Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA.
Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, NJ, 07015, USA.
J Neuroeng Rehabil. 2024 Aug 13;21(1):143. doi: 10.1186/s12984-024-01441-7.
This parallel, randomized controlled trial examined intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a 12-week, home-based upper extremity rehabilitation program. Seventeen subjects played scaffolded games, presenting eight to twelve discrete levels of increasing difficulty. Sixteen subjects performed the same activities controlled by success algorithms that modify game difficulty incrementally.
33 persons 20-80 years of age, at least 6 months post stroke with moderate to mild hemiparesis were randomized using a random number generator into the two groups. They were tested using the Action Research Arm Test, Upper Extremity Fugl Meyer Assessment, Stroke Impact Scale and Intrinsic Motivation Inventory pre and post training. Adherence was measured using timestamps generated by the gaming system. Subjects had the Home Virtual Rehabilitation System (Qiu in J Neuroeng Rehabil 17: 1-10, 2020) placed in their homes and were taught to perform rehabilitation games using it. Subjects were instructed to train twenty minutes per day but were allowed to train as much as they chose. Subjects trained for 12 weeks without appointments and received intermittent support from study staff. Group outcomes were compared using ANOVA. Correlations between subject demographics and adherence, as well as motor outcome, were evaluated using Pearson Correlation Coefficients.
There were 5 dropouts and no adverse events. The main effect of time was statistically significant for four of the five clinical outcome measures. There were no significant training group by time interactions. Measures of adherence did not differ significantly between groups. The combined groups improved their UEFMA scores on average by 5.85 (95% CI 4.73-6.98). 21 subjects from both groups demonstrating improvements in UEFMA scores of at least 5 points, exceeding the minimal clinically important difference of 4.25. IMI scores were stable pre to post training.
Scaffolding challenges during game based rehabilitation did not elicit higher levels of adherence when compared to algorithm control of game difficulty. Both sparsely supervised programs of game-based treatment in the home were sufficient to elicit statistically significant, clinically meaningful improvements in motor function and activities of daily living.
Clinical Trials.gov-NCT03985761, Registered June 14, 2019.
本平行、随机对照试验研究了两组接受为期 12 周家庭上肢康复计划的受试者的内在动机、依从性和运动功能改善情况。17 名受试者玩了有支撑的游戏，呈现了 8 到 12 个离散的递增难度级别。16 名受试者则通过成功算法进行相同的活动，该算法逐渐修改游戏难度。
33 名年龄在 20-80 岁之间、中风后至少 6 个月且有中度至轻度偏瘫的患者，使用随机数发生器随机分为两组。他们在训练前后接受动作研究上肢测试、上肢 Fugl-Meyer 评估、中风影响量表和内在动机量表的测试。依从性通过游戏系统生成的时间戳进行测量。将家庭虚拟康复系统（Qiu 等人在 J Neuroeng Rehabil 17:1-10, 2020 年发表）放置在患者家中，并教导他们使用该系统进行康复游戏。患者被要求每天训练 20 分钟，但可以根据自己的选择进行训练。患者在没有预约的情况下训练了 12 周，并接受了研究人员的间歇性支持。使用方差分析比较组间结果。使用 Pearson 相关系数评估受试者人口统计学特征与依从性以及运动结果之间的相关性。
有 5 名患者脱落，无不良事件。五项临床结果测量中有四项的时间主效应具有统计学意义。训练组与时间之间无显著交互作用。两组之间的依从性测量无显著差异。两组的 UEFMA 评分平均提高了 5.85 分（95%CI 4.73-6.98）。21 名患者（两组各 11 名）的 UEFMA 评分提高至少 5 分，超过了 4.25 分的最小临床重要差异。IMI 评分在训练前后保持稳定。
与游戏难度的算法控制相比，基于游戏的康复中的支架挑战并没有引起更高的依从性。在家中进行的两种稀疏监督的游戏治疗方案都足以引起运动功能和日常生活活动的显著、有临床意义的改善。
ClinicalTrials.gov-NCT03985761，注册于 2019 年 6 月 14 日。
