The Utilization of Nintendo Wii™ in Outpatient Rehabilitation Following Total Knee Replacement
Condition: Arthropathy of Knee Joint
MeSH terms: Joint Diseases
Study type: Interventional
Phase: Phase 2

Summary: 
      The purpose of this study is to identify whether the utilization of the Nintendo Wii™ gaming
      system, as an adjunct to conventional outpatient rehabilitation therapy, influence outcomes
      of patients following total knee replacement (TKR). The investigators hypothesize that the
      Nintendo Wii™ gaming system has a positive influence in the outcomes of patients following
      TKR.
    

Detailed description: 
      The use of video games in rehabilitation is growing in popularity and frequency. The Nintendo
      Wii™ gaming system in particular, is gaining increased attention in the rehabilitation
      setting. There is currently very little evidence to support its clinical use. Canadian total
      knee replacement (TKR) rates have risen significantly in the past decade and its patient
      demographic has shifted to reflect a younger overall population. These changes indicate
      increased emphasis on TKR patients returning to higher levels of function and the potential
      need for new intervention options when caring for these patients. The Nintendo Wii™ Sports
      application has the potential to encourage standing, while participating in an interesting
      and engaging activity. The objective of this study is to determine whether the utilization of
      the Nintendo Wii™ gaming system, as an adjunct to standard outpatient rehabilitation therapy,
      influence outcomes of patients following total knee replacement.

      Patients who consent to participate in this study will be randomized to either a control
      group which will receive 15 minutes of lower extremity exercise or a study group which will
      receive 15 minutes of gaming activity on the Wii Fit™. Both control and study interventions
      will be provided following each regularly scheduled 60 minute physiotherapy session, in a
      separate treatment area. The Nintendo Wii™ console and its accompanying Wii™ Sports game will
      be utilized for the purposes of this study. To minimize rotational movement and therefore the
      risk of injury following total knee replacement, only the tennis and bowling games will be
      used. It will be required that these games are played in standing position. Without including
      the time required for start-up, each session of Nintendo Wii™ game activity will be 15
      minutes in duration, and will be provided twice weekly.

      Recovery status will be measured in all participants on admission, and every 2 weeks until
      discharge, an expected average of 5 weeks. A combination of self-administered questionnaires,
      objective and subjective outcome measures will be used to measure function (2 Minute Walk
      Test, Lower Extremity Functional Scale) range of motion (Goniometry), pain (Numeric Pain
      Rating Scale) and satisfaction with therapy services. Change within each measure will be
      statistically analyzed to detect whether a significant difference exists between control and
      study groups. It is projected that 60 patients will be recruited for this study. Patients in
      the study group could potentially benefit from increased improvements in pain, physical
      status, function, and satisfaction at the completion of their outpatient rehabilitation
      therapy program.
    

Intervention name(s): Wii Fit; Lower Extremity Exercise
Intervention type(s): Other; Other
Intervention description(s): 15 minutes of gaming activity on the Wii Fit™ following each regularly scheduled 60 minute physiotherapy session, in a separate treatment area.; Fifteen minutes of lower extremity exercise that addressed balance, posture, weight shifting and strengthening provided bilaterally following each regularly scheduled 60 minute physiotherapy session, in a separate treatment area.
Other intervention name(s): Nintendo Wii Fit
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Total knee replacement; Outpatient; Randomized controlled trial; Video games