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Multiple Sclerosis: Clinical and Laboratory Research 2016, 22 (12): NP9-NP11

In the article The use of gaming technology for rehabilitation in people with multiple sclerosis, DOI: 10.1177/1352458514563593, published in Multiple Sclerosis Volume 21 Issue 4, Table 1 was printed incorrectly. The corrected Table 1 is below:spmsj;22/12/NP9/TABLE11352458515585718T1table1-1352458515585718Table 1.Exergaming studies.Ref.PlatformParticipants and interventionOutcomesPlow and Finlayson31 WiiPre-test vs. post-test repeated measures home-based Wii training.

PARTICIPANTS: N=30, age 43.2 ± 9.3 years, 9 ± 6.8 years since diagnosis.

INTERVENTION: 3 x per week programme consisting of yoga, balance, strength, and aerobic training in each session. Wii playing minutes ranged from 10-30 minutes based on participants' RPE when playing the "Basic Run" game. No therapist monitored training in the home. Participants were telephoned every other week (a total of four times) for the first seven weeks after receiving Wii-Fit to monitor adverse events and to encourage increases in the duration or frequency of using Wii-Fit. By the end of the seven weeks, all participants were encouraged to play Wii-Fit three to five times a week for 20 to 30 mins.TUG/TUG dual task; Maximum number of push-ups; timed number of sit-ups in 60s; Maximum number of steps in three mins onto a six-inch platform; Single/double leg balance with eyes open/closed on a soft/firm surface; Physical Activity and Disability Survey; SF-36; MFIS; The barrier self-efficacy scale.Improvements pre- vs. post-test: Number of steps and push-ups; Eyes/open closed, single leg balance on firm surface.Post-test vs. follow-up (14 weeks): measures returned to baseline.Kalron et al.29 WiiPilot intervention. No control group.

PARTICIPANTS: N=32, age 43.6 ± 1.9 years, 6.9 ± 0.8 years since diagnosis, EDSS 3.1 ± 0.2.

INTERVENTION: Wii Tennis played for one session of 30 mins (3x10 mins).FRT and FSST taken pre- and post-intervention. FRT and FSST both significantly improved by 9.1% and 17.5% respectively.Prosperini et al.28 WiiRandomized Crossover Trial - Home-Based.

PARTICIPANTS: N=36, age 36.2 ± 8.6 years, 10.7 ± 5.8 years since diagnosis, and median EDSS of 3.5 (1.5-5.0). Wii group - 12-week duration, daily sessions (with the exception of the weekend) of home-based training with the Wii Balance Board, each lasting 30 mins. No intervention group - 12 weeks of no intervention. They then swapped to the Wii group after 12 weeks and the Wii group had no intervention for 12 weeks. Contact with physiotherapists every four weeks and phone contact once per week.CoP path, Four Square Step, 25-FWT, MSIS-29. Significant improvements for time × treatment interaction for all measures.Plow and Finlayson35 WiiA repeated measures longitudinal design with a baseline control period.

PARTICIPANTS: See Plow and Finlayson31 Intervention: All participants were prescribed a three-times-a-week exercise programme - see Plow and Finalyson.31 Semi-structured interviews conducted over the phone before and after the 14-week Wii-Fit programme. Examined the usability of Nintendo Wii-Fit and identified reasons for using or not using Wii-Fit on; a regular basis.Nilsagard et al.25 WiiA multicentre RCT with random (1:1) allocation to exercise group or non-exercise group. Wii group: participants N=42, age 50.0 ± 11.5 years, 12.5 ± 8.0 years since. Individual physiotherapist-supervised sessions of 30 mins of balance exercise using Wii-Fit Plus twice a week for six to seven weeks, a total of 12 sessions. Non-exercise group: participants N=42, age 49.4 ± 11.1 years, 12.2 ± 9.2 years since diagnosis. This group was invited to start exercising using Wii-Fit Plus after the second data collection.TUG; TUG dual task; Four Square Step; Timed Chair Stands; 25-FWT; Dynamic Gait Index; ABC; MSWS-12. Improvements in Wii Group pre- vs. post-test: TUG dual task, Four Square Step, Timed Chair Stands, Dynamic Gait Index.Improvements in Non-exercise group pre- vs. post-test: Dynamic Gait Index.Wii vs. non-exercise at follow-up: No significant difference.Guidi et al.27 WiiSingle-blind, RCT.

PARTICIPANTS: Aged between 25-65 years, at least three years since diagnosis, EDSS score 0-3.5. Wii group (N=9) played Physiofun Balance Training - Physio Mode. Sessions 10x45-mins, twice a week for five weeks. Non-exercise group (N=8) received advice about strategies for behaviour and environment aimed at reducing falls.BBS significantly improved for Wii Group vs. Non-exercise group.Brichetto et al.26 WiiRCT: Wii vs. traditional rehabilitation strategies. Twelve sessions (three 60-minute sessions/week) of intervention. Wii group: participants N=18, age 40.7 ± 11.5 years, years since diagnosis 11.2 ± 6.4 years, mean EDSS 3.9 ± 1.6. One hour of supervised Wii Balance Board sessions.

