Effect of Wii Fit™ exercise therapy on
gait parameters in ankle sprain patients: A randomized controlled trial
gait parameters in ankle sprain patients: A randomized controlled trial
Punt IM,
Armand S, Ziltener JL, Allet L. Gait
& Posture. 2017; 58:52-58. doi: 10.1016/j.gaitpost.2017.06.284
Armand S, Ziltener JL, Allet L. Gait
& Posture. 2017; 58:52-58. doi: 10.1016/j.gaitpost.2017.06.284
Take
Home Message: Home-based electronic balance training
may improve gait parameters in ankle sprain patients, but is not more effective
than standard physical therapy or no intervention.
Home Message: Home-based electronic balance training
may improve gait parameters in ankle sprain patients, but is not more effective
than standard physical therapy or no intervention.
Electronically-based
exercise interventions are becoming increasingly popular in patient care as
these are relatively low-cost interventions and may increase motivation during
rehabilitation. The Nintendo Wii FitTM may improve balance through games
that require an individual to complete a virtual task while stabilizing on a
balance board. However, it is unknown if similar outcomes would exist with a
home-based exergaming protocol. Hence,
the authors compared the effectiveness of a Wii FitTM home balancing
protocol to conventional physical therapy and no physical therapy interventions
on gait measures (for example, gait speed and joint movement) among
participants with sub-acute ankle sprains (see Table below for several key gait
measures used in this study). Prior to randomizing a participant, the researchers
looked at a participant as they walked across a walkway to obtain baseline gait
measures. They then assigned a participant to one of three groups: Wii FitTM
home balance training, standard physical therapy, or control group without any
interventions. The Wii FitTM balance training group performed preselected
balance games at any difficulty level they chose for 30 minutes per session for
at least 2 times per week over 6 weeks. Physical therapists applied joint
mobilizations, and instructed muscle strengthening and balance exercises for
the therapy group for nine 30-minute sessions over 6 weeks. The control group
did not receive any therapy or intervention. Following the 6-week period, the
researchers evaluated all participants’ gait again. All groups improved with increased
gait speed and rate, and decreased step length from baseline to follow-up. The
authors found no differences over time between groups.
exercise interventions are becoming increasingly popular in patient care as
these are relatively low-cost interventions and may increase motivation during
rehabilitation. The Nintendo Wii FitTM may improve balance through games
that require an individual to complete a virtual task while stabilizing on a
balance board. However, it is unknown if similar outcomes would exist with a
home-based exergaming protocol. Hence,
the authors compared the effectiveness of a Wii FitTM home balancing
protocol to conventional physical therapy and no physical therapy interventions
on gait measures (for example, gait speed and joint movement) among
participants with sub-acute ankle sprains (see Table below for several key gait
measures used in this study). Prior to randomizing a participant, the researchers
looked at a participant as they walked across a walkway to obtain baseline gait
measures. They then assigned a participant to one of three groups: Wii FitTM
home balance training, standard physical therapy, or control group without any
interventions. The Wii FitTM balance training group performed preselected
balance games at any difficulty level they chose for 30 minutes per session for
at least 2 times per week over 6 weeks. Physical therapists applied joint
mobilizations, and instructed muscle strengthening and balance exercises for
the therapy group for nine 30-minute sessions over 6 weeks. The control group
did not receive any therapy or intervention. Following the 6-week period, the
researchers evaluated all participants’ gait again. All groups improved with increased
gait speed and rate, and decreased step length from baseline to follow-up. The
authors found no differences over time between groups.
