Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: a randomized controlled trial - 25/11/21

Doi : 10.1016/j.rehab.2021.101609

Sanaz Pournajaf ¹, Michela Goffredo ¹, Leonardo Pellicciari ^1,^⁎ , Daniele Piscitelli ^2,³, Simone Criscuolo ¹, Domenica Le Pera ¹, Carlo Damiani ¹, Marco Franceschini ^1,⁴
¹ Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
² School of Physical and Occupational Therapy, McGill University, Montreal, Canada
³ School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
⁴ Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy

^⁎Corresponding author. Leonardo Pellicciari, PhD, Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Via della Pisana, 235 I-00163 Rome, Italy. Phone: +39-06 52252319Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation SciencesIRCCS San Raffaele RomaVia della PisanaRome235 I-00163Italy

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Highlights

•	Virtual reality (VR) and serious games (SGs) are widely used in rehabilitation.
•	VR-based SG balance training and conventional therapy showed similar outcomes.
•	VR-based SG static balance training seemed to elicit a better gait pattern than conventional therapy.
•	VR-based SG statistic balance training was safe and well tolerated.
•	VR-based SG balance training can be used to intensify the rehabilitation treatment.

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Abstract

Background

Virtual reality (VR) and serious games (SGs) are widespread in rehabilitation for many orthopaedic and neurological diseases. However, few studies have addressed the effects of rehabilitation with VR-based SGs on clinical, gait, and postural outcomes in individuals with total knee replacement (TKR).

Objective

The primary objective was the efficacy of balance training using non-immersive VR-based SGs compared to conventional therapy in TKR patients on the Time Up and Go test. Secondary objectives included the efficacy on clinical, gait, and postural outcomes.

Methods

We randomly allocated 56 individuals with unilateral TKR to the experimental group (EG) or control group (CG) for 15 sessions (45 min; 5 times per week) of non-immersive VR-based SGs or conventional balance training, respectively. The primary outcome was functional mobility measured by the Timed Up and Go test; secondary outcomes were walking speed, pain intensity, lower-limb muscular strength, independence in activities of daily living as well as gait and postural parameters.

Results

We found significant within-group differences in all clinical outcomes and in a subset of gait (p<0.0001) and postural (p≤0.05) parameters. Analysis of the stance time of the affected limb revealed significant between-group differences (p=0.022): post-hoc analysis revealed within-group differences in the EG (p=0.002) but not CG (p=0.834). We found no significant between-group differences in other outcomes.

Conclusions

Balance training with non-immersive VR-based SGs can improve clinical, gait, and postural outcomes in TKR patients. It was not superior to the CG findings but could be considered an alternative to the conventional approach and can be added to a regular rehabilitation program in TKR patients. The EG had a more physiological duration of the gait stance phase at the end of the treatment than the CG.