited, Australia; School of Population Health, University of New South Wales, Australia.
| | - Stephen Lord
- Neuroscience Research Australia (NeuRA), Australia; School of Population Health, University of New South Wales, Australia
| | | | - Jasmine Menant
- Neuroscience Research Australia (NeuRA), Australia; School of Population Health, University of New South Wales, Australia
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20
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Sawa R, Saitoh M, Morisawa T, Takahashi T, Morimoto Y, Kagiyama N, Kasai T, Dinesen B, Daida H. Potential of Commercially Available Active Video Game for Application to Cardiac Rehabilitation: A Scoping Review (Preprint). JMIR Serious Games 2021; 10:e31974. [PMID: 35302503 PMCID: PMC8976248 DOI: 10.2196/31974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/04/2022] [Accepted: 01/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background Commercially available active video games (AVGs) have recently been used for rehabilitation in some specific patient populations but rarely in those with cardiovascular disease (CVD). Commercially available AVGs are designed to increase motivation for continuous play, which could be applicable to the long-term cardiac rehabilitation process. Objective The objective of this scoping review was to assess the effectiveness of AVG-induced physical exercise, safety management, and patient adherence by applying commercially available AVGs to cardiac rehabilitation. Methods Four databases (CINAHL, MEDLINE, PubMed, and SPORTDiscus) were searched for all years up to August 12, 2020. Articles were retained if they were written in English, included patients with CVD who were aged 18 years or older, and used AVGs as part of a physical exercise program. The included studies were then evaluated from the viewpoints of effectiveness as physical exercise, safety, and adherence management. Results Among 120 nonduplicate articles reviewed, 5 (4.2%) were eligible for inclusion, of which 3 (2.5%) were reported by the same research group. The AVG consoles used were Xbox Kinect and Nintendo Wii, and sports-related programs were adopted for the intervention. No adverse cardiac events occurred in the identified studies, and dropout rates tended to be low. Conclusions AVGs appear to be safe and feasible for promoting an active lifestyle in patients with CVD. However, the effectiveness of AVGs alone as a therapeutic exercise to improve physical function may be limited.
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Affiliation(s)
- Ryuichi Sawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Department of Digital Health and Telemedicine Research and Development, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Yuh Morimoto
- Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine Research and Development, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Digital Health and Telemedicine Research and Development, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Birthe Dinesen
- Laboratory for Welfare Technologies - Telehealth & Telerehabilitation, Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hiroyuki Daida
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Department of Digital Health and Telemedicine Research and Development, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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21
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Effects on gait and balance of home-based active video game interventions in persons with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2021; 51:102928. [PMID: 33845351 PMCID: PMC9764369 DOI: 10.1016/j.msard.2021.102928] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The current coronavirus disease (COVID-19) pandemic makes it difficult to obtain physical therapy in rehabilitation centres, particularly for persons with multiple sclerosis (pwMS), who are a population at high risk, since viral infections may contribute to MS exacerbations and relapses. Active video games could be a way to maintain physical therapy at home as part of the rehabilitation. The aim of this review is to summarise the current best evidence for the effectiveness of home-based active video games on gait and balance, user compliance, feasibility and safety for pwMS. METHODS We searched for studies in five databases (PubMed, Scopus, Cochrane, CINAHL and Science direct) up to October 2020. Selection of studies, extraction of data and methodological quality assessment through the PEDro scale were made independently by two authors and discussed with a third author. RESULTS Nine studies were included in this systematic review. We found significant improvements in balance; results were mixed concerning mobility, physical activity and gait. Home-based active video games are feasible and safe, with good compliance and adherence. The methodological quality of the studies was moderate (PEDro scale: 5.3 ± 2). CONCLUSION Overall, home-based active video games were found safe and effective improving static and dynamic balance in pwMS. Compliance was good, probably because it is a motivating and enjoyable training. Active video games can be a relevant alternative for physical rehabilitation at home in pwMS. Future studies should follow more rigorous methodological standards (larger sample sizes, more randomised controlled trials) to improve the quality of evidence and include cost-effectiveness in the analysis.
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Schättin A, Häfliger S, Meyer A, Früh B, Böckler S, Hungerbühler Y, de Bruin ED, Frese S, Steinlin Egli R, Götz U, Bauer R, Martin-Niedecken AL. Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies. JMIR Serious Games 2021; 9:e22826. [PMID: 33960956 PMCID: PMC8140386 DOI: 10.2196/22826] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Patients with MS experience a wide range of physical and cognitive dysfunctions that affect their quality of life. A promising training approach that concurrently trains physical and cognitive functions is video game-based physical exercising (ie, exergaming). Previous studies have indicated that exergames have positive effects on balance and cognitive functions in patients with MS. However, there is still a need for specific, user-centered exergames that function as a motivating and effective therapy tool for patients with MS and studies investigating their usability and feasibility. OBJECTIVE The aim of this interdisciplinary research project is to develop usable and feasible user-centered exergames for the pressure-sensitive plate Dividat Senso by incorporating theoretical backgrounds from movement sciences, neuropsychology, and game research as well as participatory design processes. METHODS Focus groups (patients and therapists) were set up to define the user-centered design process. This was followed by the field testing of newly developed exergame concepts. Two sequential usability and feasibility studies were conducted on patients with MS. The first study included a single exergaming session followed by measurements. Between the first and second studies, prototypes were iterated based on the findings. The second study ran for 4 weeks (1-2 trainings per week), and measurements were taken before and after the intervention. For each study, participants answered the System Usability Scale (SUS; 10 items; 5-point Likert Scale; score range 0-100) and interview questions. In the second study, participants answered game experience-related questionnaires (Flow Short Scale [FSS]: 13 items; 7-point Likert Scale; score range 1-7; Game Flow questionnaire: 17 items; 6-point Likert Scale; score range 1-6). Mixed methods were used to analyze the quantitative and qualitative data. RESULTS In the first study (N=16), usability was acceptable, with a median SUS score of 71.3 (IQR 58.8-80.0). In the second study (N=25), the median SUS scores were 89.7 (IQR 78.8-95.0; before) and 82.5 (IQR 77.5-90.0; after), and thus, a significant decrease was observed after training (z=-2.077; P=.04; r=0.42). Moreover, high values were observed for the overall FSS (pre: median 5.9, IQR 4.6-6.4; post: median 5.8, IQR 5.4-6.2) and overall Game Flow Questionnaire (pre: median 5.0, IQR 4.7-5.3; post: median 5.1, IQR 4.9-5.3). A significant decrease was observed in the item perceived importance (FSS: z=-2.118; P=.03; r=0.42). Interviews revealed that user-centered exergames were usable, well accepted, and enjoyable. Points of reference were identified for future research and development. CONCLUSIONS The project revealed that the newly developed, user-centered exergames were usable and feasible for patients with MS. Furthermore, exergame elements should be considered in the development phase of user-centered exergames (for patients with MS). Future studies are needed to provide indications about the efficacy of user-centered exergames for patients with MS.
