Validity and reliability of a wearable-controlled serious game and goniometer for telemonitoring of wrist fracture rehabilitation

Abstract

Purpose To determine the validity of wrist range of motion (ROM) measurements by the wearable-controlled ReValidate! wrist-rehabilitation game, which simultaneously acts as a digital goniometer. Furthermore, to establish the reliability of the game by contrasting ROM measurements to those found by medical experts using a universal goniometer. Methods As the universal goniometer is considered the reference standard, inter-rater reliability between surgeons was first determined. Internal validity of the game ROM measurements was determined in a test–retest setting with healthy volunteers. The reliability of the game was tested in 34 patients with a restricted range of motion, in whom the ROM was measured by experts as well as digitally. Intraclass-correlation coefficients (ICCs) were determined and outcomes were analyzed using Bland–Altman plots. Results Inter-rater reliability between experts using a universal goniometer was poor, with ICCs of 0.002, 0.160 and 0.520. Internal validity testing of the game found ICCs of − 0.693, 0.376 and 0.863, thus ranging from poor to good. Reliability testing of the game compared to medical expert measurements, found that mean differences were small for the flexion–extension arc and the radial deviation-ulnar deviation arc. Conclusion The ReValidate! game is a reliable home-monitoring device digitally measuring ROM in the wrist. Interestingly, the test–retest reliability of the serious game was found to be considerably higher than the inter-rater reliability of the reference standard, being healthcare professionals using a universal goniometer. Trial registration number (internal hospital registration only) MEC-AMC W17_003 #17.015.

Telerehabilitation Technology Used for Remote Wrist/Finger Range of Motion Evaluation: A Scoping Review

“…Based on eligibility criteria, a total of 28 studies were included in this review. 28–56 Figure 1 illustrates the PRISMA flow chart describing the article selection process. The KAPPA statistics for agreement between the two reviewers were between moderate and substantial at 0.47 and 0.66 for the title and abstract screen and the full-length text screening, respectively.…”

“…When categorizing studies based on whether the device used was high or low technology, we found that most studies utilized low technological telerehabilitation solutions (n = 23). [28][29][30][31][32][33][34][35][36][38][39][40][41][42][43]45,47,[49][50][51][52][54][55][56]…”

Dynamic assessment of the upper extremity: a review of available and emerging technologies

“…Specific engaging gamification mechanics include use of specific goals, achievements, feedback on progress and levels. Whether these effects will help overcome loss of interest is still not established, but it is generally believed that gamification principles have the power to increase user engagement, raise the quality of health behaviours (Alahäivälä and Oinas-Kukkonen, 2016), and provide an easy way of delivering direct feedback and improving supervision in exercise programmes (Meijer et al., 2018, 2022).…”

“…By use of image-based self-assessments, data on everyday pain and disability can be characterized while at the same time enhancing patient self-management and adherence to treatment protocols (Selter et al., 2018). Gamification principles (such as adding game mechanics via an App into non-game environments) can be added to the mobile applications as a further adjunct to improve patient motivation and make rehabilitation more enjoyable (Meijer et al., 2022; Xu et al., 2022). The basic idea is to draw on the motivational potential of (video) games and to motivate users to use the App for a sustained period.…”