Title: What is the clinical and cost-effectiveness, and acceptibility, of Wii Sports for improving dominant arm function after stroke?
Funder: Department of Health (England)

Abstract: Background Stroke is the most common cause of disability in the UK[1]. More than 150,000 people per year in England and Wales have a stroke, and 80% of them suffer arm and leg motor impairment and require rehabilitation[2]. Currently only half of patients receive the rehabilitation to meet their needs in the 6 months following discharge from hospital[2]. Daily home exercise is usually prescribed but less than one in three patients complete this. Motor rehabilitation after stroke using computer systems is of increasing interest[3-6]. The Nintendo Wii game Wii Sports offers task specific training that is repetitive and motivating [7-9] and may be a useful adjunct to rehabilitation[10], but there is little robust research on its use[11]. Aims The aim of this study is to investigate whether adding Wii activity to usual rehabilitation services for stroke patients with dominant arm weakness is clinically effective, cost effective and acceptable to patients. The primary outcome is a validated measure of arm strength and function. Secondary outcomes include occupational performance, impact of stroke, quality of life and adverse events. An economic evaluation will also be conducted to assess cost effectiveness. Through an embedded qualitative study we also aim to investigate in more depth what factors for patients and carers influence the use of Wii in practice as part of the rehabilitation process, to inform interpretation of the trial results and subsequent implementation. Plan of Investigation This is a pragmatic RCT with blinded outcome assessment. 240 participants with dominant arm weakness following stroke will be randomised to one of two groups. The control group will mirror the range of service provision received in different NHS service areas. The intervention group will receive those same services but with the addition of a Wii for home use. Both groups will be advised to undertake daily exercises (with or without Wii) for 6 weeks. Outcomes will be measured at baseline, end of intervention (6 weeks) and 6 months. Cost effectiveness will be measured through analyses of in- and out-patient episodes, health professional visits, and EuroQOL. Patient and carer experiences of using the Wii and barriers to its implementation will be captured through semi-structured interviews. Potential Impact Stroke has a devastating and lasting effect on people’s lives with an estimated annual £2.8 billion in direct care costs to the NHS alone[1]. Intensive physiotherapy is required in the first weeks after stroke to restore function of affected limbs; however, currently only 50% of patients receive the required physiotherapy. There is a lack of evidence for interventions that promote arm motor recovery after stroke and research is required into possible interventions for routine practice[12]. Wii Sports is starting to be used by therapists in rehab, without any current evidence to support its use. If we show the use of Wii is effective, it could offer patient centred rehabilitation in a cost effective manner, whilst if no benefit is shown, its ad-hoc use can be discouraged.


Research activity codes: 6.7 PHYSICAL
Health categories: STROKE