|
Spatiotemporal
Gait Parameters |
Definition
|
|
Cadence (step rate)
|
Number of steps per unit of time
|
|
Step Length
|
Distance between corresponding
successive points of heel contact of the opposite feet |
|
Single Limb Support Time
|
The amount of time spent on a leg
expressed as a percent of the entire gait cycle |
|
Symmetry of Single Limb Support Time
|
The amount of time spent on a limb as
a percent of the gait cycle compared between right and left legs |
These
findings indicate that a home-based Wii FitTM protocol may be an
additional means to positively impact gait in individuals with ankle sprains;
however, neither treatment group differed from the control group. These results
are based on strong analyses but they categorized participants that dropped out
of the study as “no change”. This could influence the results because there
were drop-out rates over 20% in the Wii FitTM and no intervention
groups, and about a 10% drop-out rate in the standard therapy group, this may
have influenced the outcomes. Additionally, there were differences in
intervention exposure as the standard therapy group had nine total sessions
while the Wii FitTM group did twelve or more. It would be
interesting to see the results based on participants who completed the
interventions. It would also be beneficial to see the results with patient-reported
outcomes to gauge participant responses. Despite these few limitations, these
findings are important to consider clinically as electronically-based therapy
may improve patient function efficiently and in an interactive manner. For some
patients, the gaming platforms could be used to increase patient motivation for
at-home protocols if patients cannot attend clinic-based therapy consistently. However,
there are some cautions to be taken from this study. As multiple outcomes
improved regardless of the group, certain gait outcomes may naturally improve
as ankle sprain patients recover over time. Additionally, it is not standard
practice to provide no form of treatment or intervention following injury. Without
knowing which patients may embrace home exercise programs with gaming platforms
it may be important for clinicians to adopt strategies to promote compliance (for
example, calling the patient). The results from this study should not replace
current clinical practice for managing ankle injuries, however the
implementation of an electronic intervention may be an additional means to improve
patient function and movement strategies.
findings indicate that a home-based Wii FitTM protocol may be an
additional means to positively impact gait in individuals with ankle sprains;
however, neither treatment group differed from the control group. These results
are based on strong analyses but they categorized participants that dropped out
of the study as “no change”. This could influence the results because there
were drop-out rates over 20% in the Wii FitTM and no intervention
groups, and about a 10% drop-out rate in the standard therapy group, this may
have influenced the outcomes. Additionally, there were differences in
intervention exposure as the standard therapy group had nine total sessions
while the Wii FitTM group did twelve or more. It would be
interesting to see the results based on participants who completed the
interventions. It would also be beneficial to see the results with patient-reported
outcomes to gauge participant responses. Despite these few limitations, these
findings are important to consider clinically as electronically-based therapy
may improve patient function efficiently and in an interactive manner. For some
patients, the gaming platforms could be used to increase patient motivation for
at-home protocols if patients cannot attend clinic-based therapy consistently. However,
there are some cautions to be taken from this study. As multiple outcomes
improved regardless of the group, certain gait outcomes may naturally improve
as ankle sprain patients recover over time. Additionally, it is not standard
practice to provide no form of treatment or intervention following injury. Without
knowing which patients may embrace home exercise programs with gaming platforms
it may be important for clinicians to adopt strategies to promote compliance (for
example, calling the patient). The results from this study should not replace
current clinical practice for managing ankle injuries, however the
implementation of an electronic intervention may be an additional means to improve
patient function and movement strategies.
Questions for Discussion: Do you think
it would be advantageous to add Wii-based exercise therapy into the clinical
setting? Do you think that patients would be more compliant using these or
other like forms of interactive therapies? Have you personally used or seen
electronically-based rehab, and if so, what are some of the benefits/drawbacks?
it would be advantageous to add Wii-based exercise therapy into the clinical
setting? Do you think that patients would be more compliant using these or
other like forms of interactive therapies? Have you personally used or seen
electronically-based rehab, and if so, what are some of the benefits/drawbacks?
Written by: Alexandra DeJong
Reviewed by:
Jeffrey Driban
Jeffrey Driban
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Posts:
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i am use this ankle exercises for foot sprain recovery. Good for foot stability and mobility. https://youtu.be/nsIV8Uxb4qQ
Hi Alex,
Thanks for sharing this article. I think using electronically-based therapy is an interesting concept that may help with patient enthusiasm and compliance during a rehabilitation progression in the clinic setting. However, I am generally skeptical of the compliance of any HEP, such as in this discussion where you mentioned the drop out rate was greater than 20% for the Wii-based therapy group.
Personally, I have seen this tool used in the clinic setting and with great results/feedback. Its implementation into regular HEPs leaves me skeptical though.
What are your thoughts?
Hi Kevin,
Thank you for your response! I absolutely agree that there is always an issue with potential non-compliance seen with home exercise programs given the lack of patient-clinician supervision. I think that adding in patient buy-in is one of the most important aspects of HEP’s, which can potentially be addressed through patient education, and by making the exercises more interesting and enjoyable as well. I think that especially for younger patients, adding in an electronic component may help address some of these issues, although in the present study you are right there were some drop-outs. Perhaps looking at some form of HEP monitoring could be beneficial to address this problem. It is great to hear that you have had success with this technique in the clinic! This may be another key to compliance through reinforcing techniques in clinic visits on top of home exercise. Thanks again Kevin!