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Affiliation(s)
- Alexandra Schättin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Stephan Häfliger
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Alain Meyer
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Barbara Früh
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Sonja Böckler
- Department of Design, Subject Area in Game Design, Zurich University of the Arts, Zurich, Switzerland
| | - Yannic Hungerbühler
- Department of Design, Subject Area in Game Design, Zurich University of the Arts, Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Sebastian Frese
- Technology and Innovation Unit and Department of Research, ZURZACH Care, Bad Zurzach, Switzerland
| | | | - Ulrich Götz
- Department of Design, Subject Area in Game Design, Zurich University of the Arts, Zurich, Switzerland
| | - René Bauer
- Department of Design, Subject Area in Game Design, Zurich University of the Arts, Zurich, Switzerland
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Comparison of the cardio-respiratory response of a training session on cycloergometer or treadmill versus an Adapted Physical Activity session on Nintendo Wii, in patients with chronic respiratory disease. Respir Med Res 2021; 79:100827. [PMID: 33991802 DOI: 10.1016/j.resmer.2021.100827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/15/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES During a pulmonary rehabilitation program (PRP), patients frequently report that the classically proposed activities (as cycloergometer or treadmill) are not playful. The goal of adapted physical activities is to maintain physical activity that is more playful for patients. The Nintendo Wii Gaming Console allows a playful physical activity. However, it seems important to know if this tool allows physical activity with an effective cardiorespiratory effect. The objective was to compare the cardiorespiratory response of a 30-minute training session on cycloergometer (C) and treadmill (T) versus a 30-minute training session with Wii. METHODS Patients admitted to the PR unit of Brest University Hospital (France) were eligible for this randomized study if they had a chronic pulmonary disease. The endpoints were heart rate (HR), pulse oxymetry, dyspnea, lower limb penibility and pleasure felt. RESULTS Twenty patients were prospectively included. HR was significantly higher at the end of the Wii session in comparison with C session (P=0.001); there was no significant difference in HR between Wii and T. We found no significant difference for dyspnea and lower limb penibility between Wii and C (respectively P=0.8 and P=0.7) and between Wii and T (respectively P=0.96 and P=0.5). The pleasure felt was significantly greater during Wii compared to C and T (respectively P=0.001 and P=0.001). CONCLUSIONS Exercise training using Wii with identifiable games require higher HR at the end of the session compared to C and a similar cardiorespiratory response compared to T with the same dyspnea and lower limb exertion and with a pleasure felt significantly higher. Wii can be used for exercise training during PRP.
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Martino Cinnera A, Bisirri A, Leone E, Morone G, Gaeta A. Effect of dual-task training on balance in patients with multiple sclerosis: A systematic review and meta-analysis. Clin Rehabil 2021; 35:1399-1412. [PMID: 33874763 DOI: 10.1177/02692155211010372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effects of dual-task training on static and dynamic balance in patients with multiple sclerosis. DATA SOURCES PubMed/MEDLINE, EMBASE, Scopus, and PEDro databases were searched from inception to March 1, 2021. METHODS This study was conducted in agreement with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers assessed studies for inclusion and extracted data. We used the Physiotherapy Evidence Database scale to evaluate the methodological quality and the risk-of-bias. Randomized clinical trial data were pooled for the meta-analysis. The effect sizes and 95% confidence interval (CI) were calculated by random-effect models. Egger regression and Begg-Mazumdar rank correlation test were used for publication bias. RESULTS A total of 13 studies involving 584 patients (42.3 ± 9 years mean ± SD; 377 females) met the inclusion criteria for the systematic review, while nine were included in the meta-analysis. People who received dual-task training interventions showed significant improvements in the Timed Up & Go test 0.44 [(95% CI = 0.22; 0.65), P-value<0.001], and in the Berg Balance scale 0.46 [(95% CI = 0.07; 0.85), P-value = 0.02]. Low and moderate heterogeneity between the studies was found for the Timed Up & Go test and the Berg Balance scale, respectively. CONCLUSION The findings from the current meta-analysis support dual-task training as a beneficial therapy for improving dynamic balance and functional mobility in patients with multiple sclerosis. The limited number of studies that investigated static balance performance after dual-task training do not currently allow us to draw a conclusion about any possible improvements in this ability.
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Affiliation(s)
- Alex Martino Cinnera
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Alessio Bisirri
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Enza Leone
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Giovanni Morone
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Angela Gaeta
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy
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Abstract
Home-based teleworking, associated with sedentary behavior, may impair self-reported adult health status. Current exercise recommendations, based on universal recipes, may be insufficient or even misleading to promote healthy teleworking. From the Network Physiology of Exercise perspective, health is redefined as an adaptive emergent state, product of dynamic interactions among multiple levels (from genetic to social) that cannot be reduced to a few dimensions. Under such a perspective, fitness development is focused on enhancing the individual functional diversity potential, which is better achieved through varied and personalized exercise proposals. This paper discusses some myths related to ideal or unique recommendations, like the ideal exercise or posture, and the contribution of recent computer technologies and applications for prescribing exercise and assessing fitness. Highlighting the need for creating personalized working environments and strengthening the active contribution of users in the process, new recommendations related to teleworking posture, home exercise counselling, exercise monitoring and to the roles of healthcare and exercise professionals are proposed. Instead of exercise prescribers, professionals act as co-designers that help users to learn, co-adapt and adequately contextualize exercise in order to promote their somatic awareness, job satisfaction, productivity, work–life balance, wellbeing and health.
