Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study

Abstract

BackgroundPatients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing the engagement of elderly patients and increase the uptake of rehabilitation exercises.ObjectiveThe objective of this study was to evaluate Fietsgame (Dutch for cycling game), which translates existing rehabilitation exercises into fun exercise games. The system connects exercise games with a patient’s personal record and a therapist interface by an Internet of Things server. Thus, both the patient and physiotherapist can monitor the patient’s medical status.MethodsThis paper describes a pilot study that evaluates the usability of the Fietsgame. The study was conducted in a rehabilitation center with 9 participants, including 2 physiotherapists and 7 patients. The patients were asked to play 6 exercise games, each lasting about 5 min, under the guidance of a physiotherapist. The mean age of the patients was 74.57 years (standard deviation [SD] 8.28); all the patients were in the recovery process after hip surgery. Surveys were developed to quantitatively measure the usability factors, including presence, enjoyment, pain, exertion, and technology acceptance. Comments on advantages and suggested improvements of our game system provided by the physiotherapists and patients were summarized and their implications were discussed.ResultsThe results showed that after successfully playing the games, 75% to 100% of the patients experienced high levels of enjoyment in all the games except the squats game. Patients reported the highest level of exertion in squats when compared with other exercise games. Lunges resulted in the highest dropout rate (43%) due to interference with the Kinect v2 from support chairs. All the patients (100%) found the game system useful and easy to use, felt that it would be a useful tool in their further rehabilitation, and expressed that they would like to use the game in the future. The therapists indicated that the exercise games highly meet the criteria of motor rehabilitation, and they intend to continue using the game as part of their rehabilitation treatment of patients. Comments from the patients and physiotherapists suggest that real-time corrective feedback when patients perform the exercises wrongly and a more personalized user interface with options for increasing or decreasing cognitive load are needed.ConclusionsThe results suggest that Fietsgame can be used as an alternative tool to traditional motor rehabilitation for patients with hip surgery. Lunges and squats are found to be more beneficial for patients who have relatively better balance skills. A follow-up randomized controlled study will be conducted to test the effectiveness of the Fietsgame to investigate how motivating it is over a longer period of time.

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

“…Nineteen articles remained after the screening process, describing 13 separate biofeedback home rehabilitation systems. Eight systems were described by one paper only [34][35][36][37][38][39][40][41], four systems were described by two separate papers [42][43][44][45][46][47][48][49] and one system was described by three papers [50][51][52]. All included papers fulfilled the inclusion criteria for this scoping review.…”

“…Five systems were developed for use in knee rehabilitation (chronic knee pain or post-operative care) [34,35,43,44,49], three for rehabilitation after a cerebrovascular accident (CVA/stroke) [38,46,51], two for elderly at risk of falls [37,43], and one each for rehabilitation related to carpal tunnel release surgery [36], total hip replacement [40], cerebral palsy [39] and chronic obstructive pulmonary disease (COPD) [41].…”

“…While a variety of visual, audio, haptic and multimodal modes could be used, all systems provided feedback of an audio or visual mode, and there was no haptic feedback. The BASE system by Doyle et al [37] featured multimodal feedback, and five systems applied both audio and visual modes [35,[38][39][40]44]. All systems featured concurrent, or 'real-time', feedback, and six of the systems also gave feedback with a time delay [35,38,40,41,43,44].…”

“…The terminal feedback was given after the completion of an exercise repetition, set or full session, and provided technique information or progress reports. Seven systems used descriptive feedback [34,36,37,39,40,43,46], three used both prescriptive and descriptive [35,38,51], one used prescriptive alone [41], and it was unclear what quality of feedback was used in two systems [44,49]. As each system provided feedback on more than one feature of the targeted exercise, KR and KP were noted to be applied in a variety of ways and eight systems applied both KP and KR [35,38,39,41,43,44,46,51].…”

“…As each system provided feedback on more than one feature of the targeted exercise, KR and KP were noted to be applied in a variety of ways and eight systems applied both KP and KR [35,38,39,41,43,44,46,51]. Five systems used KR only [34,36,37,40,49] and no system used KP only. Constant feedback was given by all systems, but Durfee et al [50] also employed a fading frequency protocol for some feedback features.…”