Abstract
BackgroundVirtual reality active video games are increasingly popular physical therapy interventions for children with cerebral palsy. However, physical therapists require educational resources to support decision making about game selection to match individual patient goals. Quantifying the movements elicited during virtual reality active video game play can inform individualized game selection in pediatric rehabilitation.ObjectiveThe objectives of this study were to develop and evaluate the feasibility and reliability of the Movement Rating Instrument for Virtual Reality Game Play (MRI-VRGP).MethodsItem generation occurred through an iterative process of literature review and sample videotape viewing. The MRI-VRGP includes 25 items quantifying upper extremity, lower extremity, and total body movements. A total of 176 videotaped 90-second game play sessions involving 7 typically developing children and 4 children with cerebral palsy were rated by 3 raters trained in MRI-VRGP use. Children played 8 games on 2 virtual reality and active video game systems. Intraclass correlation coefficients (ICCs) determined intra-rater and interrater reliability.ResultsExcellent intrarater reliability was evidenced by ICCs of >0.75 for 17 of the 25 items across the 3 raters. Interrater reliability estimates were less precise. Excellent interrater reliability was achieved for far reach upper extremity movements (ICC=0.92 [for right and ICC=0.90 for left) and for squat (ICC=0.80) and jump items (ICC=0.99), with 9 items achieving ICCs of >0.70, 12 items achieving ICCs of between 0.40 and 0.70, and 4 items achieving poor reliability (close-reach upper extremity-ICC=0.14 for right and ICC=0.07 for left) and single-leg stance (ICC=0.55 for right and ICC=0.27 for left).ConclusionsPoor video quality, differing item interpretations between raters, and difficulty quantifying the high-speed movements involved in game play affected reliability. With item definition clarification and further psychometric property evaluation, the MRI-VRGP could inform the content of educational resources for therapists by ranking games according to frequency and type of elicited body movements.
Highlights
There is increasing evidence for the potential of virtual reality active video games to challenge balance, promote active movement, and increase energy expenditure in children with cerebral palsy [1,2,3]
To support the integration of virtual reality and active video games into clinical practice, physical therapists require educational resources that inform decision making about matching virtual reality active video games with differing client needs [4]
These resources can build on existing information, including a classification framework that categorizes systems based on characteristics such as the ability to track therapeutically relevant variables [6], a Nintendo Wii and Wii Fit game analysis table that describes general movement requirements and feedback provided by each game [7], and a systematic assessment of serious games in health care [8]
Summary
There is increasing evidence for the potential of virtual reality active video games to challenge balance, promote active movement, and increase energy expenditure in children with cerebral palsy [1,2,3]. To support the integration of virtual reality and active video games into clinical practice, physical therapists require educational resources that inform decision making about matching virtual reality active video games with differing client needs [4]. A recent survey of Canadian physical and occupational therapists found that 76% reported the need for knowledge translation resources providing information about specific systems and games [5]. Quantifying the movements elicited during virtual reality active video game play can inform individualized game selection in pediatric rehabilitation. Conclusions: Poor video quality, differing item interpretations between raters, and difficulty quantifying the high-speed movements involved in game play affected reliability. With item definition clarification and further psychometric property evaluation, the MRI-VRGP could inform the content of educational resources for therapists by ranking games according to frequency and type of elicited body movements
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