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Lopez LP, Palmero NV, Ruano LG, San Leon Pascual C, Orile PW, Down AV, Gor Garcia-Fogeda MD, Toré S. The implementation of a reflex locomotion program according to Vojta produces short-term automatic postural control changes in patients with multiple sclerosis. J Bodyw Mov Ther 2021; 26:401-405. [PMID: 33992274 DOI: 10.1016/j.jbmt.2021.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 12/28/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Imbalance is common in people with multiple sclerosis. OBJECTIVE To examine the effectiveness of a Vojta locomotion reflex program as short-term automatic postural control in patients with Multiple sclerosis. METHODS Quasi-experimental controlled trial with a pretest-post-test design. PARTICIPANTS People with Multiple Sclerosis (N = 21) able to walk 100 m but unable to maintain 30-s tandem stance with arms alongside the body. INTERVENTION in two consecutive weeks two interventions were conducted: Vojta group(A) and standard therapy group(B). Primary outcome were: Berg Balance scale (BBS), Tandem test, 10 m Walk in the 1st session (pre and post) then at the end of the study 2 weeks later. RESULTS Intervention A had significant results in contrast to intervention B in BBS when referred to equilibrium variables (p = 0.026) and Tandem test (p = 0.01). In the 10 m Walk test a significant improvement was seen in both interventions, p = 0.00 in group A, p = 0.038 in group B. In addition, an association was found between the variable Core activation and the main equilibrium variable (BBS) in the intervention A. CONCLUSIONS The results suggest that Vojta therapy has a short-term effect improved balance in everyday skills according to BBS and the other tests (walking) in people with MS compared to a standard therapeutic procedure. www.ClinicalTrial.gov. REGISTRATION NUMBER NCT03887507.
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Affiliation(s)
| | | | | | | | | | | | | | - Silvia Toré
- Multiple Sclerosis Foundation from Madrid, Spain
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Cugusi L, Prosperini L, Mura G. Exergaming for Quality of Life in Persons Living with Chronic Diseases: A Systematic Review and Meta-analysis. PM R 2020; 13:756-780. [PMID: 32592238 DOI: 10.1002/pmrj.12444] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the evidence of effectiveness of exergame-based rehabilitative interventions on health-related quality of life (HRQoL) in persons with chronic diseases. TYPE: Systematic review and meta-analysis. LITERATURE SURVEY Randomized and nonrandomized controlled trials of exergame rehabilitation interventions in populations with chronic diseases reporting HRQoL outcomes were identified by searching PubMed, Scopus, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, using keywords and MeSH terms for papers published between January 2005 and March 2019. METHODOLOGY Risk of bias was assessed by using the PEDro scale. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system was used to score the quality of evidence. Pooled effects were reported as standardized mean differences (SMDs) or weighted mean difference (MDs) and 95% confidence intervals (CIs), using a random-effects model. Heterogeneity was weighted by inconsistency I2 tests. SYNTHESIS Thirty-four trials were identified (1594 participants). Overall, the evidence was low quality. Exergames significantly improved HRQoL in populations with chronic diseases, with a small effect size (32 studies; 1544 participants; SMD 0.24; 95% CI 0.1 to 0.4; I2 = 27%) and specifically in people with neurological disorders (20 studies, 956 participants, SMD 0.22; 95% CI 0.2 to 0.4; I2 = 49%), rheumatologic diseases (four studies, 210 participants, SMD 0.39; 95% CI 0.1 to 0.7; I2 = 4%), and cardiorespiratory and chronic metabolic conditions (five studies, 309 participants, SMD 0.23; 95% CI 0.0 to 0.5; I2 = 0%). Exergaming interventions in health care settings demonstrated similarly small but positive effects (22 studies, 905 participants, SMD 0.30; 95% CI 0.1 to 0.5; I2 = 41%), whereas those carried out in home-based contexts did not. CONCLUSIONS Exergame-based rehabilitative interventions performed in health care settings led to small but statistically significant improvements in HRQoL in persons with chronic diseases.
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Affiliation(s)
- Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Luca Prosperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Gioia Mura
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Halbrook YJ, O'Donnell AT, Msetfi RM. When and How Video Games Can Be Good: A Review of the Positive Effects of Video Games on Well-Being. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 14:1096-1104. [PMID: 31672105 DOI: 10.1177/1745691619863807] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Video games are a source of entertainment for a wide population and have varied effects on well-being. The purpose of this article is to comprehensively examine game-play research to identify the factors that contribute to these disparate well-being outcomes and to highlight the potential positive effects. On the basis of existing literature, we argue that the effects of gaming on well-being are moderated by other variables, such as motivations for gaming and video-game characteristics. Specifically, the inclusion of social activity can benefit prosocial behaviors and affect the relationship between violent video games and aggression that some studies have demonstrated. Moreover, the research on the relationship between violent video games and aggression depends greatly on individual and sociocontextual variables outside of game play. The inclusion of physical activity in games can provide an improvement in physical health with high levels of enjoyment, potentially increasing adherence rates. Overall, following our review, we determined that the effects of gaming on well-being are moderated by and depend on the motivation for gaming, outside variables, the presence of violence, social interaction, and physical activity. Thus, we argue that there is potential for an "optimal gaming profile" that can be used in the future for both academic- and industry-related research.
