Task-oriented training with computer gaming in people with rheumatoid arthritisor osteoarthritis of the hand: study protocol of a randomized controlled pilot trial

Cynthia Swarnalatha Srikesavan, Barbara Shay, David B Robinson, Tony Szturm, Cynthia Swarnalatha Srikesavan, Barbara Shay, David B Robinson, Tony Szturm

Abstract

Background: Significant restriction in the ability to participate in home, work and community life results from pain, fatigue, joint damage, stiffness and reduced joint range of motion and muscle strength in people with rheumatoid arthritis or osteoarthritis of the hand. With modest evidence on the therapeutic effectiveness of conventional hand exercises, a task-oriented training program via real life object manipulations has been developed for people with arthritis. An innovative, computer-based gaming platform that allows a broad range of common objects to be seamlessly transformed into therapeutic input devices through instrumentation with a motion-sense mouse has also been designed. Personalized objects are selected to target specific training goals such as graded finger mobility, strength, endurance or fine/gross dexterous functions. The movements and object manipulation tasks that replicate common situations in everyday living will then be used to control and play any computer game, making practice challenging and engaging.

Methods/design: The ongoing study is a 6-week, single-center, parallel-group, equally allocated and assessor-blinded pilot randomized controlled trial. Thirty people with rheumatoid arthritis or osteoarthritis affecting the hand will be randomized to receive either conventional hand exercises or the task-oriented training. The purpose is to determine a preliminary estimation of therapeutic effectiveness and feasibility of the task-oriented training program. Performance based and self-reported hand function, and exercise compliance are the study outcomes. Changes in outcomes (pre to post intervention) within each group will be assessed by paired Student t test or Wilcoxon signed-rank test and between groups (control versus experimental) post intervention using unpaired Student t test or Mann-Whitney U test.

Discussion: The study findings will inform decisions on the feasibility, safety and completion rate and will also provide preliminary data on the treatment effects of the task-oriented training compared with conventional hand exercises in people with rheumatoid arthritis or osteoarthritis of the hand.

Trial registration: ClinicalTrials.gov: NCT01635582.

Figures

Figure 1
Figure 1
Instrumentation of objects. (A) A coffee mug is instrumented with the motion sense mouse using Velcro strips. (B) A turning knob is instrumented with the mouse using a wooden block, dowel, rubber pad and Velcro strips.
Figure 2
Figure 2
Framework for selecting personalized therapeutic objects for the task-oriented training program.
Figure 3
Figure 3
Task-oriented training with a few selected objects. (A) A bottle cap is manipulated by rotating it left or right. (B) A medium-sized ball is manipulated by rotating it left or right. (C) A flat wooden board is manipulated by tilting it up down and vice versa. (D) A dumbbell is used for strengthening the wrist extensors.
Figure 4
Figure 4
Objective variables of the predictable tracking task. (A) Coefficient of determination of user motion trajectory. Bold lined waveform, user motion signal; thin line, reference waveform for a manipulation task. (B) Temporal accuracy. Bold lined waveform in the top plot, reference waveform; light shading, user motion signal for a manipulation task. A maximum and minimum point on the up and down cycles of the user signal is shown. The time taken to reach maximum and minimum points for each movement cycle is compared between the two signals. (C) Amplitude consistency. An arbitrary line drawn on a user motion signal represents amplitude consistency in upward and downward directions.
Figure 5
Figure 5
Parsed movements from a random game play. Outcome measures derived from episodic game play are shown.
Figure 6
Figure 6
Flowchart of the clinical trial from recruitment to final assessment stages.

