A multi-center randomized control trial, comparing gamification with remote monitoring against standard rehabilitation for patients after arthroscopic shoulder surgery.

Abstract Background Gamification has become increasingly popular in rehabilitation and is viewed as a tool to improve patient activation, motivation and engagement. The aim of this study was to compare the efficacy of validated Exergames played through a system using ‘depth sensor’ and bespoke software against standard physiotherapy in patients treated with arthroscopic shoulder surgery. This included the following common conditions; subacromial impingement syndrome, calcific tendinopathy and rotator cuff tears. Methods Following arthroscopic shoulder surgery patients were randomized into one of two groups: 1. Standard rehabilitation. Patients were followed up for 12 weeks post-surgery with standard postoperative physiotherapy and had electronic measurements of their active range of movement (ROM). 2. Postoperative regime of exergames using the principles of gamification with physiotherapy support. Patients were given an Exergames schedule prescribed by their therapist on Medical Interactive Recovery Assistant (MIRA) software (MIRA Rehab Ltd., London, UK) paired with a Microsoft Kinect sensor (Microsoft Corp., Redmond, WA, USA). The primary outcome was active ROM objectively measured by MIRA + Kinect. Secondary outcome measures included The Oxford Shoulder Score (OSS), the Disabilities of the Arm, Shoulder and Hand (DASH) Score and EQ-VAS at 12 weeks post-surgery. Results 71 patients were recruited to the study. 7 Patients were excluded due to intra-operative findings. 33 patients were treated with Exergames and 31 patients had conventional physiotherapy. There was no significant difference between the two groups in baseline ROM. Postoperatively there was no significant difference in any of the cardinal planes of movement (Forward flexion (P= 0.64), abduction (p=0.33), external rotation (P=0.75)). The mean OSS in the control group improved from 29.25 to 38.2 (p=0.001) and from 27.1 to 35.1 (p=0.01) in the trial group. There was no significant difference between the groups at 12 weeks (p=.246). The mean DASH improved from 38.13 to 16.98 (p=0.001) in the control group and from 42.3 to 22.54 (p=0.007) in the trial group- there was no significant difference between the two groups (p=.328). There was no significant difference in EQ-VAS in either group at any timepoint (p= 0.5866). Conclusion This randomized controlled trial demonstrates that Exergames can be used effectively in the rehabilitation of patients following arthroscopic shoulder surgery. Outcomes, judged by range of movement and patient reported outcome measures, are equivalent to conventional physiotherapy rehab protocols. This healthcare innovation has the potential to relieve some of the heavy burden placed on physiotherapy departments for ‘routine’ postoperative care in shoulder surgery.