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Affiliation(s)
- Yemaya J Halbrook
- Centre for Social Issues Research, Department of Psychology, University of Limerick in Limerick, Ireland
| | - Aisling T O'Donnell
- Centre for Social Issues Research, Department of Psychology, University of Limerick in Limerick, Ireland
| | - Rachel M Msetfi
- Health Research Institute, University of Limerick in Limerick, Ireland
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Ozkul C, Guclu-Gunduz A, Yazici G, Atalay Guzel N, Irkec C. Effect of immersive virtual reality on balance, mobility, and fatigue in patients with multiple sclerosis: A single-blinded randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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De Sanctis P, Malcolm BR, Mabie PC, Francisco AA, Mowrey WB, Joshi S, Molholm S, Foxe JJ. Mobile Brain/Body Imaging of cognitive-motor impairment in multiple sclerosis: Deriving EEG-based neuro-markers during a dual-task walking study. Clin Neurophysiol 2020; 131:1119-1128. [PMID: 32200093 DOI: 10.1016/j.clinph.2020.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Individuals with a diagnosis of multiple sclerosis (MS) often present with cognitive and motor deficits, and thus the ability to perform tasks that rely on both domains may be particularly impaired. Yet, dual-task walking studies yield mixed results. Individual variance in the ability to cope with brain insult and mobilize additional brain resources may contribute to mixed findings. METHODS To test this hypothesis, we acquired event-related potentials (ERP) in individuals with MS and healthy controls (HCs) performing a Go/NoGo task while sitting (i.e., single task) or walking (i.e., dual-task) and looked at the relationship between task related modulation of the brain response and performance. RESULTS On the Go/NoGo task the MS group showed dual-task costs when walking, whereas HCs showed a dual-task benefit. Further, whereas the HC group showed modulation of the brain response as a function of task load, this was not the case in the MS group. Analysis for the pooled sample revealed a positive correlation between load-related ERP effects and dual-task performance. CONCLUSIONS These data suggest a neurophysiological marker of cognitive-motor dysfunction in MS. SIGNIFICANCE Understanding neural processes underlying dual-task walking will help identify objective brain measurements of real-world issues and may improve assessment of MS.
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Affiliation(s)
- Pierfilippo De Sanctis
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA; The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
| | - Brenda R Malcolm
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA
| | - Peter C Mabie
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ana A Francisco
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA
| | - Wenzhu B Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sonja Joshi
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA
| | - Sophie Molholm
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA; The Dominick P. Purpura Department of Neuroscience, Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; The Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - John J Foxe
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA; The Dominick P. Purpura Department of Neuroscience, Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; The Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
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TOLLÁR JÓZSEF, NAGY FERENC, TÓTH BÉLAE, TÖRÖK KATALIN, SZITA KINGA, CSUTORÁS BENCE, MOIZS MARIANN, HORTOBÁGYI TIBOR. Exercise Effects on Multiple Sclerosis Quality of Life and Clinical–Motor Symptoms. Med Sci Sports Exerc 2019; 52:1007-1014. [DOI: 10.1249/mss.0000000000002228] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Hayes S, Galvin R, Kennedy C, Finlayson M, McGuigan C, Walsh CD, Coote S. Interventions for preventing falls in people with multiple sclerosis. Cochrane Database Syst Rev 2019; 11:CD012475. [PMID: 31778221 PMCID: PMC6953359 DOI: 10.1002/14651858.cd012475.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is one of the most prevalent diseases of the central nervous system with recent prevalence estimates indicating that MS directly affects 2.3 million people worldwide. Fall rates of 56% have been reported among people with MS in a recent meta-analysis. Clinical guidelines do not outline an evidence-based approach to falls interventions in MS. There is a need for synthesised information regarding the effectiveness of falls prevention interventions in MS. OBJECTIVES The aim of this review was to evaluate the effectiveness of interventions designed to reduce falls in people with MS. Specific objectives included comparing: (1) falls prevention interventions to controls and; (2) different types of falls prevention interventions. SEARCH METHODS We searched the Trials Register of the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group, Cochrane Central Register of Controlled Trials (2018 Issue 9); MEDLINE (PubMed) (1966 to 12 September 2018); Embase (EMBASE.com) (1974 to 12 September 2018); Cumulative Index to Nursing and Allied Health Literature (EBSCOhost) (1981 to 12 September 2018); Latin American and Caribbean Health Science Information Database (Bireme) (1982 to 12 September 2018); ClinicalTrials.gov; and World Health Organization International Clinical Trials Registry Platform; PsycINFO (1806 to 12 September 2018; and Physiotherapy Evidence Database (1999 to 12 September 2018). SELECTION CRITERIA We selected randomised controlled trials or quasi-randomised trials of interventions to reduce falls in people with MS. We included trials that examined falls prevention interventions compared to controls or different types of falls prevention interventions. Primary outcomes included: falls rate, risk of falling, number of falls per person and adverse events. DATA COLLECTION AND ANALYSIS Two review authors screened studies for selection, assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval to compare falls rate between groups. For risk of falling, we used a risk ratio (RR) and 95% CI based on the number of fallers in each group. MAIN RESULTS A total of 839 people with MS (12 to 177 individuals) were randomised in the 13 included trials. The mean age of the participants was 52 years (36 to 62 years). The percentage of women participants ranged from 59% to 85%. Studies included people with all types of MS. Most trials compared an exercise intervention with no intervention or different types of falls prevention interventions. We included two comparisons: (1) Falls prevention intervention versus control and (2) Falls prevention intervention versus another falls prevention intervention. The most common interventions tested were exercise as a single intervention, education as a single intervention, functional electrical stimulation and exercise plus education. The risk of bias of the included studies mixed, with nine studies demonstrating high risk of bias related to one or more aspects of their methodology. The evidence was uncertain regarding the effects of exercise versus control on falls rate (RaR of 0.68; 95% CI 0.43 to 1.06; very low-quality evidence), number of fallers (RR of 0.85; 95% CI 0.51 to 1.43; low-quality evidence) and adverse events (RR of 1.25; 95% CI 0.26 to 6.03; low-quality evidence). Data were not available on quality of life outcomes comparing exercise to control. The majority of other comparisons between falls interventions and controls demonstrated no evidence of effect in favour of either group for all primary outcomes. For the comparison of different falls prevention interventions, the heterogeneity of intervention types across studies prohibited the pooling of data. In relation to secondary outcomes, there was evidence of an effect in favour of exercise interventions compared to controls for balance function with a SMD of 0.50 (95% CI 0.09 to 0.92), self-reported mobility with a SMD of 16.30 (95% CI 9.34 to 23.26) and objective mobility with a SMD of 0.28 (95% CI 0.07 to 0.50). Secondary outcomes were not assessed under the GRADE criteria and results must be interpreted with caution. AUTHORS' CONCLUSIONS The evidence regarding the effects of interventions for preventing falls in MS is sparse and uncertain. The evidence base demonstrates mixed risk of bias, with very low to low certainty of the evidence. There is some evidence in favour of exercise interventions for the improvement of balance function and mobility. However, this must be interpreted with caution as these secondary outcomes were not assessed under the GRADE criteria and as the results represent data from a small number of studies. Robust RCTs examining the effectiveness of multifactorial falls interventions on falls outcomes are needed.
