针对患有肌肉骨骼问题的老年人的游戏化物理康复：非劣效性随机临床试验试点

Gamified Physical Rehabilitation for Older Adults With Musculoskeletal Issues: Pilot Noninferiority Randomized Clinical Trial.

作者信息

Randriambelonoro Mirana, Perrin Franck Caroline, Herrmann François, Carmona Gorki Antonio, Geissbuhler Antoine, Graf Christophe, Frangos Emilia

机构信息

HI5Lab, Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Division of Rehabilitation and Geriatrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

出版信息

JMIR Rehabil Assist Technol. 2023 Mar 6;10:e39543. doi: 10.2196/39543.

DOI:10.2196/39543

PMID:36877563

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10029857/

Abstract

BACKGROUND

Resource-rich countries are facing the challenge of aging societies, a high risk of dependence, and a high cost of care. Researchers attempted to address these issues by using cost-efficient, innovative technology to promote healthy aging and regain functionality. After an injury, efficient rehabilitation is crucial to promote returning home and prevent institutionalization. However, there is often a lack of motivation to carry out physical therapies. Consequently, there is a growing interest in testing new approaches like gamified physical rehabilitation to achieve functional targets and prevent rehospitalization.

OBJECTIVE

The purpose of this study is to assess the effectiveness of a personal mobility device compared with standard care in the rehabilitation treatment of patients with musculoskeletal issues.

METHODS

A total of 57 patients aged 67-95 years were randomly assigned to the intervention group (n=35) using the gamified rehabilitation equipment 3 times a week or to the control group (n=22) receiving usual standard care. Due to dropout, only 41 patients were included in the postintervention analysis. Outcome measures included the short physical performance battery (SPPB), isometric hand grip strength (IHGS), functional independence measure (FIM), and the number of steps.

RESULTS

A noninferiority related to the primary outcome (SPPB) was identified during the hospital stay, and no significant differences were found between the control and intervention groups for any of the secondary outcomes (IHGS, FIM, or steps), which demonstrates the potential of the serious game-based intervention to be as effective as the standard physical rehabilitation at the hospital. The analysis by mixed-effects regression on SPPB showed a group×time interaction (SPPB_I_t1=-0.77, 95% CI -2.03 to 0.50, P=.23; SPPB_I_t2=0.21, 95% CI -1.07 to 0.48, P=.75). Although not significant, a positive IHGS improvement of more than 2 kg (Right: 2.52 kg, 95% CI -0.72 to 5.37, P=.13; Left: 2.43 kg, 95% CI -0.18 to 4.23, P=.07) for the patient from the intervention group was observed.

CONCLUSIONS

Serious game-based rehabilitation could potentially be an effective alternative for older patients to regain their functional capacities.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03847454; https://clinicaltrials.gov/ct2/show/NCT03847454.

摘要

背景

资源丰富的国家正面临老龄化社会的挑战、高依赖风险和高昂的护理成本。研究人员试图通过使用具有成本效益的创新技术来促进健康老龄化并恢复功能，以解决这些问题。受伤后，有效的康复对于促进患者回家和防止住院至关重要。然而，患者往往缺乏进行物理治疗的动力。因此，人们越来越有兴趣测试诸如游戏化物理康复等新方法，以实现功能目标并防止再次住院。

目的

本研究的目的是评估一种个人移动设备与标准护理相比，在肌肉骨骼问题患者康复治疗中的有效性。

方法

共有57名年龄在67 - 95岁之间的患者被随机分配到干预组（n = 35），每周使用3次游戏化康复设备，或对照组（n = 22）接受常规标准护理。由于失访，干预后分析仅纳入了41名患者。结局指标包括简短体能状况量表（SPPB）、等长握力（IHGS）、功能独立性测量（FIM）和步数。

结果

在住院期间确定了与主要结局（SPPB）相关的非劣效性，并且在任何次要结局（IHGS、FIM或步数）方面，对照组和干预组之间均未发现显著差异，这表明基于严肃游戏的干预与医院标准物理康复一样有效的潜力。对SPPB进行的混合效应回归分析显示了组×时间交互作用（SPPB_I_t1 = -0.77，95% CI -2.03至0.50，P = 0.23；SPPB_I_t2 = 0.21，95% CI -1.07至0.48，P = 0.75）。虽然不显著，但观察到干预组患者的等长握力有超过2千克的正向改善（右侧：2.52千克，95% CI -0.72至5.37，P = 0.13；左侧：2.43千克，95% CI -0.18至4.23，P = 0.07）。