So not powered enough to come up with protocols, so further research required. I blame the mentors and senior researchers for not advising the researchers properly.
Efficacy of a technology-based client-centred training system in neurological rehabilitation: a randomised controlled trial
Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 184 (2021)
Abstract
Background
A client-centred task-oriented approach has advantages towards motivation and adherence to therapy in neurorehabilitation, but it is costly to integrate in practice. An intelligent Activity-based Client-centred Training (i-ACT), a low-cost Kinect-based system, was developed which integrates a client-centred and task-oriented approach. The objectives were (1) to investigate the effect of additional i-ACT training on functioning. And (2) to assess whether training with i-ACT resulted in more goal oriented training.
Methods
A single-blind randomised controlled trial was performed in 4 Belgian rehabilitation centres with persons with central nervous system deficits. Participants were randomly allocated through an independent website-based code generator using blocked randomisation (n = 4) to an intervention or control group. The intervention group received conventional care and additional training with i-ACT for 3 × 45 min/week during 6 weeks. The control group received solely conventional care. Functional ability and performance, quality of life (QoL), fatigue, trunk movement, and shoulder active range of motion (AROM) were assessed at baseline, after 3 weeks and 6 weeks of training, and 6 weeks after cessation of training. Data were analysed using non-parametric within and between group analysis.
Results
47 persons were randomised and 45 analysed. Both intervention (n = 25) and control (n = 22) group improved over time on functional ability and performance as measured by the Wolf Motor Function Test, Manual Ability Measure-36, and Canadian Occupational Performance Measure, but no major differences were found between the groups on these primary outcome measures. Regarding QoL, fatigue, trunk movement, and shoulder AROM, no significant between group differences were found. High adherence for i-ACT training was found (i.e. 97.92%) and no adverse events, linked to i-ACT, were reported. In the intervention group the amount of trained personal goals (88%) was much higher than in the control group (46%).
Conclusions
Although additional use of i-ACT did not have a statistically significant added value regarding functional outcome over conventional therapy, additional i-ACT training provides more individualised client-centred therapy, and adherence towards i-ACT training is high. A higher intensity of i-ACT training may increase therapy effects, and should be investigated in future research.
Trial registration: ClinicalTrials.gov Identifier NCT02982811. Registered 29 November 2016.
Background
Rehabilitation in persons with central nervous system (CNS) deficits such as stroke, multiple sclerosis, and spinal cord injury, is important to regain and/or maintain functional ability in activities of daily life (ADLs), and consequently optimise quality of life (QoL) [1,2,3,4,5]. Practice methods that showed promising results regarding motivation and effectiveness in neurorehabilitation, are task-oriented therapy and client-centred training [6,7,8,9,10,11]. Task-oriented training is considered a highly individualised training of functional tasks based on task segmentation [6, 7]. The client-centred approach incorporates the person’s wishes and needs, and actively involves the person with deficits in setting certain goals in their rehabilitation process [7, 9,10,11,12]. By using occupational models and assessments, such as the Person-Environment-Occupation model (PEO-model) [13] and Canadian Occupational Performance Measure (COPM) [14,15,16], therapists can involve the person with deficits in the process of setting unique and individual goals, which increases therapy motivation and consequently adherence. The extra advantage of the COPM is that it cannot only be used for goal setting but also for the assessment of self-perceived occupational performance [14,15,16].
Although motivation is higher when using a task-oriented client-centred approach, in practice this is time-consuming. To increase persons’ motivation and treatment adherence, technology-based systems with immersive or non-immersive virtual reality (VR) or augmented reality (AR) such as Nintendo Wii or Microsoft Kinect, can be used [1, 2, 5, 17,18,19,20]. However, these commercially available, low-cost systems do not incorporate a client-centred task-oriented approach, and the standard (exer)games are not developed to meet the rehabilitation goals such as improving coordination patterns or compensation strategies when performing task-oriented exercises [1, 2, 4, 5, 21]. Although these systems are not developed to meet rehabilitation goals, we explored the skeleton tracking feature of Microsoft Kinect in earlier research and developed an intelligent activity-based client-centred training (i-ACT) system using Microsoft Kinect sensor and software development kit [22]. i-ACT allows persons with CNS deficits to train more explicit on individual goals and the usability of i-ACT and persons’ motivation, credibility and expectancy towards using i-ACT for rehabilitation purposes, was established [23]. Results of that cohort study showed an increase over time regarding upper limb functional ability and perceived performance, but no comparison was made with a control group [24]. The purpose of this trial was to investigate the effect of additional i-ACT training on functional ability, occupational performance, quality of life (QoL), fatigue, trunk movement, and shoulder active range of motion (AROM) compared to conventional therapy alone. Our first hypothesis was that there is a positive effect of additional i-ACT training on functional ability and perceived occupational performance in comparison with conventional therapy. Our secondary hypothesis was that as compared to conventional therapy, there is a positive effect of additional i-ACT training on quality of life, fatigue, trunk impairment and AROM in the shoulder. The third hypothesis was that the individualised goals set by persons with deficits are trained more explicit when exercising with i-ACT compared to conventional therapy.
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