The effects of exergaming on balance, gait, technology acceptance and flow experience in people with multiple sclerosis: a randomized controlled trial

Jonathan Robinson, John Dixon, Alasdair Macsween, Paul van Schaik, Denis Martin, Jonathan Robinson, John Dixon, Alasdair Macsween, Paul van Schaik, Denis Martin

Abstract

Background: Exergaming is a promising new alternative to traditional modes of therapeutic exercise which may be preferable and more effective for people with Multiple Sclerosis (MS). Impaired balance is reported as one of the most disabling aspects of MS. The purposes of this study were to examine the effects of exergaming on: (1) postural sway, (2) gait, (3) technology acceptance and (4) flow experience in people with MS. Secondary outcomes were disability: 12-item Multiple Sclerosis Walking Scale (MSWS-12) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire.

Methods: Fifty-six adults (mean age = 52 years, SD = 5.8; 38 women) with a clinical diagnosis of MS and able to walk 100 meters with or without use of a walking aid were included in this study and randomized into 3 groups. Group 1 received balance training using the Nintendo Wii Fit™ (exergaming) and Group 2 undertook traditional balance training (non-exergaming). Group 3 acted as a control group, receiving no intervention. Exergaming and traditional balance training groups received four weeks of twice weekly balance-orientated exercise. Postural sway was measured using a Kistler™ force platform. Spatiotemporal parameters of gait were measured using a GAITRite™ computerised walkway. Technology acceptance and flow experience were measured using the Unified Theory of Acceptance and Use of Technology and the Flow State Scale questionnaires, respectively.

Results: There were significant improvements in bipedal postural sway in both intervention groups when compared to the control group; and no effects of either intervention on gait. There were no significant differences between the interventions in technology acceptance but on several dimensions of flow experience the Wii Fit™ was superior to traditional balance training. Both interventions showed improvements in disability compared to control.

Conclusions: In terms of the physical effects of exergaming, the Wii Fit™ is comparable to traditional balance training. These findings would support the use of the Wii Fit™ as an effective means of balance and gait training for people with MS, which is both accepted and intrinsically motivating to MS users.

Trial registration: Controlled Trials ISRCTN13924231.

Keywords: Balance training; Exergaming; Flow state experience; Gait; Multiple sclerosis; Nintendo Wii™; Technology acceptance.

Figures

Figure 1
Figure 1
CONSORT flow diagram illustrating a participant entering the study. The final number of participants analysed is based on the principle of complete case analysis and intention-to-treat principles.

