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Video game-based exercises for older people with chronic low back pain: a randomized controlled trial (GAMEBACK)
Zadro JR, Shirley D, Simic M, Mousavi SJ, Ceprnja D, Maka K, Sung J, Ferreira P
Physical Therapy 2019 Jan 1;99(1):14-27
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Video game technology increases adherence to home exercise and could support self-management for older people with chronic low back pain (LBP). OBJECTIVES: The objective was to investigate the effects of home-based video game exercises on pain self-efficacy and care seeking in older people with chronic LBP. DESIGN: The study was a randomized controlled trial. SETTING: The setting was a community and waiting list. PATIENTS: Sixty participants, aged 55 years or older, with chronic LBP were randomized (1:1) to Wii Fit U exercises or to continue their usual activities for 8 weeks. INTERVENTION: Home-based Wii Fit U flexibility, strengthening, and aerobic exercises, for 60 minutes, 3 times per week, with fortnightly calls from a physical therapist was prescribed. MEASUREMENTS: Measurements included pain self-efficacy and care seeking (primary outcomes), and physical activity, pain, function, disability, fear of movement/re-injury, falls-efficacy, recruitment and response rates, adherence, experience with the intervention, and adverse events (secondary outcomes). RESULTS: The mean age of participants was 67.8 (SD 6.0) years. Adherence to the total recommended exercise time was 70.8%, and no adverse events were reported. Participants completing Wii Fit U exercises had significantly higher pain self-efficacy at 6 months, but not immediately post-intervention or at 3 months; there were no between-group differences in care-seeking. Compared with the control group, participants completing Wii Fit U exercises demonstrated significantly greater improvements in pain and function at 8 weeks and were more likely to engage in flexibility exercises at 6 months. There were no significant between-group differences for the remaining outcomes. LIMITATIONS: Participants and therapists were not blinded. CONCLUSION: Wii Fit U exercises improved pain self-efficacy at 6 months and pain and function immediately post-intervention in older people with chronic LBP, but the clinical importance of these changes are questionable. Wii Fit U exercises had no effect on care-seeking, physical activity, disability, fear of movement/re-injury, or falls-efficacy. The study protocol was registered prospectively with the Australian New Zealand Clinical Trials Registry ACTRN12615000703505).

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