Feedback Design in Targeted Exercise Digital Biofeedback Systems for Home Rehabilitation: A Scoping Review

Abstract

Digital biofeedback systems (DBSs) are used in physical rehabilitation to improve outcomes by engaging and educating patients and have the potential to support patients while doing targeted exercises during home rehabilitation. The components of feedback (mode, content, frequency and timing) can influence motor learning and engagement in various ways. The feedback design used in DBSs for targeted exercise home rehabilitation, as well as the evidence underpinning the feedback and how it is evaluated, is not clearly known. To explore these concepts, we conducted a scoping review where an electronic search of PUBMED, PEDro and ACM digital libraries was conducted from January 2000 to July 2019. The main inclusion criteria included DBSs for targeted exercises, in a home rehabilitation setting, which have been tested on a clinical population. Nineteen papers were reviewed, detailing thirteen different DBSs. Feedback was mainly visual, concurrent and descriptive, frequently providing knowledge of results. Three systems provided clear rationale for the use of feedback. Four studies conducted specific evaluations of the feedback, and seven studies evaluated feedback in a less detailed or indirect manner. Future studies should describe in detail the feedback design in DBSs and consider a robust evaluation of the feedback element of the intervention to determine its efficacy.Sensors 2020, 20, 181 2 of 20 to improve motor learning, engagement with and adherence to rehabilitation in musculoskeletal, neurological and orthopaedic populations [3][4][5]. They can improve awareness of exercise technique by providing information regarding movement that was previously unavailable. DBSs can generate objective measurements which act as rehabilitation goals, such as knee range of movement (ROM). With the appropriate data analytics and visualisations, the data collected can be compiled to create progress reports and allow remote monitoring by physiotherapists [6,7].Feedback consists of four main components (mode, content, frequency and timing), which each may be applied in a multitude of ways. Different combinations of these components will result in different feedback designs, and, theoretically, different effects on the user [8]. We have summarised the components of feedback that are observed in the relevant literature and presented them in Figure 1 as a framework within which to describe feedback interventions in detail. The first of these components is feedback mode, this may be visual, audio, haptic or multimodal (more than one mode represents the same variable at the same time). Through these modes, the feedback may be presented in a direct manner, e.g., a measure of ROM [9], or in an indirect manner, e.g., abstract graphical displays or gamified interfaces [10,11]. Feedback timing can be concurrent (also known as 'real-time' or 'simultaneous') or terminal, meaning it can be delivered during or after exercise execution, respectively. The frequency of feedback can be constant, reduced, or fading (decreasing over time). Feedback con...

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