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Affiliation(s)
- Sara Hayes
- University of LimerickSchool of Allied Health, Ageing Research Centre, Health Research InstituteLimerickIreland
| | - Rose Galvin
- University of LimerickDepartment of Clinical Therapies, Faculty of Education and Health SciencesCastletroyLimerickIreland
| | - Catriona Kennedy
- Robert Gordon UniversitySchool of Nursing and MidwiferyGarthdee RoadAberdeenUKAB10 7QG
| | - Marcia Finlayson
- Queen's UniversitySchool of Rehabilitation Therapy31 George StreetKingstonONCanada
| | - Christopher McGuigan
- St. Vincent's University Hospital & University College DublinDepartment of NeurologyElm ParkDublinIreland
| | - Cathal D Walsh
- Department of Mathematics and StatisticsHealth Research Institute (HRI) and MACSIUniversity of LimerickIreland
| | - Susan Coote
- University of LimerickDepartment of Clinical Therapies, Faculty of Education and Health SciencesCastletroyLimerickIreland
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Feys P, Straudi S. Beyond therapists: Technology-aided physical MS rehabilitation delivery. Mult Scler 2019; 25:1387-1393. [DOI: 10.1177/1352458519848968] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the last decade, rehabilitation technology has been developed, investigated, and entered specialized clinical settings. In this chapter, we first discuss the potential of rehabilitation technology to support the achievement of key factors in motor recovery, such as delivering massed practice with good movement quality but also question task-specificity and cognitive motor control mechanisms. Second, we discuss available technology-supported rehabilitation methods for improving gait, balance and fitness, and upper limb function. Finally, we discuss considerations in relation to the professional workforce in order to deliver optimal rehabilitation.
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Affiliation(s)
- Peter Feys
- REVAL/BIOMED, Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium
| | - Sofia Straudi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
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Tietjen AM, Devereux GR. Physical Demands of Exergaming in Healthy Young Adults. J Strength Cond Res 2019; 33:1978-1986. [DOI: 10.1519/jsc.0000000000002235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Virtual reality in multiple sclerosis rehabilitation: A review on cognitive and motor outcomes. J Clin Neurosci 2019; 65:106-111. [PMID: 30898488 DOI: 10.1016/j.jocn.2019.03.017] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 12/26/2022]
Abstract
Multiple sclerosis (MS) is a demyelinating neurodegenerative disease with lesions involving the central nervous system. Clinical symptoms consist of disturbances in motor activity (e.g., weakness, spasticity, and tremor), sensory functioning (e.g., pain), visual functions (e.g., diplopia and optic neuritis), besides different cognitive (attention deficit and executive dysfunction) and behavioral abnormalities. This review aims to evaluate the role of VR tools in cognitive and motor rehabilitation of MS patients. Studies performed between 2010 and 2017 and fulfilling the selected criteria were searched on PubMed, Scopus, Cochrane and Web of Sciences databases, by combining the terms "VR rehabilitation" and "MS". Our findings showed that, following the use of VR training, MS patients presented a significant improvement in motor (especially gait and balance) and cognitive function (with regard to executive and visual-spatial abilities, attention and memory skills). This review supports the idea that rehabilitation through new VR tools could positively affect MS patients' outcomes, by boosting motivation and participation with a better response to treatment.
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Kramer A, Poppendieker T, Gruber M. Suitability of jumps as a form of high-intensity interval training: effect of rest duration on oxygen uptake, heart rate and blood lactate. Eur J Appl Physiol 2019; 119:1149-1156. [DOI: 10.1007/s00421-019-04105-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
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Yang F, Qiao M, Su X, Lazarus J. Relative importance of physical and psychological factors to slowness in people with mild to moderate multiple sclerosis. Mult Scler Relat Disord 2019; 27:81-90. [DOI: 10.1016/j.msard.2018.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/17/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022]
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Giboin LS, Gruber M, Kramer A. Three months of slackline training elicit only task-specific improvements in balance performance. PLoS One 2018; 13:e0207542. [PMID: 30475850 PMCID: PMC6261037 DOI: 10.1371/journal.pone.0207542] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/01/2018] [Indexed: 02/07/2023] Open
Abstract
Slackline training is a challenging and motivating type of balance training, with potential usefulness for fall prevention and balance rehabilitation. However, short-term slackline training seems to elicit mostly task-specific performance improvements, reducing its potential for general fall prevention programs. It was tested whether a longer duration slackline training (three months, 2 sessions per week) would induce a transfer to untrained tasks. Balance performance was tested pre and post slackline training on the slackline used during the training, on a slackline with different slack, and in 5 different non-trained static and dynamic balance tasks (N training = 12, N control = 14). After the training, the training group increased their performance more than the control group in both of the slackline tasks, i.e. walking on the slackline (time × group interaction with p < 0.001 for both tasks). However, no differences between groups were found for the 5 non-trained balance tasks, only a main effect of time for four of them. The long-term slackline training elicited large task-specific performance improvements but no transfer to other non-trained balance tasks. The extensive slackline training that clearly enhanced slackline performance did not improve the capability to keep balance in other tasks and thus cannot be recommended as a general fall prevention program. The significant test-retest effect seen in most of the tested tasks emphasizes the need of a control group to adequately interpret changes in performance following balance training.
