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

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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

Related collections

Most cited references 51

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2011 Compendium of Physical Activities: a second update of codes and MET values.

BARBARA E. AINSWORTH, WILLIAM L. HASKELL, STEPHEN HERRMANN … (2011)

The Compendium of Physical Activities was developed to enhance the comparability of results across studies using self-report physical activity (PA) and is used to quantify the energy cost of a wide variety of PA. We provide the second update of the Compendium, called the 2011 Compendium. The 2011 Compendium retains the previous coding scheme to identify the major category headings and specific PA by their rate of energy expenditure in MET. Modifications in the 2011 Compendium include cataloging measured MET values and their source references, when available; addition of new codes and specific activities; an update of the Compendium tracking guide that links information in the 1993, 2000, and 2011 compendia versions; and the creation of a Web site to facilitate easy access and downloading of Compendium documents. Measured MET values were obtained from a systematic search of databases using defined key words. The 2011 Compendium contains 821 codes for specific activities. Two hundred seventeen new codes were added, 68% (561/821) of which have measured MET values. Approximately half (317/604) of the codes from the 2000 Compendium were modified to improve the definitions and/or to consolidate specific activities and to update estimated MET values where measured values did not exist. Updated MET values accounted for 73% of all code changes. The Compendium is used globally to quantify the energy cost of PA in adults for surveillance activities, research studies, and, in clinical settings, to write PA recommendations and to assess energy expenditure in individuals. The 2011 Compendium is an update of a system for quantifying the energy cost of adult human PA and is a living document that is moving in the direction of being 100% evidence based.

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2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis

Jo Adams, Nina Brodin, Hanne Dagfinrud … (2018)

Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

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Author and article information

Contributors

Eeva Aartolahti:

ORCID: https://orcid.org/0000-0003-2938-926X

Institute of RehabilitationJAMK University of Applied SciencesPiippukatu 2Jyväskylä, FI-40100Finland358 503237511eeva.aartolahti@jamk.fi

Journal

Journal ID (nlm-ta): JMIR Res Protoc

Journal ID (iso-abbrev): JMIR Res Protoc

Journal ID (publisher-id): ResProt

Title: JMIR Research Protocols

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 1929-0748

Publication date Collection: November 2022

Publication date (Electronic): 28 November 2022

Volume: 11

Issue: 11

Electronic Location Identifier: e38434

Affiliations

[1 ] Institute of Rehabilitation JAMK University of Applied Sciences Jyväskylä Finland

[2 ] Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland

[3 ] Faculty of Health and Well-being Turku University of Applied Sciences Turku Finland

[4 ] Department of Surgery Central Finland Healthcare District and University of Eastern Finland Jyväskylä Finland

[5 ] Department of Orthopedics Coxa Hospital for Joint Replacement Tampere Finland

[6 ] Department of Orthopedics and Traumatology Turku University Hospital and University of Turku Turku Finland

[7 ] Faculty of Business and Engineering Turku University of Applied Sciences Turku Finland

[8 ] Department of Sports and Exercise Medicine Oulu Deaconess Institute Foundation sr Oulu Finland

[9 ] Research Unit of Population Health University of Oulu Oulu Finland

[10 ] Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland

[11 ] Research Unit of Medical Imaging, Physics and Technology University of Oulu Oulu Finland

Author notes

Corresponding Author: Eeva Aartolahti eeva.aartolahti@ 123456jamk.fi

Author information

Eeva Aartolahti https://orcid.org/0000-0003-2938-926X

Maarit Janhunen https://orcid.org/0000-0001-9004-8013

Niina Katajapuu https://orcid.org/0000-0002-7416-8928

Juha Paloneva https://orcid.org/0000-0003-3340-9390

Konsta Pamilo https://orcid.org/0000-0001-5961-4072

Airi Oksanen https://orcid.org/0000-0002-5402-4839

Hannes Keemu https://orcid.org/0000-0002-3607-1666

Mikko Karvonen https://orcid.org/0000-0002-9629-065X

Mika Luimula https://orcid.org/0000-0001-6368-1366

Raija Korpelainen https://orcid.org/0000-0002-3627-0542

Timo Jämsä https://orcid.org/0000-0001-8394-9462

Keijo Mäkelä https://orcid.org/0000-0002-4115-1767

Ari Heinonen https://orcid.org/0000-0002-3681-9953

Article

Publisher ID: v11i11e38434

DOI: 10.2196/38434

PMC ID: 9745648

PubMed ID: 36441574

SO-VID: 67e2cd04-acbb-442c-a729-aa3025892e48

Copyright © ©Eeva Aartolahti, Maarit Janhunen, Niina Katajapuu, Juha Paloneva, Konsta Pamilo, Airi Oksanen, Hannes Keemu, Mikko Karvonen, Mika Luimula, Raija Korpelainen, Timo Jämsä, Keijo Mäkelä, Ari Heinonen. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 28.11.2022.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

History

Date received : 19 April 2022

Date revision requested : 27 June 2022

Date revision received : 3 September 2022

Date accepted : 11 October 2022

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

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Abstract

Background

Objective

Methods

Results

Conclusions

Trial Registration

International Registered Report Identifier (IRRID)

Related collections

JMIR: Research Protocols

Most cited references 51

2011 Compendium of Physical Activities: a second update of codes and MET values.

A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.

2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis

Author and article information

Contributors

Journal

Affiliations

Author notes

Author information

Article

History

Categories

Comments

Comment on this article

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Cited by 2

Most referenced authors 729