Abstract
Objective
To investigate how participants self-schedule their engagement with domestic rehabilitation
gaming platform, and how their scheduling behavior in turn influence overall compliance.
Design
Cohort of individuals randomized to receive in-home rehabilitation gaming during a
multi-site randomized controlled trial.
Setting
In-home self-managed rehabilitation.
Participants
Eighty community-dwelling participants who were >6 months post-stroke and had mild
to moderate upper extremity impairment (N=80).
Interventions
Participants were prescribed 15 hours of independent in-home self-scheduled game play
for upper extremity mobility over 3 weeks.
Main Outcome Measures
Total number of hours of active game play was objectively measured by the rehabilitation
gaming system. Cluster analysis identified scheduling patterns from the following
scheduling characteristics: total number of sessions, average session length, and
consistency of play schedule.
Results
Four distinct scheduling profiles were revealed, 3 of which were associated with complete
or near-complete compliance, while a fourth (inconsistent schedule of short, infrequent
sessions) was associated with very poor compliance. Poor compliance could be predicted
within the first 7 days of the program with 78% accuracy based on the same play pattern
metrics used to identify player profiles.
Conclusions
Our findings support client autonomy in selecting the home practice schedule that
works best for them, as compliance can successfully be achieved through a variety
of different scheduling patterns. The objective measurements of compliance provided
through rehabilitation gaming can assist therapists to identify individuals early
on who exhibit scheduling behavior that is predictive of poor compliance.
Keywords
List of abbreviations:
ANCOVA (analysis of covariance), VIGoROUS (video game rehabilitation for outpatient stroke)To read this article in full you will need to make a payment
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References
- Three-year changes in physical activity and subsequent loss of ability to walk 400 m in older adults.Am J Phys Med Rehabil. 2018; 97: 212-215
- 8 Physical activity among persons with disabilities: a public health perspective.Exerc Sport Sci Rev. 1997; 25: 195-234
- Physical activity participation among persons with disabilities.Am J Prev Med. 2004; 26: 419-425
- Monitoring of physical activity after stroke: a systematic review of accelerometry-based measures.Arch Phys Med Rehabil. 2010; 91: 288-297
World Health Organization. Global recommendations on physical activity for health. World Health Organization; 2010.
- The physical activity guidelines for Americans.JAMA. 2018; 320: 2020
- Compliance to a home-based exercise program for individuals after stroke.Top Stroke Rehabil. 2011; 18: 277-284
- Physical activity and exercise after stroke.Stroke. 2014; 45: 3742-3747
- Associations between compliance to the physical activity and exercise program applied in the LAST study and functional recovery after stroke.Arch Phys Med Rehabil. 2019; 100: 2251-2259
US Department of Health and Human Services. Physical activity guidelines for Americans. 2nd ed. 2018. Available at: https://health.gov/paguidelines/second-edition. Accessed July 25, 2022.
- Prevalence of stroke–United States, 2006-2010.Morb Mortal Wkly Rep. 2012; 61 (Available at) (Accessed January 10, 2021): 379-382
- Barriers associated with exercise and community access for individuals with stroke.J Rehabil Res Dev. 2008; 45: 315-322
- Telehealth physical therapy as an innovative clinical education model with positive patient impact: a case report in the context of the COVID-19 pandemic.J Phys Ther Educ. 2020; 34: 275-281
- A self-administered graded repetitive arm supplementary program (GRASP) improves arm function during inpatient stroke rehabilitation: a multi-site randomized controlled trial.Yearbook Sports Med. 2010; 2010: 254
- Feasibility of a virtual service delivery model to support physical activity engagement during the COVID-19 pandemic for those with spinal cord injury.J Spinal Cord Med. 2021; 44: S256-S265
- Recognizing physical activities for spinal cord injury rehabilitation using wearable sensors.Sensors. 2021; 21: 5479
- A novel methodology for extracting and evaluating therapeutic movements in game-based motion capture rehabilitation systems.J Med Syst. 2018; 42: 255
- Capturing upper limb gross motor categories using the Kinect® sensor.Am J Occup Ther. 2019; 73 (7304205090p1-p10)
- Virtual reality for stroke rehabilitation.Cochrane Database Syst Rev. 2017; 11CD008349
- Effectiveness of virtual reality-and gaming-based interventions for upper extremity rehabilitation poststroke: a meta-analysis.Arch Phys Med Rehabil. 2020; 101: 885-896
