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Group-based telerehabilitation intervention using Wii Fit to improve walking in older adults with lower limb amputation (WiiNWALK): a randomized control trial [with consumer summary]
Tao G, Miller WC, Eng JJ, Esfandiari E, Imam B, Lindstrom H, Payne MW
Clinical Rehabilitation 2022 Mar;36(3):331-341
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; 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*

OBJECTIVE: Determine efficacy of the novel WiiNWalk intervention on walking-related outcomes in older adults with lower limb amputation. DESIGN: Multi-site, parallel, evaluator-masked randomized controlled trial. SETTING: Home-setting in three Canadian cities. PARTICIPANTS: Community-dwelling lower limb prosthesis users over 50 years of age. INTERVENTIONS: The WiiNWalk group (n = 38) used modified Wii Fit activities for prosthetic rehabilitation. The attention control group (n = 33) used Big Brain Academy: Wii Degree, comprising of cognitive activities. Both groups completed a 4-week supervised phase with three 1-hour sessions/week in groups of three overseen by a clinician via videoconferencing and a 4-week unstructured and unsupervised phase. MAIN MEASURES: Primary outcome was walking capacity (2 min walk test); secondary outcomes were balance confidence (activities-specific balance confidence scale), dynamic balance (four-step square test), and lower limb functioning (short physical performance battery). Outcomes were compared across time points with repeated measures analysis of covariance, adjusting for baseline and age. RESULTS: Mean age was 65.0 (8.4) years, with 179.5 (223.5) months post-amputation and 80% transtibial amputation. No group difference in a 2 min walk test with an effect size: 1.53 (95% CI -3.17 to 6.23) metres. Activities balance confidence was greater in the WiiNWalk group by 5.53% (95% CI 2.53 to 8.52). No group difference in the four-step square test -0.16 (95% CI -1.25 to 0.92) seconds, nor short physical performance battery 0.48 (95% CI -0.65 to 1.61). A post-hoc analysis showed the greatest difference in balance confidence immediately after an unsupervised phase. CONCLUSIONS: The WiiNWalk intervention improved balance confidence, but not walking-related physical function in older adult lower limb prosthesis users. Future rehabilitation games should be specific to the amputation context. CLINICAL TRIAL REGISTRATION NUMBER: NCT01942798.

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