An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study

Abstract

Background Balance impairments are common in people with multiple sclerosis (MS), with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (eg, depression) that are frequently associated with physical inactivity. Objective In this paper, we aimed to describe the design, development, and usability testing of MS Fitness Intervention Training (MS-FIT), a Kinect-based tool implementing Pilates exercises customized for MS. Methods MS-FIT has been developed using a user-centered design approach (design, prototype, user feedback, and analysis) to gain the target user’s perspective. A team composed of 1 physical therapist, 2 game programmers, and 1 game designer developed the first version of MS-FIT that integrated the knowledge and experience of the team with MS literature findings related to Pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D (Unity Technologies) game engine software with Kinect Sensor V2 for Windows, implements exercises for breathing, posture, and balance. Feedback from an Italian panel of experts in MS rehabilitation (neurologists, physiatrists, physical therapists, 1 statistician, and 1 bioengineer) and people with MS was collected to customize the tool for use in MS. The context of MS-FIT is traveling around the world to visit some of the most important cities to learn the aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a Pilates teacher shows the user the exercises to be performed. Overall, 9 people with MS (n=4, 44% women; mean age 42.89, SD 11.97 years; mean disease duration 10.19, SD 9.18 years; Expanded Disability Status Scale score 3.17, SD 0.75) were involved in 3 outpatient user test sessions of 30 minutes; MS-FIT’s usability was assessed through an ad hoc questionnaire (maximum value=5; higher the score, higher the usability) evaluating easiness to use, playability, enjoyment, satisfaction, and acceptance. Results A user-centered design approach was used to develop an accessible and challenging tool for balance training. All people with MS (9/9, 100%) completed the user test sessions and answered the ad hoc questionnaire. The average score on each item ranged from 3.78 (SD 0.67) to 4.33 (SD 1.00), which indicated a high usability level. The feedback and suggestions provided by 64% (9/14) of people with MS and 36% (5/14) of therapists involved in the user test were implemented to refine the first prototype to release MS-FIT 2.0. Conclusions The participants reported that MS-FIT was a usable tool. It is a promising system for enhancing the motivation and engagement of people with MS in performing exercise with the aim of improving their physical status.

Effect of an interactive Pilates-based telerehabilitation intervention in people with multiple sclerosis: Protocol for a Randomized Controlled Trial. (Preprint)

“…Recently, MS-FIT, a usable Kinect-based exergame implementing Pilates exercises, has been developed by an Italian network of experts in the field of MS rehabilitation for a future use in research and clinic (Tacchino et al, 2023). It has been customized for PwMS, allows to tailor the intervention in order to potentiate the effects of an ongoing program, and was intended to be developed for asynchronous telerehabilitation purposes.…”

“…We are conducting a multicentre 2-arm randomized controlled trial with 3 assessment points (baseline, post-intervention at 12 weeks, and follow-up at 6 weeks). Participants in the intervention condition (MS-FIT group) will receive access to MS-FIT exergame for at-home self-administration (Tacchino et al, 2023) in addition to their leisure time physical activities. Participants in the control condition (CTRL group) will only have access to their leisure time physical activities.…”

“…Subjects in the MS-FIT group will receive the MS-FIT exergame (Tacchino et al, 2023). MS-FIT is a tool for an individual interactive game-based training using Microsoft Kinect Sensor V2.…”

“…It implements Pilates exercises appropriately adapted to MS requirements. The usability of the tool has been successfully tested in a previous work (Tacchino et al, 2023). The Microsoft Kinect Sensor V2 allows the user to interact through gestures and spoken commands that warrant better access, participation and benefit to people with impairment such as PwMS.…”

“…Patients and the public were not involved in the design, conduct, reporting, or dissemination plans of our research, although the patient feedback was an important source for the development and improvement of the MS-FIT tool investigated in this trial (Tacchino et al, 2023). Published results will be disseminated to the study participants on request.…”