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Zadro JR, Shirley D, Simic M, et al. Video-Game-Based Exercises for Older People With Chronic Low Back Pain: A Randomized Controlledtable Trial (GAMEBACK). Phys Ther. 2019 Jan 1;99(1):14-27. doi: 10.1093/ptj/pzy112. (Original study)
Abstract

Background: Video game technology increases adherence to home exercise and could support self-management for older people with chronic low back pain (LBP).

Objective: The objective was to investigate the effects of home-based video game exercises on pain self-efficacy and care-seeking in older people with chronic LBP.

Design: The study was a randomized controlled trial.

Setting: The setting was a community and waiting list.

Participants: Sixty participants, aged > 55 years with chronic LBP, were randomized (1:1) to Wii Fit U exercises or to continue their usual activities for 8 weeks.

Intervention: The intervention was home-based Wii Fit U flexibility, strengthening, and aerobic exercises for 60 minutes, 3 times per week, with fortnightly calls from a physical therapist.

Measurements: Measurements included pain self-efficacy and care-seeking (primary outcomes), and physical activity, pain, function, disability, fear of movement/reinjury, falls efficacy, recruitment and response rates, adherence, experience with the intervention, and adverse events (secondary outcomes).

Results: The mean age of participants was 67.8 (standard deviation = 6.0) years. Adherence to the total recommended exercise time was 70.8%, and no adverse events were reported. Participants completing Wii Fit U exercises had significantly higher pain self-efficacy at 6 months, but not immediately postintervention or at 3 months; there were no between-group differences in care-seeking. Compared with the control group, participants completing Wii Fit U exercises demonstrated significantly greater improvements in pain and function at 8 weeks and were more likely to engage in flexibility exercises at 6 months. There were no significant between-group differences for the remaining outcomes.

Limitations: Participants and therapists were not blinded.

Conclusions: Wii Fit U exercises improved pain self-efficacy at 6 months, and pain and function immediately postintervention in older people with chronic LBP, but the clinical importance of these changes is questionable. Wii Fit U exercises had no effect on care-seeking, physical activity, disability, fear of movement/reinjury, or falls efficacy.

Ratings
Discipline Area Score
Nurse 6 / 7
Physician 5 / 7
Rehab Clinician (OT/PT) 5 / 7
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  Back Pain   Chronic Low Back Pain
Comments from MORE raters

Nurse rater

This is a very interesting study, particularly with respect to the age of the participants. The results were positive.

Nurse rater

The small sample size would indicate replication of this study is required. Replication in different countries would also be beneficial so as to eliminate cultural differences as related to pain, care seeking and exercise.

Nurse rater

Home-based exercise is cost effective but we need a better/rigorous way to report adherence beside self-report.

Nurse rater

LBP is a the most commonly reported pain in my clinical population and medication has been the most ineffective treatment. Any exploration of other treatment plans need to be explored.

Physician rater

This is a small novel efficacy trial. The results are promising but not ready for clinical translation.

Physician rater

Too small, sample of 60.

Physician rater

These are interesting results from a small randomized controlled trial using the Wii Fit U software to encourage exercise in older adults with low back pain. Benefits were modest and not all the observed differences are intuitive in terms of timing until benefit is seen. However, the software is relatively low cost and anything that might help deal with chronic low back pain in older adults is worth considering given how common and costly this condition is in the older adult population.

Physician rater

This study is very well conducted with statistical rigor. It has significant merit in dealing with patients who are maybe less mobile but capable of these types of motions. This is a novel approach with great potential to impact on a population with limited access.

Physician rater

At best, a modest positive effect of the intervention.

Physician rater

This is a very strict study and the conclusion is appropriate.

Rehab Clinician (OT/PT) rater

Given that the mean age of this sample was approximately 67 years, I would not have expected very different results. It might be interesting to see this study were repeated in a group of older adults who are in their 80s and have greater risk for falls and other conditions that require medical intervention.

Rehab Clinician (OT/PT) rater

It's very difficult to make large changes in the chronic older back patient, so no clinically significant changes would not be surprising. It's a good attempt to use video, especially when personalized and given good follow up Re: soreness.
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