CONTROL GROUP: participants N=18, age 43.2 ± 10.6 years, years since diagnosis 12.3 ± 7.2 years, mean EDSS 4.3 ± 1.6. Exercises consisted of static and dynamic exercises in both single leg and double leg stance, with or without an equilibrium board and half-kneeling exercises of increasing difficulty.BBS and MFIS. Postural assessment was quantified with a stabilometric platform (quiet standing, barefoot with open/closed eyes). No significant differences between the groups at baseline. Significant improvements in outcomes for both modes at post-test. A significant group × time interaction, revealing a more marked improvement for BBS score, open/closed-eye stabilometry in the Wii group compared to the control group.Ortiz-Gutiérrez, et al.32 KinectXbox-group: participants N=24, age 39.7 ± 8.1 years, years since diagnosis 9.7 ± 6.8. 40 sessions - four sessions per week (20 mins per session) for 10 weeks. Individual Tele-Rehabilitation treatments using commercial games. Sessions were monitored via videoconference.

CONTROL GROUP: participants N=23, age 42.8 ± 7.4 years, years since diagnosis 10.9 ± 5.4. Physiotherapy treatment twice a week (40 mins per session) at a clinic for 10 weeks. Low-load strength exercises, proprioception exercises on unstable surfaces, gait facilitation exercises, and muscle-tendon stretching.Computerized dynamic posturography and SOT. Improvement of general balance in both groups. Visual preference and the contribution of vestibular information, via SOT, yielded significant differences in the exercise group.Kramer et al.34 WiiMatched controlled trial (3 groups). Three weeks, nine supervised training sessions lasting 30 mins each.

PARTICIPANTS: N=23, age 42.8 ± 7.4 years, years since diagnosis 10.9 ± 5.4. Conventional balance training (control) group: Consisted of various exercises on the floor. Exergame training (playing exergames on an unstable platform) group: Wii Sports/Sports Resort/Fit games that require arm movements (tennis, table tennis, boxing, archery, and sword fight) or displacements of the whole body to control the game avatar (ski slalom, balance bubble, penguin picnic, soccer heading, tilt city, and perfect ten). Table tennis, tennis, and tilt city were the preferred games. Single task (ST) exercises on the unstable platform group.Pre- and post-testing. Combination of single and dual tasks. Six static balance tests: four balance tests on an unstable surface, and two gait analyses (normal and dual task). All groups significantly improved balance and gait measures. The exergame training group showed significantly higher improvements in the gait dual task condition compared to the single task condition. Adherence to home-based balance training was highest in the exergame group.Goble et al.24 WiiCase study. N=1, 28 year old Male. Relapsing-remitting MS since age 11. EDSS 5.0.

INTERVENTION: Six-week balance training, 3x30 mins per week. Wii-Fit games (yoga, table-tilt, penguin slide, ski jump and bubble balance).20s double leg standing. CoP path length (body sway). Participant relapsed after five weeks training. Follow-up measure taken post-relapse (two months). Over first two weeks 12% decrease in body sway from baseline. 22% increase in body sway over the next two weeks despite training. Relapse occurred week five. Balance impairment remained upon remittance (follow-up) when compared to week two.Forsberg et al.33 WiiParticipants: N=15, median age 55 years, median time since diagnosis 13 years.

INTERVENTION: See Nilsagard et al.25 Qualitative research approach. Interviewed (15-45 mins) within two weeks after the end of the intervention period. Interview covered reflections on using Wii-Fit for exercising. Patients considered Wii-Fit exercises to be fun, challenging, and self-motivating.*Thomas et al.24 WiiPublished trial methodology multicentre definitive RCT to assess the clinical and cost-effectiveness of a home-based physiotherapist-supported Wii intervention. Immediate arm (N=15): Wii training for 12 months. Delayed arm (N=15): Wii training after six months. Comparison between first six months of immediate arm vs. six months of no training in delayed group, and then 12 months of Wii training in immediate group vs. six months Wii training in delayed group.Balance, gait and mobility: Two-minute walk test, Step test, Steady stance test, Instrumented TUG, Gait stride-time rhythmicity, Static posturography.Physical activity: GLTEQ, ActivPAL.Hand dexterity/coordination: Nine-hole peg test.Self-efficacy: SCI-ESES, MSSE.Psychological well-being and QoL: HADS, EQ-5D-5L, MSIS-29, FSI, SF-36v2. Adherence to training.*published trial methodology25-FWT: 25 Foot Walk Time; ABC: Activities-specific Balance Confidence; AI: Ambulation Index; BBS: Berg Balance Score; CoP: Centre of Pressure; EDSS: Expanded Disability Status Scale; EQ-5D-5L: EuroQual 5 Dimensions-5 Levels; FRT: Functional Reach Test; FSI: Fatigue Symptom Inventory; FSST: Four Square Step Test; GLTEQ: Godin Leisure-Time Exercise Questionnaire; HADS: Hospital Anxiety and Depression Scale; MFIS: Modified Fatigue Impact Scale; MMSE: Mini-Mental State Examination; MS: Multiple Sclerosis; MSIS-29: Multiple Sclerosis Impact Scale; MSSE: Multiple Sclerosis Self-Efficacy Scale; MSWS-12: MS Walking Scale; QoL: Quality of Life; RCT: Randomized Control Trial; RPE: Ratings of Perceived Exertion; SCI-ESES: Spinal Cord Injury Exercise Self-Efficacy Scale; SF-36: Short-Form Health Survey; SOT: Sensory Organization Test; TUG: Timed-Up-and-Go.

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