Effects of a home-based, exergaming intervention on physical function and pain after total knee replacement in older adults: a randomised controlled trial.

Objectives: To investigate the effects of 4 months of customised, home-based exergaming on physical function and pain after total knee replacement (TKR) compared with standard exercise protocol. Methods: In this non-blinded randomised controlled trial, 52 individuals aged 60-75 years undergoing TKR were randomised into an exergaming (intervention group, IG) or a standard exercising group (control group, CG). Primary outcomes were physical function and pain measured before and after (2 months and 4 months) surgery using the Oxford Knee Score (OKS) and Timed Up and Go (TUG) test. Secondary outcomes included measures of the Visual Analogue Scale, 10m walking, short physical performance battery, isometric knee extension and flexion force, knee range of movement and satisfaction with the operated knee. Results: Improvement in mobility measured by TUG was greater in the IG (n=21) at 2 (p=0.019) and 4 months (p=0.040) than in the CG (n=25). The TUG improved in the IG by -1.9 s (95% CI, -2.9 to -1.0), while it changed by -0.6 s (95% CI -1.4 to 0.3) in the CG. There were no differences between the groups in the OKS or secondary outcomes over 4 months. 100% of patients in the IG and 74% in the CG were satisfied with the operated knee. Conclusion: In patients who have undergone TKR, training at home with customised exergames was more effective in mobility and early satisfaction and as effective as standard exercise in pain and other physical functions. In both groups, knee-related function and pain improvement can be considered clinically meaningful. Trial registration number: NCT03717727.

Effectiveness of Gamification in Knee Replacement Rehabilitation: Protocol for a Randomized Controlled Trial With a Qualitative Approach.

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.

Movement characteristics during customized exergames after total knee replacement in older adults.

Introduction: There is limited understanding of how older adults can reach kinematic goals in rehabilitation while performing exergames and conventional exercises, and how similar or different the kinematics during exergaming are when compared with conventional therapeutic exercise with similar movement. The aim of this study was to describe the movement characteristics performed during exercise in custom-designed exergames and conventional therapeutic exercises among patients who have undergone unilateral total knee replacement (TKR). In addition, the secondary aim was to assess the relation of these exercise methods, and to assess participants' perceived exertion and knee pain during exergaming and exercising. Materials and methods: Patients up to 4 months after the TKR surgery were invited in a single-visit exercise laboratory session. A 2D motion analysis and force plates were employed to evaluate movement characteristics as the volume, range, and intensity of movement performed during custom-designed knee extension-flexion and weight shifting exergames and conventional therapeutic exercises post TKR. The perceived exertion and knee pain were assessed using the Borg Rating of Perceived Exertion and Visual Analog Scale, respectively. Results: Evaluation of seven patients with TKR [age median (IQR), 65 (10) years] revealed that the volume and intensity of movement were mostly higher during exergames. Individual goniometer-measured knee range of motion were achieved either with exergames and conventional therapeutic exercises, especially in knee extension exercises. The perceived exertion and knee pain were similar after exergames and conventional therapeutic exercises. Conclusions: During custom-designed exergaming the patients with TKR achieve the movement characteristics appropriate for post-TKR rehabilitation without increasing the stress and pain experienced even though the movement characteristics might be partly different from conventional therapeutic exercises by the volume and intensity of movement. Physical therapists could consider implementing such exergames in rehabilitation practice for patients with TKR once effectiveness have been approved and they are widely available.

Differential interactions of age and sleep deprivation in driving and spatial perception by male drivers in a virtual reality environment.

