Gamifying Hand Therapy: Development of a Mixed Reality Rhythm Game to Reduce Pain and Improve Motivation

June 18, 2026 updated by: Yushi Wang, Western University

The hand is one of the most functional and frequently injured parts of the body. Without proper recovery, patients can face significant impairments performing everyday tasks. Hand therapy is the cornerstone of hand rehabilitation, but the painful, repetitive, and monotonous nature of prescribed exercises leads to poor patient motivation and adherence, ultimately compromising long-term recovery outcomes.

New technologies such as virtual reality (VR) and augmented reality (AR) have emerged as interactive and engaging modalities for rehabilitation, and can even reduce pain by distracting patients during exercises. However, mixed reality (MR), which is a new modality combining VR and AR has not been well studied for its ability to reduce pain in hand rehabilitation. Therefore, we developed HoloRehab, a mixed reality video game for hand rehabilitation, built for the Microsoft HoloLens 2 headset. This device allow users to see and interact with realistic 3D holograms projected into their physical environment.

This pilot study will evaluate whether using HoloRehab can reduce discomfort and improve the exercise experience compared to traditional self-guided hand therapy exercises. After development of a prototyped game, we will run a pilot study involving 20 healthy participants assigned to either the mixed reality intervention or a traditional exercise group. Outcomes will include measures of discomfort, fatigue, and user experience.

Findings from this study will inform further development of the HoloRehab system.

Study Overview

Status

Enrolling by invitation

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

20

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • Ontario
      • London, Ontario, Canada, N6A 3K7
        • University of Western Ontario

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Adult (≥18 years old) medical students at Western University
  • English-speaking
  • No existing hand pathology
  • Able and willing to provide informed consent

Exclusion Criteria:

  • Musculoskeletal conditions
  • Neurological conditions
  • Chronic pain conditions
  • Previous hand surgeries
  • Function-altering hand injuries
  • History of motion sickness
  • History of seizures or epilepsy
  • Cold sensitivity or cold intolerance
  • Current use of analgesic medications (e.g., NSAIDs, acetaminophen, opioids)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Traditional Rehabilitation
Participants in the traditional rehabilitation group perform self-guided finger range of motion exercises according to a provided guide, without any gaming component.
Other: Cold pressor test
Participants submerge their dominant hand in a cold-water bath while performing hand exercises with their non-dominant hand.
Other Names:
  • Cold water submersion test
Other: Exercise under resistance
Participants perform hand exercises against finger extension resistance bands attached to the non-dominant hand.
Other Names:
  • Resistance exercise
Experimental: HoloRehab Gaming Rehablitation
Participants in the HoloRehab Gaming Rehabilitation group perform the same finger range of motion exercises compared to traditional rehabilitation group, but through the medium of an extended reality rhythm video game with Microsoft HoloLens 3.
Other: Cold pressor test
Participants submerge their dominant hand in a cold-water bath while performing hand exercises with their non-dominant hand.
Other Names:
  • Cold water submersion test
Other: Exercise under resistance
Participants perform hand exercises against finger extension resistance bands attached to the non-dominant hand.
Other Names:
  • Resistance exercise

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time to cold water withdrawal
Time Frame: Assessed continuously during the cold pressor test, from hand immersion until voluntary withdrawal or a maximum of 15 minutes.
The duration (seconds) that participants keep their hand submerged in a cold water bath before voluntarily withdrawing due to discomfort.
Assessed continuously during the cold pressor test, from hand immersion until voluntary withdrawal or a maximum of 15 minutes.
Time to fatigue failure
Time Frame: Assessed continuously during resisted hand exercise, from exercise initiation until voluntary cessation due to fatigue or a maximum of 15 minutes.
The duration (seconds) that participants continue performing hand exercises against resistance bands before voluntarily stopping due to fatigue.
Assessed continuously during resisted hand exercise, from exercise initiation until voluntary cessation due to fatigue or a maximum of 15 minutes.
Discomfort Rating After Cold Water Withdraw
Time Frame: Assessed immediately following completion of the cold pressor test (within 1 minute of hand withdrawal).
Participant-reported level of hand discomfort immediately following the cold pressor test, measured on a 1-10 numerical rating scale.
Assessed immediately following completion of the cold pressor test (within 1 minute of hand withdrawal).
Discomfort Rating After Resisted Exercise
Time Frame: Assessed immediately following completion of the resisted exercise task (within 1 minute of exercise cessation).
Participant-reported level of hand discomfort immediately following resisted hand exercises, measured on a 1-10 numerical rating scale.
Assessed immediately following completion of the resisted exercise task (within 1 minute of exercise cessation).

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
User experience
Time Frame: Assessed once immediately following completion of all study procedures during the single study visit (approximately 45 minutes after intervention initiation).
Participant-reported overall satisfaction, usability, comfort, enjoyment, and perceived effectiveness of the assigned exercise modality, assessed using a post-intervention questionnaire consisting of Likert-scale items. For participants in the intervention arm, this includes experience with the HoloRehab game and the HoloLens 2 headset.
Assessed once immediately following completion of all study procedures during the single study visit (approximately 45 minutes after intervention initiation).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Western University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

June 8, 2026

Primary Completion (Estimated)

June 30, 2026

Study Completion (Estimated)

July 7, 2026

Study Registration Dates

First Submitted

June 9, 2026

First Submitted That Met QC Criteria

June 18, 2026

First Posted (Actual)

June 25, 2026

Study Record Updates

Last Update Posted (Actual)

June 25, 2026

Last Update Submitted That Met QC Criteria

June 18, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 128579

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

No, individual participant data will not be shared, and is retained and used only by the study team. Use of data is described in detail during the informed consent process, and will be stored securely in accordance with institutional research ethics requirements. Due to our small sample size, there is a risk that participants can be re-identified even after de-identification if IPD is shared.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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