References

    1. Horsten NC, Ursum J, Roorda LD, van Schaardenburg D, Dekker J, Hoeksma AF. Prevalence of hand symptoms, impairments and activity limitations in rheumatoid arthritis in relation to disease duration. J Rehabil Med. 2010;42:916–921. doi: 10.2340/16501977-0619.
    1. Philips CA. Rehabilitation of the patient with rheumatoid hand involvement. Phys Ther. 1989;69:1091–1098.
    1. Rogers MW, Wilder FV. Exercise and hand osteoarthritis symptomatology: a controlled crossover trial. J Hand Ther. 2009;22:7–10. discussion 19–20; quiz 18.
    1. Van der Giesen FJ, Nelissen RG, Rozing PM, Arendzen JH, de Jong Z, Wolterbeek R, Vliet Vlieland TP. A multidisciplinary hand clinic for patients with rheumatic diseases: a pilot study. J Hand Ther. 2007;20:251–260. doi: 10.1197/j.jht.2007.04.004. quiz 261.
    1. Vliet Vlieland TP. Non-drug care for RA – is the era of evidence-based practice approaching? Rheumatology (Oxford) 2007;46:1397–1404. doi: 10.1093/rheumatology/kem149.
    1. Vliet Vlieland TP, van den Ende CH. Nonpharmacological treatment of rheumatoid arthritis. Curr Opin Rheumatol. 2011;23:259–264. doi: 10.1097/BOR.0b013e32834540fb.
    1. Astin JA, Beckner W, Soeken K, Hochberg MC, Berman B. Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials. Arthritis Rheum. 2002;47:291–302. doi: 10.1002/art.10416.
    1. Forestier R, Andre-Vert J, Guillez P, Coudeyre E, Lefevre-Colau MM, Combe B, Mayoux-Benhamou MA. Non-drug treatment (excluding surgery) in rheumatoid arthritis: clinical practice guidelines. Joint Bone Spine. 2009;76:691–698. doi: 10.1016/j.jbspin.2009.01.017.
    1. Gossec L, Pavy S, Pham T, Constantin A, Poiraudeau S, Combe B, Flipo RM, Goupille P, Le Loët X, Mariette X, Puéchal X, Wendling D, Schaeverbeke T, Sibilia J, Tebib J, Cantagrel A, Dougados M. Nonpharmacological treatments in early rheumatoid arthritis: clinical practice guidelines based on published evidence and expert opinion. Joint Bone Spine. 2006;73:396–402. doi: 10.1016/j.jbspin.2006.01.008.
    1. Christie A, Jamtvedt G, Dahm KT, Moe RH, Haavardsholm EA, Hagen KB. Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: an overview of systematic reviews. Phys Ther. 2007;87:1697–1715. doi: 10.2522/ptj.20070039.
    1. Hammond A. Rehabilitation in rheumatoid arthritis: a critical review. Musculoskeletal Care. 2004;2:135–151. doi: 10.1002/msc.66.
    1. Kavuncu V, Evcik D. Physiotherapy in rheumatoid arthritis. MedGenMed. 2004;6:3.
    1. Zhang W, Doherty M, Leeb BF, Alekseeva L, Arden NK, Bijlsma JW, Dinçer F, Dziedzic K, Häuselmann HJ, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Maheu E, Martín-Mola E, Pavelka K, Punzi L, Reiter S, Sautner J, Smolen J, Verbruggen G, Zimmermann-Górska I. EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT) Ann Rheum Dis. 2007;66:377–388. doi: 10.1136/ard.2006.062091.
    1. Valdes K, Marik T. A systematic review of conservative interventions for osteoarthritis of the hand. J Hand Ther. 2010;23:50–334.
    1. Ye L, Kalichman L, Spittle A, Dobson F, Bennell K. Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis: a systematic review. Arthritis Res Ther. 2011;13:R28. doi: 10.1186/ar3254.
    1. Wessel J. The effectiveness of hand exercises for persons with rheumatoid arthritis: a systematic review. J Hand Ther. 2004;17:174–180. doi: 10.1197/j.jht.2004.02.006.
    1. Chadwick A. A review of the history of hand exercises in rheumatoid arthritis. Musculoskeletal Care. 2004;2:29–39. doi: 10.1002/msc.54.
    1. Guzelkucuk U, Duman I, Taskaynatan MA, Dincer K. Comparison of therapeutic activities with therapeutic exercises in the rehabilitation of young adult patients with hand injuries. J Hand Surg Am. 2007;32:1429–1435. doi: 10.1016/j.jhsa.2007.08.008.
    1. Gillen G. Stroke Rehabilitation – Function Based Approach. 3 2011.
    1. Szturm T, Peters JF, Otto C, Kapadia N, Desai A. Task-specific rehabilitation of finger–hand function using interactive computer gaming. Arch Phys Med Rehabil. 2008;89:2213–2217. doi: 10.1016/j.apmr.2008.04.021.
