scholarly journals Perspectives on the Gamification of an Interactive Health Technology for Postoperative Rehabilitation of Pediatric Anterior Cruciate Ligament Reconstruction: User-Centered Design Approach

10.2196/27195 ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. e27195
Author(s):  
Michael McClincy ◽  
Liliana G Seabol ◽  
Michelle Riffitts ◽  
Ethan Ruh ◽  
Natalie E Novak ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Health Technology ◽  
Self Management ◽  
User Centered Design ◽  
Postoperative Rehabilitation ◽  
Card Sort ◽  
Cruciate Ligament Reconstruction ◽  
Interactive Health ◽  
Anterior Cruciate

Background Pediatric and adolescent athletes are a large demographic undergoing anterior cruciate ligament reconstruction (ACL-R). Postoperative rehabilitation is critical, requiring patients to complete home exercise programs (HEPs). To address obstacles to HEP adherence, we developed an interactive health technology, interACTION (iA), to monitor knee-specific rehabilitation. iA is a web-based platform that incorporates wearable motion sensors and a mobile app that provides feedback and allows remote monitoring. The Wheel of Sukr is a gamification mechanism that includes numerous behavioral elements. Objective This study aims to use a user-centered design process to incorporate behavioral change strategies derived from self-management theory into iA using the Wheel of Sukr, with the aim of influencing patient behavior. Methods In total, 10 athletes aged 10-18 years with a history of ACL-R were included in this study. Patients were between 4 weeks and 1 year post–ACL-R. Participants underwent a 60-minute triphasic interview. Phase 1 focused on elements of gaming that led to high participation and information regarding surgery and recovery. In phase 2, participants were asked to think aloud and rank cards representing the components of the Wheel of Sukr in order of interest. In phase 3, the patients reviewed the current version of iA. Interviews were recorded, transcribed, and checked for accuracy. Qualitative content analysis segmented the data and tagged meaningful codes until descriptive redundancy was achieved; next, 2 coders independently coded the data set. These elements were categorized according to the Wheel of Sukr framework. The mean age of participants was 12.8 (SD 1.32) years, and 70% (7/10) were female. Most participants (7/10, 70%) reported attending sessions twice weekly. All patients were prescribed home exercises. Self-reported HEP compliance was 75%-100% in 40% (4/10), 50%-75% in 40% (4/10), and 25%-50% of prescribed exercises in 20% (2/10) of the participants. Results The participants responded positively to an app that could track home exercises. Desirable features included exercise demonstrations, motivational components, and convenience. The participants listed sports specificity, competition, notifications, reminders, rewards, and social aspects of gameplay as features to incorporate. In the Wheel of Sukr card sort exercise, motivation was ranked first; self-management, second; and growth, esteem, and fun tied for the third position. The recommended gameplay components closely followed the themes from the Wheel of Sukr card sort activity. Conclusions The participants believe iA is a helpful addition to recovery and want the app to include exercise movement tracking and encouragement. Despite the small number of participants, thematic saturation was reached, suggesting the sample was sufficient to obtain a representative range of perspectives. Future work will implement motivation; self-management; and growth, confidence, and fun in the iA user experience. Young athlete ACL-R patients will complete typical clinical scenarios using increasingly developed prototypes of the gamified iA in a controlled setting.

scholarly journals Perspectives on the Gamification of an Interactive Health Technology for Postoperative Rehabilitation of Pediatric Anterior Cruciate Ligament Reconstruction: User-Centered Design Approach (Preprint)

2021 ◽  
Author(s):  
Michael McClincy ◽  
Liliana G Seabol ◽  
Michelle Riffitts ◽  
Ethan Ruh ◽  
Natalie E Novak ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Health Technology ◽  
Self Management ◽  
User Centered Design ◽  
Postoperative Rehabilitation ◽  
Card Sort ◽  
Cruciate Ligament Reconstruction ◽  
Interactive Health ◽  
Anterior Cruciate

BACKGROUND Pediatric and adolescent athletes are a large demographic undergoing anterior cruciate ligament reconstruction (ACL-R). Postoperative rehabilitation is critical, requiring patients to complete home exercise programs (HEPs). To address obstacles to HEP adherence, we developed an interactive health technology, <i>interACTION (iA)</i>, to monitor knee-specific rehabilitation. <i>iA</i> is a web-based platform that incorporates wearable motion sensors and a mobile app that provides feedback and allows remote monitoring. The Wheel of Sukr is a gamification mechanism that includes numerous behavioral elements. OBJECTIVE This study aims to use a user-centered design process to incorporate behavioral change strategies derived from self-management theory into <i>iA</i> using the Wheel of Sukr, with the aim of influencing patient behavior. METHODS In total, 10 athletes aged 10-18 years with a history of ACL-R were included in this study. Patients were between 4 weeks and 1 year post–ACL-R. Participants underwent a 60-minute triphasic interview. Phase 1 focused on elements of gaming that led to high participation and information regarding surgery and recovery. In phase 2, participants were asked to <i>think aloud</i> and rank cards representing the components of the Wheel of Sukr in order of interest. In phase 3, the patients reviewed the current version of <i>iA</i>. Interviews were recorded, transcribed, and checked for accuracy. Qualitative content analysis segmented the data and tagged meaningful codes until descriptive redundancy was achieved; next, 2 coders independently coded the data set. These elements were categorized according to the Wheel of Sukr framework. The mean age of participants was 12.8 (SD 1.32) years, and 70% (7/10) were female. Most participants (7/10, 70%) reported attending sessions twice weekly. All patients were prescribed home exercises. Self-reported HEP compliance was 75%-100% in 40% (4/10), 50%-75% in 40% (4/10), and 25%-50% of prescribed exercises in 20% (2/10) of the participants. RESULTS The participants responded positively to an app that could track home exercises. Desirable features included exercise demonstrations, motivational components, and convenience. The participants listed sports specificity, competition, notifications, reminders, rewards, and social aspects of gameplay as features to incorporate. In the Wheel of Sukr card sort exercise, motivation was ranked first; self-management, second; and growth, esteem, and fun tied for the third position. The recommended gameplay components closely followed the themes from the Wheel of Sukr card sort activity. CONCLUSIONS The participants believe <i>iA</i> is a helpful addition to recovery and want the app to include exercise movement tracking and encouragement. Despite the small number of participants, thematic saturation was reached, suggesting the sample was sufficient to obtain a representative range of perspectives. Future work will implement motivation; self-management; and growth, confidence, and fun in the <i>iA</i> user experience. Young athlete ACL-R patients will complete typical clinical scenarios using increasingly developed prototypes of the gamified <i>iA</i> in a controlled setting. CLINICALTRIAL

