Video and computer-based interactive exercises are safe and improve task-specific balance in geriatric and neurological rehabilitation: a randomised trial.
QUESTION
Does adding video/computer-based interactive exercises to inpatient geriatric and neurological rehabilitation improve mobility outcomes? Is it feasible and safe?


DESIGN
Randomised trial.


PARTICIPANTS
Fifty-eight rehabilitation inpatients.


INTERVENTION
Physiotherapist-prescribed, tailored, video/computer-based interactive exercises for 1 hour on weekdays, mainly involving stepping and weight-shifting exercises.


OUTCOME MEASURES
The primary outcome was the Short Physical Performance Battery (0 to 3) at 2 weeks. Secondary outcomes were: Maximal Balance Range (mm); Step Test (step count); Rivermead Mobility Index (0 to 15); activity levels; Activity Measure for Post Acute Care Basic Mobility (18 to 72) and Daily Activity (15 to 60); Falls Efficacy Scale (10 to 40), ED5D utility score (0 to 1); Reintegration to Normal Living Index (0 to 100); System Usability Scale (0 to 100) and Physical Activity Enjoyment Scale (0 to 126). Safety was determined from adverse events during intervention.


RESULTS
At 2 weeks the between-group difference in the primary outcome (0.1, 95% CI -0.2 to 0.3) was not statistically significant. The intervention group performed significantly better than usual care for Maximal Balance Range (38mm difference after baseline adjustment, 95% CI 6 to 69). Other secondary outcomes were not statistically significant. Fifty-eight (55%) of the eligible patients agreed to participate, 25/29 (86%) completed the intervention and 10 (39%) attended > 70% of sessions, with a mean of 5.6 sessions (SD 3.3) attended and overall average duration of 4.5hours (SD 3.1). Average scores were 62 (SD 21) for the System Usability Scale and 62 (SD 8) for the Physical Activity Enjoyment Scale. There were no adverse events.


CONCLUSION
The addition of video/computer-based interactive exercises to usual rehabilitation is a safe and feasible way to increase exercise dose, but is not suitable for all. Adding the exercises to usual rehabilitation resulted in task-specific improvements in balance but not overall mobility.


REGISTRATION
ACTRN12613000610730.
['van den Berg|Maayken|M|', 'Sherrington|Catherine|C|', 'Killington|Maggie|M|', 'Smith|Stuart|S|', 'Bongers|Bert|B|', 'Hassett|Leanne|L|', 'Crotty|Maria|M|']
D000058:Accidental Falls D000368:Aged D000369:Aged, 80 and over D015444:Exercise D005081:Exercise Therapy D005260:Female D006801:Humans D007297:Inpatients D008297:Male D000066530:Neurological Rehabilitation D004856:Postural Balance D012047:Rehabilitation Centers D013813:Therapy, Computer-Assisted D016896:Treatment Outcome D018910:Video Games
Exercise Rehabilitation Feasibility studies Randomised controlled trial Technology