- Efficacy of home-based telerehabilitation vs in-clinic therapy for adults after stroke.JAMA Neurol. 2019; 76: 1079-1087
- Home program practices for supporting and measuring compliance in post-stroke rehabilitation: a scoping review.Top Stroke Rehabil. 2019; 27: 377-400
- Compliance to postacute rehabilitation guidelines is associated with functional recovery in stroke.Stroke. 2002; 33: 167-178
- Engineering person-specific behavioral interventions to promote physical activity.Exerc Sport Sci Rev. 2020; 48: 170
- Effects of intermittent exercise and use of home exercise equipment on compliance, weight loss, and fitness in overweight women.JAMA. 1999; 282: 1554
- Participants, usage, and use patterns of a Web-based intervention for the prevention of depression within a randomized controlled trial.J Med Internet Res. 2013; 15: e172
- Tutorial for using control systems engineering to optimize adaptive mobile health interventions.J Med Internet Res. 2018; 20: e8622
- Game-based rehabilitation for myoelectric prosthesis control.JMIR Serious Games. 2017; 5: e3
- Video game rehabilitation for outpatient stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis.BMC Neurol. 2017; 17: 109
Maung D, Crawfis R, Gauthier LV, et al. Development of recovery rapids—a game for cost effective stroke therapy. Foundation of Digital Games, April 2014.
- The mathematical theory of communication.University of Illinois Press, Urbana1949
- Information theory, inference, and learning algorithms.Cambridge University Press, Cambridge2003
- Estimating the decline in excess risk of cerebrovascular disease following quitting smoking—a systematic review based on the negative exponential model.Regul Toxicol Pharmacol. 2014; 68: 85-95
- A game analytics model to identify scheduling profiles in Singleplayer games.in: 18th Brazilian Symposium on Computer Games and Digital Entertainment (SBGames), Rio de Janeiro, Brazil2019: 11-20
- Cluster quality analysis using Silhouette score.in: 2020 IEEE 7th International Conference on Data Science and Advanced Analytics (DSAA). October 2020
- Towards an immersive virtual reality game for smarter post-stroke rehabilitation.in: 2018 IEEE International Conference on Smart Computing (SMARTCOMP). June 2018
- Design and development of a web-based platform for comprehensive autonomous home rehabilitation management in multiple sclerosis.Converging Clinical and Engineering Research on Neurorehabilitation III, October 2018: 400-404
- Using large-scale sensor data to test factors predictive of perseverance in home movement rehabilitation: optimal challenge and steady engagement.Front Neurol. 2022; 13896298
- Randomized controlled trial of an e-learning designed behavioral intervention for increasing physical activity behavior in multiple sclerosis.Mult Scler J Exp Transl Clin. 2017; 3205521731773488
- Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: sustainability and secondary outcomes.Psychol Health Med. 2012; 17: 636-651
- An online community improves compliance in an Internet-mediated walking program. Part 1: results of a randomized controlled trial.J Med Internet Res. 2010; 12: e71
- Insights for exercise compliance from a minimal planning intervention to increase physical activity.Health Educ Behav. 2015; 42: 730-735
- Virtual reality, augmented reality, gamification, and telerehabilitation: psychological impact on orthopedic patients’ rehabilitation.J Clin Med. 2020; 9: 2567
- Effectiveness of gamification for the rehabilitation of neurodegenerative disorders.Chaos Solitons Fractals. 2020; 140
- Effect of specific over nonspecific VR-based rehabilitation on poststroke motor recovery: a systematic meta-analysis.Neurorehabil Neural Repair. 2019; 33: 11229
Article info
Publication history
Published online: November 06, 2022
Accepted:
October 4,
2022
Received in revised form:
September 19,
2022
Received:
December 15,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
Presented at the UMOVE Research Symposium on February 6, 2021, to fellow researchers studying biological movement.
Dr Gauthier's contribution to this study was financially supported by The Patient-Centered Outcomes Research Institute (PCORI, AD-1409-20772).
Disclosures: Dr Gauthier is co-founder of Games That Move You, PBC, that developed the software used in this study and receives royalties. Ms Peznola is an employee of The MITRE Corporation. Ms Peznola's affiliation with The MITRE Corporation is provided for identification purposes only and is not intended to convey or imply MITRE's concurrence with, or support for, the positions, opinions, or viewpoints expressed by the author. The other authors have nothing to disclose.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
