The influence of scaffolding on intrinsic motivation and autonomous adherence to a game-based, sparsely supervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial.

IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Journal of NeuroEngineering and Rehabilitation Pub Date : 2024-08-13 DOI:10.1186/s12984-024-01441-7
Gerard Fluet, Qinyin Qiu, Amanda Gross, Holly Gorin, Jigna Patel, Alma Merians, Sergei Adamovich
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Abstract

Background: This parallel, randomized controlled trial examined intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a 12-week, home-based upper extremity rehabilitation program. Seventeen subjects played scaffolded games, presenting eight to twelve discrete levels of increasing difficulty. Sixteen subjects performed the same activities controlled by success algorithms that modify game difficulty incrementally.

Methods: 33 persons 20-80 years of age, at least 6 months post stroke with moderate to mild hemiparesis were randomized using a random number generator into the two groups. They were tested using the Action Research Arm Test, Upper Extremity Fugl Meyer Assessment, Stroke Impact Scale and Intrinsic Motivation Inventory pre and post training. Adherence was measured using timestamps generated by the gaming system. Subjects had the Home Virtual Rehabilitation System (Qiu in J Neuroeng Rehabil 17: 1-10, 2020) placed in their homes and were taught to perform rehabilitation games using it. Subjects were instructed to train twenty minutes per day but were allowed to train as much as they chose. Subjects trained for 12 weeks without appointments and received intermittent support from study staff. Group outcomes were compared using ANOVA. Correlations between subject demographics and adherence, as well as motor outcome, were evaluated using Pearson Correlation Coefficients.

Results: There were 5 dropouts and no adverse events. The main effect of time was statistically significant for four of the five clinical outcome measures. There were no significant training group by time interactions. Measures of adherence did not differ significantly between groups. The combined groups improved their UEFMA scores on average by 5.85 (95% CI 4.73-6.98). 21 subjects from both groups demonstrating improvements in UEFMA scores of at least 5 points, exceeding the minimal clinically important difference of 4.25. IMI scores were stable pre to post training.

Conclusions: Scaffolding challenges during game based rehabilitation did not elicit higher levels of adherence when compared to algorithm control of game difficulty. Both sparsely supervised programs of game-based treatment in the home were sufficient to elicit statistically significant, clinically meaningful improvements in motor function and activities of daily living.

Trial registration: Clinical Trials.gov-NCT03985761, Registered June 14, 2019.

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支架对因中风导致上肢偏瘫的患者参加以游戏为基础、缺乏监督的家庭康复计划的内在动机和自主坚持的影响。随机对照试验。
研究背景这项平行随机对照试验考察了两组受试者的内在动机、坚持性和运动功能改善情况,这两组受试者都参加了为期 12 周的家庭上肢康复计划。17 名受试者进行了支架式游戏,游戏难度从 8 到 12 级不等,难度不断增加。方法:使用随机数字生成器将 33 名年龄在 20-80 岁、中风后至少 6 个月、患有中度至轻度偏瘫的人随机分为两组。他们在训练前后分别接受了行动研究手臂测试、上肢 Fugl Meyer 评估、中风影响量表和内在动机量表的测试。使用游戏系统生成的时间戳对坚持情况进行测量。受试者家中安装了家庭虚拟康复系统(Qiu,发表于《神经康复》杂志17:1-10,2020年),并学习如何使用该系统进行康复游戏。研究人员要求受试者每天进行二十分钟的训练,但受试者也可以自行选择训练时间。受试者在没有预约的情况下接受了 12 周的训练,并得到了研究人员的间歇性支持。采用方差分析对各组结果进行比较。使用皮尔逊相关系数评估受试者人口统计学特征与坚持情况以及运动结果之间的相关性:结果:共有 5 人辍学,无不良事件发生。在五项临床结果测量中,时间对其中四项的主效应具有统计学意义。培训组与时间之间没有明显的交互作用。各组间的依从性测量没有明显差异。综合组的 UEFMA 评分平均提高了 5.85 分(95% CI 4.73-6.98)。两组中均有 21 名受试者的 UEFMA 分数至少提高了 5 分,超过了 4.25 的最小临床重要性差异。IMI评分在训练前和训练后保持稳定:结论:与通过算法控制游戏难度相比,在基于游戏的康复训练过程中进行脚手架挑战并不能提高坚持率。两种在家中进行的游戏式治疗方案都受到了稀少的监督,但都足以在运动功能和日常生活活动方面取得具有统计学意义和临床意义的改善:临床试验.gov-NCT03985761,2019年6月14日注册。
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来源期刊
Journal of NeuroEngineering and Rehabilitation
Journal of NeuroEngineering and Rehabilitation 工程技术-工程:生物医学
CiteScore
9.60
自引率
3.90%
发文量
122
审稿时长
24 months
期刊介绍: Journal of NeuroEngineering and Rehabilitation considers manuscripts on all aspects of research that result from cross-fertilization of the fields of neuroscience, biomedical engineering, and physical medicine & rehabilitation.
期刊最新文献
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