The effects of exergaming on pain, postural control, technology acceptance and flow experience in older people with chronic musculoskeletal pain: a randomised controlled trial

Abstract

Background: Older people with chronic musculoskeletal pain are at risk of falls. This study aimed to investigate the effects of exergaming on pain and postural control in older people with chronic musculoskeletal pain. Secondary outcomes were technology acceptance, flow experience, perceived physical exertion, expended mental effort and heart rate. Methods: 54 older adults (age: 71 ± 5 years) with chronic musculoskeletal pain were randomised into 2 groups. Group 1 received exergaming training using the Interactive Rehabilitation and Exercise System (IREX®). Group 2 undertook traditional gym-based exercise (TGB). Both groups completed twice weekly 40-minute exercise sessions for six weeks. Perceived pain was measured using a numeric pain rating scale and the Multidimensional Affect and Pain Survey questionnaire. Postural control was measured as sway using a Kistler™ force platform. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology questionnaire and flow experience with the Flow State Scale. Physiological measures of perceived physical exertion, expended mental effort and heart rate were recorded during all sessions. Results: The exergaming group demonstrated significant reductions in pain intensity and thermal pain including a near significant approach in physical engagement in comparison to TGB group. Although no intervention effects on postural control were found, the exergaming group showed significant improvements in three sway measures (AP SD, ML SD and AP range) over time whereas significant improvements in ML range were found in the TGB group. Relating to technology acceptance, significant intervention effects on social influence and behavioural intention were found in the TGB group instead, although both groups demonstrated increases of acceptance over time. Regarding flow experience, concentration at task was significantly influenced in the TGB group and significant increases in flow variables over time were observed in both groups. Significant increases over time in perceived physical exertion and expended mental effort were found in both groups. Conclusion: Our findings support the potential of exergaming to alleviate pain and improve balance in older people with chronic musculoskeletal pain. Both forms of exercise are acceptable, intrinsically motivating and show evidence of benefit to older people with chronic musculoskeletal pain. Trial registration: ClinicalTrials.gov Identifier: NCT04029285 (retrospectively registered, July 23, 2019) https://clinicaltrials.gov/ct2/show/study/NCT04029285?term=Alasdair+Macsween&draw=2&rank=2

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“…Similar previous studies include evidence that conventional exercise therapy is effective for chronic low back pain, 4 literature that discusses the possibility that CBT can relieve chronic low back pain, 2,3,5 and other literature that discusses the possibility that exergaming is effective in relieving chronic musculoskeletal pain. [16][17][18][19] Research on the therapeutic effects of exergaming on chronic pain disorders and the effects of exergaming on socio-psychological factors is still limited, and the results of this study should provide new evidence and the need for new research.…”

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“…In a study where exergaming with the Nintendo Wii was included into the treatment, participants were not able to maintain single-legged stance for longer than before the intervention [67]. In contrast, in a study with older participants with diverse chronic musculoskeletal complaints and an exergame that mainly focused on translations of the body weight, several postural balance parameters improved but not relative to participants who had performed similar exercises without gamification [68]. A meta-analysis on studies with older participants without complaints suggests that exergames affect different measures of postural balance positively, but an enhancement of postural balance assessed under stable, unperturbed conditions could not be confirmed either [69].…”