Abstract
BackgroundThe enduring aging of the world population and prospective increase of age-related chronic diseases urge the implementation of new models for healthcare delivery. One strategy relies on ICT (Information and Communications Technology) home-based solutions allowing clients to pursue their treatments without institutionalization. Stroke survivors are a particular population that could strongly benefit from such solutions, but is not yet clear what the best approach is for bringing forth an adequate and sustainable usage of home-based rehabilitation systems. Here we explore two possible approaches: coaching and gaming.MethodsWe performed trials with 20 healthy participants and 5 chronic stroke survivors to study and compare execution of an elbow flexion and extension task when performed within a coaching mode that provides encouragement or within a gaming mode. For each mode we analyzed compliance, arm movement kinematics and task scores. In addition, we assessed the usability and acceptance of the proposed modes through a customized self-report questionnaire.ResultsIn the healthy participants sample, 13/20 preferred the gaming mode and rated it as being significantly more fun (p < .05), but the feedback delivered by the coaching mode was subjectively perceived as being more useful (p < .01). In addition, the activity level (number of repetitions and total movement of the end effector) was significantly higher (p < .001) during coaching. However, the quality of movements was superior in gaming with a trend towards shorter movement duration (p = .074), significantly shorter travel distance (p < .001), higher movement efficiency (p < .001) and higher performance scores (p < .001). Stroke survivors also showed a trend towards higher activity levels in coaching, but with more movement quality during gaming. Finally, both training modes showed overall high acceptance.ConclusionsGaming led to higher enjoyment and increased quality in movement execution in healthy participants. However, we observed that game mechanics strongly determined user behavior and limited activity levels. In contrast, coaching generated higher activity levels. Hence, the purpose of treatment and profile of end-users has to be considered when deciding on the most adequate approach for home based stroke rehabilitation.
Highlights
The enduring aging of the world population and prospective increase of age-related chronic diseases urge the implementation of new models for healthcare delivery
Does gaming increase compliance? Our first hypothesis stated that the gaming mode would be more enjoyable and lead to increased compliance during training, as measured by the number of exercise repetitions and the total arm movement during training, when compared to the coaching mode
Further pairwise comparisons revealed that the total number of repetitions during gaming were significantly less than during coaching (T = 0, p < 0.001, r = −0.62) and during control (T = 0, p < 0.001, r = −0.62); no significant difference was found between control and coaching (T = 78.5, p = 0.32, r = −0.16) (Fig. 2a)
Summary
The enduring aging of the world population and prospective increase of age-related chronic diseases urge the implementation of new models for healthcare delivery. Stroke survivors are a particular population that could strongly benefit from such solutions, but is not yet clear what the best approach is for bringing forth an adequate and sustainable usage of home-based rehabilitation systems. The challenge becomes yet higher taking into account the enduring aging of the population worldwide [1] that will result in the increase of the number of individuals with age related diseases such as stroke. Home-based stroke rehabilitation has been increasingly addressed during the last years, and while showing promising results in terms of feasibility and impact on recovery [3, 4] it poses a number of technical and human challenges. It is important to investigate what characteristics should be included in such systems so that stroke survivors feel more engaged and motivated to use these tools in a systematic way over long periods of time
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