References

    1. Sloka JS, Pryse-Phillips WEM, Stefanelli M. Incidence and prevalence of multiple sclerosis in Newfoundland and Labrador. Can J Neurol Sci. 2005;32:37–42. doi: 10.1017/S0317167100016851.
    1. Matsuda PN, Shumway-Cook A, Ciol MA, Bombardier CH, Kartin DA. Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments. Phys Ther. 2012;92:407–15. doi: 10.2522/ptj.20100380.
    1. Scheinberg L, Holland N, Larocca N, Laitin P, Bennett A, Hall H. Multiple sclerosis; earning a living. N Y State J Med. 1980;80:1395–400.
    1. Stokes M. Physical management in neurological rehabilitation. 2. London: Elsevier Health Sciences; 2004.
    1. Langdon DW, Thompson AJ. Multiple sclerosis: a preliminary study of selected variables affecting rehabilitation outcome. Mult Scler. 1999;5:94–100. doi: 10.1177/135245859900500205.
    1. Martyn C. McAlpine’s Mult Scler. 4. Oxford, England: Churchill Livingstone; 2005. Symptoms and signs in the course of disease; pp. 287–346.
    1. Staiano AE, Calvert SL. The promise of exergames as tools to measure physical health. Entertain Comput. 2011;2:17–21. doi: 10.1016/j.entcom.2011.03.008.
    1. Bateni H. Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study. Physiotherapy. 2012;98:211–6. doi: 10.1016/j.physio.2011.02.004.
    1. Brumels KKA, Blasius T, Cortright T, Oumedian D, Solberg B. Comparison of efficacy between traditional and video game based balance programs. Clin Kinesiol. 2008;62:26–31.
    1. Nitz JC, Kuys S, Isles R, Fu S. Is the Wii FitTM a new-generation tool for improving balance, health and well-being? A pilot study. Climacteric. 2010;13:487–91. doi: 10.3109/13697130903395193.
    1. Kim JH, Jang SH, Kim CS, Jung JH, You JH. Use of virtual reality to enhance balance and ambulation in chronic stroke: a double-blind, randomized controlled study. Am J Phys Med Rehabil. 2009;88:693–701. doi: 10.1097/PHM.0b013e3181b33350.
    1. Deutsch JE, Borbely M, Filler J, Huhn K, Guarrera-Bowlby P. Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. Phys Ther. 2008;88:1196–207. doi: 10.2522/ptj.20080062.
    1. Esculier J-F, Vaudrin J, Bériault P, Gagnon K, Tremblay LE. Home-based balance training programme using Wii Fit with balance board for Parkinsons’s disease: a pilot study. J Rehabil Med. 2012;44:144–50. doi: 10.2340/16501977-0922.
    1. Prosperini L, Fortuna D, Giannì C, Leonardi L, Marchetti MR, Pozzilli C. Home-based balance training using the Wii balance board a randomized, crossover pilot study in multiple sclerosis. Neurorehabil Neural Repair. 2013;27:516–25. doi: 10.1177/1545968313478484.
    1. Nilsagård YE, Forsberg AS, von Koch L. Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study. Mult Scler J. 2013;19:209–16. doi: 10.1177/1352458512450088.
    1. Brichetto G, Spallarossa P, de Carvalho MLL, Battaglia MA. The effect of Nintendo® Wii® on balance in people with multiple sclerosis: a pilot randomized control study. Mult Scler J. 2013;19:1219–21. doi: 10.1177/1352458512472747.
    1. Staiano AE, Calvert SL. Exergames for physical education courses: physical, social, and cognitive benefits. Child Dev Perspect. 2011;5:93–8. doi: 10.1111/j.1750-8606.2011.00162.x.
    1. Warburton DER, Bredin SSD, Horita LTL, Zbogar D, Scott JM, Esch BTA, et al. The health benefits of interactive video game exercise. Appl Physiol Nutr Metab. 2007;32:655–63. doi: 10.1139/H07-038.
    1. Rhodes RE, Warburton D, Coble J. Effect of interactive video bikes on exercise adherence and social cognitive expectancies in young men: A pilot study. In: Ann Behav Med, vol. Volume 35. 233 Spring St, New York, NY 10013 USA: Springer; 2008. p. S62–2.
    1. Warburton DER, McKenzie DC, Haykowsky MJ, Taylor A, Shoemaker P, Ignaszewski AP, et al. Effectiveness of high-intensity interval training for the rehabilitation of patients with coronary artery disease. Am J Cardiol. 2005;95:1080–4. doi: 10.1016/j.amjcard.2004.12.063.
    1. De Bourdeaudhuij I, Crombez G, Deforche B, Vinaimont F, Debode P, Bouckaert J. Effects of distraction on treadmill running time in severely obese children and adolescents. Int J Obes. 2002;26:1023–9. doi: 10.1038/sj.ijo.0802052.
    1. Yamashita S, Iwai K, Akimoto T, Sugawara J, Kono I. Effects of music during exercise on RPE, heart rate and the autonomic nervous system. J Sports Med Phys Fitness. 2006;46:425–30.
    1. Venkatesh V, Morris M, Davis G, Davis F. User acceptance of information technology: toward a unified view. Manag Inf Syst Q. 2003;27:425–78.
    1. Jackson SA, Marsh H. Development and validation of a scale to measure optimal experience: The Flow State Scale. J Sport Exerc Psychol. 1996;18:17–35. doi: 10.1123/jsep.18.1.17.
    1. Kurtzke JF. Rating neurologic impairment in multiple sclerosis an expanded disability status scale (EDSS) Neurology. 1983;33:1444. doi: 10.1212/WNL.33.11.1444.
    1. Research Randomizer (Version 4.0) [Computer software] []