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Affiliation(s)
- Louis-Solal Giboin
- Human Performance Research Centre, Sensorimotor Performance Lab, University of Konstanz, Universitätsstrasse, Konstanz, Germany
- * E-mail:
| | - Markus Gruber
- Human Performance Research Centre, Sensorimotor Performance Lab, University of Konstanz, Universitätsstrasse, Konstanz, Germany
| | - Andreas Kramer
- Human Performance Research Centre, Sensorimotor Performance Lab, University of Konstanz, Universitätsstrasse, Konstanz, Germany
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Effect of telerehabilitation on mobility in people after hip surgery: a pilot feasibility study. Int J Rehabil Res 2018; 41:244-250. [PMID: 29794545 DOI: 10.1097/mrr.0000000000000296] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The goal of this study was to evaluate the effects of telerehabilitation on mobility in people following hip surgery. This feasibility pilot randomized controlled trial included a sample of 40 participants, with 22 male and 18 female patients and mean age (SD) of 67.5 (7.8) years following a surgical intervention. Participants were equally divided and randomly assigned to a telerehabilitation or control intervention group (6 weeks, 3 sessions/week). Telerehabilitation was based on video clips of common rehabilitation exercises focusing on the lower limbs. The control group received an exercise booklet. Both groups participated in physical therapy sessions, twice a week. Outcome measures included the Timed Up and Go test, 2-min walk test, 10-m walk test, sit to stand test, walking speed, and mean step length. Measurements were completed at baseline, at termination of the intervention, and at a 4-week follow-up examination. Improvements in both groups were demonstrated in all outcome measures in the postintervention evaluation. Improvements in the telerehabilitation group were greater in five of six tests compared with those achieved by the controls. The telerehabilitation group showed greater improvements in the 2-min walking test (86.1%) and walking speed (65.6%). During follow-up, the telerehabilitation group continued to improve in all outcome measures in contrast to the control group, who showed no changes in five of the six outcome measures. Telerehabilitation, a complementary treatment to standard physical therapy, generates a positive effect on mobility in people following hip surgery.
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de Vries AW, van Dieën JH, van den Abeele V, Verschueren SMP. Understanding Motivations and Player Experiences of Older Adults in Virtual Reality Training. Games Health J 2018; 7:369-376. [PMID: 30285493 DOI: 10.1089/g4h.2018.0008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We studied which games and underlying game mechanics are considered motivating by older adults, so that designers and therapists make informed choices when designing or selecting virtual reality (VR)-training interventions. MATERIALS AND METHODS We conducted a repeated measures design with 30 older participants, who played eight different VR-training games and afterward filled out the intrinsic motivation inventory (IMI). Differences in intrinsic motivation between games were analyzed using Friedman's tests. In addition, in-depth interviews were conducted according to the laddering technique, to unveil the underlying game mechanics that lead to the players preferences. RESULTS IMI scores were relatively high for all games, indicating that these VR games seem effective for inducing a high intrinsic motivation. Wii yoga and Kinect Adventures were the highest scoring games on all but the negative subscale tension. Both games provided regular positive feedback. An important game mechanic was Variation, which showed a strong link to important values such as: to Stay Focused, Improve Fitness, and Health and Independency. Furthermore, the game mechanics Visual Feedback and Positive Feedback, which lead to an increased Drive to Perform, were perceived valuable. Seemingly contradicting, but both important attributes such as Speed versus Slow Movements emphasize the importance of designing VR training that adapts to the skill level of the player. CONCLUSION We have shown that games with different game mechanics can induce high intrinsic motivation. When designing or selecting VR balance training games for older adults, these game mechanics should be incorporated to optimize a positive user experience and increase intrinsic motivation.
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Affiliation(s)
- Aijse W de Vries
- 1 Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven , Leuven, Belgium
| | - Jaap H van Dieën
- 2 MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam , Amsterdam, The Netherlands
| | - Vero van den Abeele
- 3 Computer Science Technology TC, Group T, Faculty of Engineering Technology, Katholieke Universiteit Leuven , Leuven, Belgium
| | - Sabine M P Verschueren
- 1 Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven , Leuven, Belgium
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Cohen M. Connected health and multiple sclerosis. Rev Neurol (Paris) 2018; 174:480-485. [PMID: 29680178 DOI: 10.1016/j.neurol.2018.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 01/08/2023]
Abstract
There is as yet no consensual definition of "connected health". In general, the term refers to the growing use of technology and, in particular, mobile technology in medicine. Over the past 10 years, there have been an increasing number of published reports on the wide-ranging and heterogeneous fields involving the application of technology in medicine, ranging from telemedicine to tools to improve patients' evaluation and monitoring by physicians, as well as a multitude of patient-centered applications. They also represent promising tools in the field of clinical research. This report is a review of the importance of using this technology in the management of multiple sclerosis patients.
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Affiliation(s)
- M Cohen
- Service de neurologie, hôpital Pasteur 2, université Côte d'Azur, centre hospitalier universitaire de Nice, 30, voie Romaine, 06000 Nice, France.
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Casuso-Holgado MJ, Martín-Valero R, Carazo AF, Medrano-Sánchez EM, Cortés-Vega MD, Montero-Bancalero FJ. Effectiveness of virtual reality training for balance and gait rehabilitation in people with multiple sclerosis: a systematic review and meta-analysis. Clin Rehabil 2018; 32:1220-1234. [PMID: 29651873 DOI: 10.1177/0269215518768084] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the evidence for the use of virtual reality to treat balance and gait impairments in multiple sclerosis rehabilitation. DESIGN Systematic review and meta-analysis of randomized controlled trials and quasi-randomized clinical trials. METHODS An electronic search was conducted using the following databases: MEDLINE (PubMed), Physiotherapy Evidence Database (PEDro), Cochrane Database of Systematic Reviews (CDSR) and (CINHAL). A quality assessment was performed using the PEDro scale. The data were pooled and a meta-analysis was completed. This systematic review was conducted in accordance with the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guideline statement. It was registered in the PROSPERO database (CRD42016049360). RESULTS A total of 11 studies were included. The data were pooled, allowing meta-analysis of seven outcomes of interest. A total of 466 participants clinically diagnosed with multiple sclerosis were analysed. Results showed that virtual reality balance training is more effective than no intervention for postural control improvement (standard mean difference (SMD) = -0.64; 95% confidence interval (CI) = -1.05, -0.24; P = 0.002). However, significant overall effect was not showed when compared with conventional training (SMD = -0.04; 95% CI = -0.70, 0.62; P = 0.90). Inconclusive results were also observed for gait rehabilitation. CONCLUSION Virtual reality training could be considered at least as effective as conventional training and more effective than no intervention to treat balance and gait impairments in multiple sclerosis rehabilitation.
