STUDY DESIGN: Secondary analysis of a multi-site parallel evaluator-masked randomized control trial. OBJECTIVE: Examine usage of an in-home exergame, compared to control, unsupervised after supervised training by older persons with lower-limb amputation. METHODS: WiiNWalk uses the WiiFit and teleconferencing for in-home group-based exergame therapy with clinical supervision. Participants engaged in a 4-week supervised training phase followed by a 4-week unsupervised phase in experimental (WiiNWalk) and attention control groups. Usage between phases and between groups was compared using unsupervised/supervised ratio of session count (over 4 weeks) and session time (mean min/session over 4 weeks) for each phase. RESULTS: Participants: n = 36 experimental, n = 28 control, unilateral lower-limb amputation, age > 50 years, prosthesis usage >= 2 hours/day. Session count ratio unsupervised/supervised, median and interquartile range (IQR), was less than parity (p < 0.01) for experimental (0.25, IQR 0.00 to 0.68) and control (0.18, IQR 0.00 to 0.67) groups, with no different between groups (p = 0.92). Experimental session time unsupervised/supervised showed consistency (1.12, IQR 0.80 to 1.41) between phases (p = 0.24); control showed lower (0.76, IQR 0.57 to 1.08) ratios compared to experimental (p = 0.027). CONCLUSIONS: Unsupervised exercise duration remained consistent with supervised, but frequency was reduced. Social and clinical guidance features may remain necessary for sustained lower-limb amputation exergame engagement at home.

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