    1. Dalgas U, Stenager E, Ingemann-Hansen T. Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training. Mult Scler. 2008;14:35–53. doi: 10.1177/1352458507079445.
    1. American College of Sports Medicine . ACSM’s resource manual for guidelines for exercise testing and prescription. 6. Philadelphia, Pa; London: Lippincott Williams & Wilkins; 2010.
    1. American College of Sports Medicine . ACSM’s exercise management for persons with chronic diseases and disabilities. 3. Leeds: Human Kinetics; 2009.
    1. Wii FitTM Plus, Balance Games []
    1. Hobart JC, Riazi A, Lamping DL, Fitzpatrick R, Thompson AJ. Measuring the impact of MS on walking ability The 12-Item MS Walking Scale (MSWS-12) Neurology. 2003;60:31–6. doi: 10.1212/WNL.60.1.31.
    1. WHO | WHO Disability Assessment Schedule 2.0 []
    1. Schulmann DL, Godfrey B, Fisher AG. Effect of eye movements on dynamic equilibrium. Phys Ther. 1987;67:1054–7.
    1. Rome K, Brown CL. Randomized clinical trial into the impact of rigid foot orthoses on balance parameters in excessively pronated feet. Clin Rehabil. 2004;18:624–30. doi: 10.1191/0269215504cr767oa.
    1. Givon U, Zeilig G, Achiron A. Gait analysis in multiple sclerosis: characterization of temporal–spatial parameters using GAITRite functional ambulation system. Gait Posture. 2009;29:138–42. doi: 10.1016/j.gaitpost.2008.07.011.
    1. Jackson S, Eklund R. Assessing flow in physical activity: the flow state scale-2 and dispositional flow scale-2. J Sport Exerc Psychol. 2002;24:133–50. doi: 10.1123/jsep.24.2.133.
    1. Csikszentmihalyi M. Flow: the psychology of optimal experience. London: Harper Perennial; 1990.
    1. Motl RW, Snook EM. Confirmation and extension of the validity of the Multiple Sclerosis Walking Scale-12 (MSWS-12) J Neurol Sci. 2008;268:69–73. doi: 10.1016/j.jns.2007.11.003.
    1. Raymakers JA, Samson MM, Verhaar HJJ. The assessment of body sway and the choice of the stability parameter(s) Gait Posture. 2005;21:48–58. doi: 10.1016/j.gaitpost.2003.11.006.
    1. Heritier SR, Gebski VJ, Keech AC. Inclusion of patients in clinical trial analysis: the intention-to-treat principle. Med J Aust. 2003;179:438–40.
    1. Montedori A, Bonacini MI, Casazza G, Luchetta ML, Duca P, Cozzolino F, et al. Modified versus standard intention-to-treat reporting: Are there differences in methodological quality, sponsorship, and findings in randomized trials? A cross-sectional study. Trials. 2011;12:58. doi: 10.1186/1745-6215-12-58.
    1. Allison PD. Handling missing data by maximum likelihood. In SAS® Glob Forum 2012 Conf SAS Inst (Paper 312–2012). Cary, NC; 2012.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 3. New York: Academic Press; 1988.
    1. Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91. doi: 10.3758/BF03193146.
    1. Shafizadeh M, Abolfazli R, Platt GK. Effect of visual force biofeedback on balance control in people with Multiple Sclerosis-a Pilot Quasi-experimental study. J Phys Ther. 2012;6:21–7.
    1. Cameron MMH, Lord S. Postural control in multiple sclerosis: implications for fall prevention. Curr Neurol Neurosci Rep. 2010;10:407–12. doi: 10.1007/s11910-010-0128-0.
    1. Porosińska A, Pierzchała K, Mentel M, Karpe J. Evaluation of postural balance control in patients with multiple sclerosis–effect of different sensory conditions and arithmetic task execution. A pilot study. Neurol Neurochir Pol. 2010;44:35–42.
    1. Sosnoff J, Socie M, Boes M, Sandroff B. Mobility, balance and falls in persons with multiple sclerosis. PLoS One. 2011;6 doi: 10.1371/journal.pone.0028021.
    1. Kato PM. Video games in health care: closing the gap. Rev Gen Psychol. 2010;14:113. doi: 10.1037/a0019441.
    1. Andrews G, Kemp A, Sunderland M, Von Korff M, Ustun TB. Normative data for the 12 item WHO Disability Assessment Schedule 2.0. PLoS One. 2009;4 doi: 10.1371/journal.pone.0008343.
    1. Prosperini L, Pozzilli C. The clinical relevance of force platform measures in multiple sclerosis: a review. Mult Scler Int. 2013;2013:756564.
    1. Jones MG. Creating electronic learning environments: games, flow, and the user interface. In: Proc Sel Res Dev Present Natl Conv Assoc Educ Commun Technol. St. Louis, MO: ERIC; 1998.
    1. Middleton A. Chronic low back pain: patient compliance with physiotherapy advice and exercise, perceived barriers and motivation. Phys Ther Rev. 2004;9:153–60. doi: 10.1179/108331904225006312.
    1. Campbell R, Evans M, Tucker M, Quilty B, Dieppe P, Donovan JL. Why don’t patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee. J Epidemiol Community Health. 2001;55:132–8. doi: 10.1136/jech.55.2.132.
    1. Thin AG, Hansen L, McEachen D. Flow experience and mood states while playing body movement-controlled video games. Games Cult. 2011;6:414–28. doi: 10.1177/1555412011402677.

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