The 9-Hole Peg Test detects change in Gaming trial

A big beast of the outcome measurement world has criticised our drive for self-assessment and self-monitoring in pwMS. Why? 

They suggested that the learning effect that occurs with repeated assessments will make it difficult to judge the results of a clinical trial. I disagree. Why? Surely the randomisation process between active and placebo groups will take care of learning effects?

It is clear from the spinal cord injury field that rehabilitation is essential to improve outcomes. Rats with spinal cord injury that are not given tasks to use the affected, or paralysed, limbs don't recover function. In comparison rats who are given rehabilitation have a remarkable ability to recover function. The same applies to humans with spinal cord injury and surely to pwMS. If you don't use it you lose it.

Contrary to the status quo we think that getting pwMS to use their hands and limbs will improve outcomes. This is why this study below of using computer games to promote recovery of upper limb function is so important. Alison in our group is currently developing a new upper limb outcome measure for pwMS. Her idea is that the outcome measure will encourage people to improve rather than remain the same or to simply watch themselves deteriorate. In other words, the outcome measure becomes the catalyst to 'Do It and not Lose It'.

Alison is currently running an online survey to help with her project. If you have the time could you please complete the survey it takes less than 3 minutes. Thank you.

For more information on this research, please read the participant information and leave any questions in the comments field.

Jonsdottir et al. Serious games for arm rehabilitation of persons with multiple sclerosis. A randomized controlled pilot study. Mult Scler Relat Disord. 2017 Oct 28;19:25-29

OBJECTIVES: The feasibility and preliminary evidence for the efficacy of a serious games platform compared to exergame using the Wii for arm rehabilitation in persons with multiple sclerosis (MS) was investigated.

METHODS: A pilot single-blind randomized (2:1) controlled in clinical trial was carried out. Sixteen persons with MS participated (age years 56.8 (SD 12.3), MS-onset years 19.4 (SD 12.3), EDSS 6.5). Ten participants used a serious games platform (Rehab@Home) while 6 participants played with the commercial Wii platform, for four weeks (40min, 12 sessions/4 weeks). Feasibility and user experience measures were collected. Primary outcomes were the 9 Hole Peg Test (9HPT) and the Box and Block test (BBT). Secondary outcomes were the EQ-5D visual analogue scale (EQ-VAS) and the SF-12. Nonparametric analysis was used to verify changes from pre to post-rehabilitation within group and treatment effect was verified with Mann-Whitney U test. P value was set at 0.10 and clinical improvement was set at 20% improvement from baseline.

RESULTS: Serious games were perceived positively in terms of user experience and motivation. There were clinically significant improvements in arm function in the serious games group as measured by 9HPT (38-29.5s, P = 0.046, > 20%) and BBT 32-42 cubes, P = 0.19, > 20%) following the 12 gaming sessions while the exergame group did not improve on either test (9HPT 34.5-41.5s, P = 0.34; BBT 38,5 to 42 cubes, P = 0.34). Only the exergame group perceived themselves as having improved their health. There was a significant between groups treatment effect only in the perception of health (EQ-VAS) (Z = 1.93, P = 0.06) favouring the exergame group.

CONCLUSIONS: Virtual reality in a serious gaming approach was feasible and beneficial to arm function of persons with MS but motivational aspects of the approach may need further attention.


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