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Negahban H, Monjezi S, Mehravar M, Mostafaee N, Shoeibi A. Responsiveness of postural performance measures following balance rehabilitation in multiple sclerosis patients. J Bodyw Mov Ther 2018; 22:502-510. [DOI: 10.1016/j.jbmt.2017.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 05/10/2017] [Accepted: 06/12/2017] [Indexed: 12/26/2022]
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Tăut D, Pintea S, Roovers JPWR, Mañanas MA, Băban A. Play seriously: Effectiveness of serious games and their features in motor rehabilitation. A meta-analysis. NeuroRehabilitation 2018; 41:105-118. [PMID: 28527226 DOI: 10.3233/nre-171462] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence for the effectiveness of serious games (SGs) and their various features is inconsistent in the motor rehabilitation field, which makes evidence based development of SGs a rare practice. OBJECTIVE To investigate the effectiveness of SGs in motor rehabilitation for upper limb and movement/balance and to test the potential moderating role of SGs features like feedback, activities, characters and background. METHODS We ran a meta-analysis including 61 studies reporting randomized controlled trials (RCTs), controlled trials (CTs) or case series designs in which at least one intervention for motor rehabilitation included the use of SGs as standalone or in combination. RESULTS There was an overall moderate effect of SGs on motor indices, d = 0.59, [95% CI, 0.48, 0.71], p < 0.001. Regarding the game features, only two out of 17 moderators were statistically different in terms of effect sizes: type of activity (combination of group with individual activities had the highest effects), and realism of the scenario (fantasy scenarios had the highest effects). CONCLUSIONS While we showed that SGs are more effective in improving motor upper limb and movement/balance functions compared to conventional rehabilitation, there were no consistent differences between various game features in their contribution to effects. Further research should systematically investigate SGs features that might have added value in improving effectiveness.
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Affiliation(s)
- Diana Tăut
- Department of Psychology, Babeş-Bolyai University of Cluj-Napoca, Cluj-Napoca, Romania
| | - Sebastian Pintea
- Department of Psychology, Babeş-Bolyai University of Cluj-Napoca, Cluj-Napoca, Romania
| | - Jan-Paul W R Roovers
- Department of Gynaecology, Amsterdam Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Miguel-Angel Mañanas
- Biomedical Engineering Research Centre, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Adriana Băban
- Department of Psychology, Babeş-Bolyai University of Cluj-Napoca, Cluj-Napoca, Romania
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Parent AA, Gosselin-Boucher V, Houle-Peloquin M, Poirier C, Comtois AS. Pilot project: Physiologic responses to a high-intensity active video game with COPD patients-Tools for home rehabilitation. CLINICAL RESPIRATORY JOURNAL 2018; 12:1927-1936. [DOI: 10.1111/crj.12760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 12/08/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Andrée-Anne Parent
- Sciences Faculty; University of Quebec in Montreal, 141 av. President-Kennedy; Montreal, Canada
| | | | | | - Claude Poirier
- Hotel-Dieu Hospital of Montréal, 3840 Rue Saint-Urbain; Montréal Canada
| | - Alain-Steve Comtois
- Sciences Faculty; University of Quebec in Montreal, 141 av. President-Kennedy; Montreal, Canada
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Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) and the most widespread nontraumatic cause of disability in young adults around the world. MS occurs in people of all ages, races, and ethnicities. MS is characterized by clinical symptoms resulting from lesions in the brain, spinal cord, or optic nerves that can affect balance, gait, and fall risk. Lesions accumulate over time and occur in different areas of the CNS causing symptoms that include weakness, spasticity, and fatigue, as well as changes in sensation, coordination, vision, cognition, and bladder function. Thus, it is not surprising that imbalance, gait dysfunction, and falls are common in people with MS. The overwhelming majority have abnormalities of postural control and gait even early in the disease course. In all, 50-80% have balance and gait dysfunction and over 50% fall at least once each year. Balance dysfunction in MS is conceptualized as three interrelated problems: decreased ability to maintain position, limited and slowed movement towards limits of stability, and delayed responses to postural displacements and perturbations. In addition, functional balance performance may be affected by impaired dual-task integration. Walking changes in MS include reduced gait speed, impaired walking balance, and reduced walking-related physical activity. Falls in people with MS are associated with injuries, reduced participation, and increased fear of falling. A wide and growing range of rehabilitation and medical interventions are available to address the changes in balance, gait, and fall risk associated with MS.
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Affiliation(s)
- Michelle H Cameron
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.
| | - Ylva Nilsagard
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
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Legerlotz K, Bey ME, Götz S, Böhlke N. Constant performance in balance and proprioception tests across the menstrual cycle - a pilot study in well trained female ice hockey players on hormonal contraception. Health Sci Rep 2018; 1:e18. [PMID: 30623036 PMCID: PMC6266417 DOI: 10.1002/hsr2.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/04/2017] [Accepted: 10/16/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION It has yet to be explained why female athletes appear to suffer more often from non-contact ligament injuries during the first half of the menstrual cycle. Fluctuations in balance, caused by impaired proprioception due to increased fluid retention, may be relevant factors contributing to this anomaly in distribution. The aim of this study was therefore to uncover relationships between dynamic stability, proprioception and fluid retention in association with the menstrual cycle as a possible explanation for the observed changes in injury rates. METHODS Nine healthy, female, well trained ice hockey players on hormonal contraception with regular cycles were tested at least twelve times during one menstrual cycle. Bioimpedance analysis was applied to investigate body composition and fluid distribution. A joint position sense test was performed to characterize changes in proprioception, while unexpected perturbations on a balance board were used to obtain measures for dynamic postural control. RESULTS No distinct changes in proprioception, dynamic stability and fluid retention were identified across the menstrual cycle in this population. Weak correlations were found between parameters for dynamic stability and proprioception. CONCLUSION Variations in proprioception, dynamic stability and fluid retention seem unlikely to be major contributors to injury risk peaks, at least in this population of healthy trained athletes using hormonal contraception.