Current Perspectives of the Australian Knee Society on Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 29 (7) ◽  
pp. 970-975 ◽  
Author(s):  
Jay R. Ebert ◽  
Kate E. Webster ◽  
Peter K. Edwards ◽  
Brendan K. Joss ◽  
Peter D’Alessandro ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Postoperative Rehabilitation ◽  
Cruciate Ligament Reconstruction ◽  
Orthopedic Surgeons ◽  
Anterior Cruciate ◽  
Retear Rate

Context: The importance of rehabilitation and evaluation prior to return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction has been reported. Objective: This study sought to investigate current perspectives of Australian orthopedic surgeons on rehabilitation and RTS evaluation. Design: Survey. Participants: Members of the Australian Knee Society. Main Outcome Measures: A 14-question survey was disseminated to Australian Knee Society members (orthopedic surgeons) to investigate (1) preferred graft choice, (2) estimated retear rate, (3) importance of preoperative and postoperative rehabilitation, and (4) preferred timing of RTS and evaluation prior to RTS discharge. Results: Of all 85 Australian Knee Society members contacted, 86% (n = 73) responded. Overall, 66 respondents (90.4%) preferentially used hamstring tendon autografts. All surgeons estimated their retear rate to be ≤15%, with 31 (42.5%) <5%. Twenty-eight surgeons (38.4%) reported no benefit in preoperative rehabilitation. The majority of surgeons (82.2%–94.5%) reported that postoperative rehabilitation was important within various periods throughout the postoperative timeline. Most surgeons did not permit RTS until ≥9 months (n = 56, 76.7%), with 17 (23.3%) allowing RTS between 6 and 9 months. The most highly reported considerations for RTS clearance were time (90.4%), functional capacity (90.4%), and strength (78.1%). Most commonly, knee strength and/or function was assessed via referral to a preferred rehabilitation specialist (50.7%) or with the surgeon at their practice (11.0%). Conclusions: This survey revealed variation in beliefs and practices surrounding rehabilitation and RTS evaluation. This is despite the current evidence demonstrating the benefit of preoperative and postoperative rehabilitation, as well as the emerging potential of RTS assessments consisting of strength and functional measures to reduce reinjury rates.

scholarly journals The effect of proprioception training on knee kinematics after anterior cruciate ligament reconstruction

2020 ◽  
Author(s):  
Lisi Jiang ◽  
Yongjian Wang ◽  
Wenhan Huang
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Training Group ◽  
Rehabilitation Program ◽  
Control Group ◽  
Postoperative Rehabilitation ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Abstract Background Proprioception is essential for the normal movement of joint knees. The degree of functional recovery after ACL reconstruction is related with the degree of postoperative recovery of proprioception. The current study aimed to investigate the effect of proprioception training on functional level of activity and knee kinematics after anterior cruciate ligament reconstruction. Methods Forty patients who underwent ACL reconstruction between January 2017 and June 2019 were included. The patients were divided into proprioception group (n=20) and control group (n=20). All the patients followed common postoperative rehabilitation program. The proprioception group were given proprioception enhancement program besides common postoperative rehabilitation program. All the patients were assessed preoperatively, 6 months and 1 year after operation. The lymsolm scores, hop distances, and knee kinematics during unanticipated jump–cut maneuver were compared at different follow-up time points. Results There were no significant differences preoperative and postoperative Lysholm scores between two groups. After surgery, the proprioception group showed significantly higher hop distance (133.9 ± 26.2 cm) when compared with the control group (81.2 ± 17.2 cm, P=0.026) in 6-months and one-year follow-up (153.1 ± 19.3 vs 105.8 ± 20.7cm, P=0.034). For knee joint kinematics, the proprioception training group showed reduced knee abduction (valgus) angles and external rotations, and increased knee flexion when compared with the common training group. Conclusions We conclude that proprioceptive rehabilitation training enhance the kinematic performance and single leg hop distance in ACL-reconstructed populations during jump-stop, unanticipated cut maneuver. The findings will be scientific evidences to help clinicians and physiotherapists to evaluate the patients’ readiness for exercises and sports, especially in the cases of loading and extreme rotation conditions. Trial registration This study was retrospectively registered on Clnicaltrails.gov on 24 December.

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