We determined the effects of age and sleep deprivation on driving and spatial perception in a virtual reality environment. Twenty-two young (mean age: 22 years, range: 18-35) and 23 old (mean age: 71 years, range: 65-79) participants were tested after a normal night of sleep and a night of sleep deprivation. The participants drove a virtual car while responding to uni- and bilateral visual and auditory stimuli. Driving errors (crossing the lane borders), reaction times and accuracy to visual and auditory stimuli, performance in psychological tests, and subjective driving ability and tiredness were measured. Age had no effect on the number of driving errors, whereas sleep deprivation increased significantly especially the number of left lane border crossings. Age increased the number of stimulus detection errors, while sleep deprivation increased the number of errors particularly in the young and in the auditory modality as response omissions. Age and sleep deprivation together increased the number of response omissions in both modalities. Left side stimulus omissions suggest a bias to the right hemispace. The subjective evaluations were consistent with the objective measures. The psychological tests were more sensitive to the effects of age than to those of sleep deprivation. Driving simulation in a virtual reality setting is sensitive in detecting the effects of deteriorating factors on both driving and simultaneous spatial perception.

ExerSense: Physical Exercise Recognition and Counting Algorithm from Wearables Robust to Positioning.

Wearable devices are currently popular for fitness tracking. However, these general usage devices only can track limited and prespecified exercises. In our previous work, we introduced ExerSense that segments, classifies, and counts multiple physical exercises in real-time based on a correlation method. It also can track user-specified exercises collected only one motion in advance. This paper is the extension of that work. We collected acceleration data for five types of regular exercises by four different wearable devices. To find the best accurate device and its position for multiple exercise recognition, we conducted 50 times random validations. Our result shows the robustness of ExerSense, working well with various devices. Among the four general usage devices, the chest-mounted sensor is the best for our target exercises, and the upper-arm-mounted smartphone is a close second. The wrist-mounted smartwatch is third, and the worst one is the ear-mounted sensor.

The right-side perceptual bias in aging determined in a laboratory setting and during a virtual driving task.

Spatial perceptual rightward bias which was originally described in Dichotic Listening studies seems to be a general phenomenon. This bias is age dependent, being evident in children with developing executive functions, and emerging again at older age as a function of aging and the declining executive functions. In the two studies presented here we compared the performance of young and elderly adults in spatial divided attention tasks with auditory and visual stimuli when the stimulus detection performance was measured in separate sessions in a laboratory setting (Study I), to performance when the same types of stimuli were mixed with a task in which the subject's primary objective was to drive a car in a virtual environment (virtual reality; Study II). The aim was to see if the perceptual bias could be detected and also to look at how it would differ in these two situations. 90 right-handed subjects (50 young and 40 elderly) participated in Study I and 84 subjects (64 young and 20 elderly) participated in Study II. Study I showed the rightward bias to be more evident in the elderly subjects in both modalities and in more demanding tasks. Study II revealed that in the triple task the spatial perceptual bias was evident in both modalities for the elderly participants when the conditions were more demanding. An interesting finding concerning the right-side perceptual bias was the simultaneous occurrence of left-side driving errors, i.e. crossing the lane border to the left especially by the elderly. Both of these biases may reflect the asymmetries of the attention-related neuronal networks.

Exergames Designed for Older Adults: A Pilot Evaluation on Psychosocial Well-Being.

OBJECTIVE: Exergames are increasingly been used in the primary healthcare domain for older adults who are 65 years and above. However, most of the exergames on current market are not designed for the aging population. The current study introduced five new exergames developed for elderly and evaluated their benefits. METHODS: Five new exergames were developed by researchers from Finland, Singapore, and Japan, in which the game topics, difficulties, and user interface were designed particularly for older adults. A between-group pilot study was further conducted to evaluate their psychosocial effects by comparing to traditional exercise and care-as-usual program, with a sample of 30 community-dwelling older adults in Singapore. RESULTS: Results showed that exergame group had significantly higher exercise enjoyment over other two groups. Exergame group has lower self-efficacy than other two groups, although it was not statistically significant. Significant subgroup difference was detected in neither life satisfaction nor loneliness across the three groups. CONCLUSION: The study highlighted the effect of fun and entertainment elements on the psychosocial effect of exergames and called for simpler interactive systems and easier exergame tasks for the older adults.