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Affiliation(s)
- Kirsten Legerlotz
- Department of Training and Movement SciencesHumboldt UniversityBerlinGermany
| | - Marie Elena Bey
- Department of Training and Movement SciencesHumboldt UniversityBerlinGermany
| | - Susann Götz
- Division of Training and Movement ScienceUniversity of PotsdamPotsdamGermany
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Current Trends in Exercise Intervention Research, Technology, and Behavioral Change Strategies for People With Disabilities. Am J Phys Med Rehabil 2017; 96:748-761. [DOI: 10.1097/phm.0000000000000743] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Sosnoff JJ, Wajda DA, Sandroff BM, Roeing KL, Sung J, Motl RW. Dual task training in persons with Multiple Sclerosis: a feasability randomized controlled trial. Clin Rehabil 2017; 31:1322-1331. [PMID: 28933609 DOI: 10.1177/0269215517698028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To determine the feasibility of dual task training in persons with Multiple Sclerosis. DESIGN Randomized, single-blinded controlled trial. SETTING University research laboratory. PARTICIPANTS A total of 234 individuals inquired about the investigation. After screening, 20 individuals with multiple sclerosis who self-reported problems with multitasking and were ambulatory volunteered for the investigation. 14 participants completed the post-assessment following the 12-week intervention. INTERVENTION Participants were randomly assigned to either single task training program which focused on balance and walking function ( n=6) or dual task training program that incorporated cognitive tasks in balance and walking training ( n=8). MEASURES Before and after the 12-week interventions participants underwent assessments of walking; dual task walking; balance (Berg Balance Scale and balance confidence) and cognition as indexed by the Brief International Cognitive Assessment for MS. RESULTS There was an 8.5% recruitment rate, a 70% retention rate, and a 100% adherence rate. There was a trend for dual task gait speed to improve in the dual task training group following the intervention (Pre: task 1: 109.8±39, task 2: 104.2±34.1; Post: task 1:127.6±40.1, task 2: 122.8±37.4; P=0.14; η2 = 0.24). There was also a trend for the dual task training group (28.1) to have greater performance than the control group (24.7) on visuospatial memory ( P=0.10; η2= 0.23). There were no changes in cognitive performance during walking trials. CONCLUSIONS The study procedures were found to be feasible and improvements should be made in recruitment efforts going forward. Further examination of dual task training programs in individuals with multiple sclerosis is warranted.
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Affiliation(s)
- Jacob J Sosnoff
- 1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
| | - Douglas A Wajda
- 2 Department of Exercise Science, Cleveland State University, USA
| | | | - Kathleen L Roeing
- 1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
| | - JongHun Sung
- 1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
| | - Robert W Motl
- 4 Department of Physical Therapy, University of Alabama at Birmingham, USA
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Thomas S, Fazakarley L, Thomas PW, Collyer S, Brenton S, Perring S, Scott R, Thomas F, Thomas C, Jones K, Hickson J, Hillier C. Mii-vitaliSe: a pilot randomised controlled trial of a home gaming system (Nintendo Wii) to increase activity levels, vitality and well-being in people with multiple sclerosis. BMJ Open 2017; 7:e016966. [PMID: 28954791 PMCID: PMC5623500 DOI: 10.1136/bmjopen-2017-016966] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES While the health and well-being benefits of physical activity are recognised, people with multiple sclerosis (MS) often face greater barriers than the general population. The Nintendo Wii potentially offers a fun, convenient way of overcoming some of these. The aim was to test the feasibility of conducting a definitive trial of the effectiveness and cost-effectiveness of Mii-vitaliSe; a home-based, physiotherapist-supported Nintendo Wii intervention. DESIGN A single-centre wait-list randomised controlled study. SETTING MS service in secondary care. PARTICIPANTS Ambulatory, relatively inactive people with clinically confirmed MS. INTERVENTION Thirty participants were randomised to receive Mii-vitaliSe either immediately (for 12 months) or after a 6-month wait (for 6 months). Mii-vitaliSe consisted of two supervised Nintendo Wii familiarisation sessions in the hospital followed by home use (Wii Sports, Sports Resort and Fit Plus software) with physiotherapist support and personalised resources. OUTCOMES Included self-reported physical activity levels, quality of life, mood, self-efficacy, fatigue and assessments of balance, gait, mobility and hand dexterity at baseline, 6 and 12 months. Interviews (n=25) explored participants' experiences and, at study end, the two Mii-vitaliSe facilitators' experiences of intervention delivery (main qualitative findings reported separately). RESULTS Mean (SD) age was 49.3 (8.7) years, 90% female, with 47% diagnosed with MS <6 years ago and 60% new to active gaming. The recruitment rate was 31% (95% CI 20% to 44%). Outcome data were available for 29 (97%) at 6 months and 28 (93%) at 12 months. No serious adverse events were reported during the study. Qualitative data indicated that Mii-vitaliSe was well-received. Mean Wii use across both groups over the initial 6-month intervention period was twice a week for 27 min/day. Mean cost of delivering Mii-vitaliSe was £684 per person. DISCUSSION Mii-vitaliSe appears acceptable and a future trial feasible and warranted. These findings will inform its design. TRIAL REGISTRATION ISRCTN49286846.
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Affiliation(s)
- Sarah Thomas
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | - Louise Fazakarley
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | - Peter W Thomas
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | - Sarah Collyer
- Poole Hospital NHS Foundation Trust, Dorset Multiple Sclerosis Service, Poole, Dorset, UK
| | - Sarah Brenton
- Poole Hospital NHS Foundation Trust, Dorset Multiple Sclerosis Service, Poole, Dorset, UK
| | - Steve Perring
- Poole Hospital NHS Foundation Trust, Medical Physics, Poole, Dorset, UK
| | - Rebecca Scott
- National Star College, Cheltenham, Gloucestershire, UK
| | - Fern Thomas
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | - Charlotte Thomas
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | | | | | - Charles Hillier
- Poole Hospital NHS Foundation Trust, Dorset Multiple Sclerosis Service, Poole, Dorset, UK
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