    1. Wilkinson N, Ang RP, Goh DH. Online video game therapy for mental health concerns: a review. Int J Soc Psychiatry. 2008;54:370–382. doi: 10.1177/0020764008091659.
    1. Wong FS, Campbell DR, Becker BE. Head injury and video games. West J Med. 1983;138:107.
    1. Lange B, Flynn SM, Rizzo AA. Game-based telerehabilitation. Eur J Phys Rehabil Med. 2009;45:143–151.
    1. Betker AL, Szturm T, Moussavi ZK, Nett C. Video game-based exercises for balance rehabilitation: a single-subject design. Arch Phys Med Rehabil. 2006;87:1141–1149. doi: 10.1016/j.apmr.2006.04.010.
    1. Szturm T, Betker A, Goodman V, Desai A, Moussavi Z. Effects of an interactive computer game exercise regimen on balance impairment in frail community dwelling older adults: a randomized controlled trial. Phys Ther. 2011;91:1–14.
    1. Herndon CD, Decambre M, McKenna PH. Interactive computer games for treatment of pelvic floor dysfunction. J Urol. 2001;166:1893–1898. doi: 10.1016/S0022-5347(05)65714-X.
    1. Higgins S. Motor skill acquisition. Phys Ther. 1991;71:123–139.
    1. Roddy E, Zhang W, Doherty M, Arden NK, Barlow J, Birrell F, Carr A, Chakravarty K, Dickson J, Hay E, Hosie G, Hurley M, Jordan KM, McCarthy C, McMurdo M, Mockett S, O’Reilly S, Peat G, Pendleton A, Richards S. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee – the MOVE consensus. Rheumatology (Oxford) 2005;44:67–73. doi: 10.1093/rheumatology/keh399.
    1. Bennell LK, Hinman SR. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. 2011;14:4–9. doi: 10.1016/j.jsams.2010.08.002.
    1. Care for people with arthritis. Evidence and Best Practices. 2005.
    1. Lancaster GA, Dodd S, Williamson PR. Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract. 2004;10:307–312. doi: 10.1111/j..2002.384.doc.x.
    1. Stamm TA, Machold KP, Smolen JS, Fischer S, Redlich K, Graninger W, Ebner W, Erlacher L. Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: a randomized controlled trial. Arthritis Rheum. 2002;47:44–49. doi: 10.1002/art1.10246.
    1. Brorsson S, Hilliges M, Sollerman C, Nilsdotter A. A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis. J Rehabil Med. 2009;41:338–342. doi: 10.2340/16501977-0334.
    1. Buljina AI, Taljanovic MS, Avdic DM, Hunter TB. Physical and exercise therapy for treatment of the rheumatoid hand. Arthritis Rheum. 2001;45:392–397. doi: 10.1002/1529-0131(200108)45:4<392::AID-ART353>;2-2.
    1. Dellhag B, Wollersjo I, Bjelle A. Effect of active hand exercise and wax bath treatment in rheumatoid arthritis patients. Arthritis Care Res. 1992;5:87–92. doi: 10.1002/art.1790050207.
    1. Flatt AE. Restoration of rheumatoid finger-joint function. J Bone Joint Surg Am. 1963;45:1101–1103.
    1. Hoenig H, Groff G, Pratt K, Goldberg E, Franck W. A randomized controlled trial of home exercise on the rheumatoid hand. J Rheumatol. 1993;20:785–789.
    1. Backman C, Mackie H. Reliability and validity of the Arthritis Hand Function test in adults with osteoarthritis. Occup Ther J Res. 1997;17:55–67.
    1. Backman C, Mackie H. Arthritis hand function test: inter-rater reliability among self-trained raters. Arthritis Care Res. 1995;8:10–15. doi: 10.1002/art.1790080105.
    1. Raven EE, Haverkamp D, Sierevelt IN, van Montfoort DO, Poll RG, Blankevoort L, Tak PP. Construct validity and reliability of the disability of arm, shoulder and hand questionnaire for upper extremity complaints in rheumatoid arthritis. J Rheumatol. 2008;35:2334–2338. doi: 10.3899/jrheum.080067.
    1. Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability & responsiveness of the disabilities of the arm, shoulder, and hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14:128–146. doi: 10.1016/S0894-1130(01)80043-0.
    1. Andersen Hammond ER, Shay BL, Szturm T. Objective evaluation of fine motor manipulation-a new clinical tool. J Hand Ther. 2009;22:28–35. doi: 10.1197/j.jht.2008.06.006. quiz 36.
    1. Lockery D, Peters JF, Ramanna S, Shay BL, Szturm T. Store-and-feedforward adaptive gaming system for hand-finger motion tracking in telerehabilitation. IEEE Trans Inf Technol Biomed. 2011;15:467–473.

Source: PubMed

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