TOTAL HIP ARTHROPLASTY IN COVID-19 TIME: EFFECTS OF AUTONOMOUS USE OF AN EXERGAME IN EARLY REHABILITATION. EXPLORATIVE PILOT STUDY

L. Marin^1,2,3,4, M. Febbi^2,4, S. Ottobrini¹, E. Caldarella⁵, F. Abbiati², D. Silvestri⁶, M. Chiodaroli^3,2

Background: Patients undergoing Total Hip Arthroplasty (THA) develop asymmetric patterns of movement, due to muscle weakness and/or pain. Early post-operative rehabilitation, within the first five days, is important to improve short-term outcomes, in particular recovery of functional capabilities and patient autonomy. Exergames have also been introduced in clinical practice due to the potential benefits on motor learning and functional capabilities.The news from China on the COVID-19 pandemic has accelerated the search for tools that allow to decrease physiotherapist / patient contacts during rehabilitation path.

Purpose: This explorative pilot study aims to evaluate the effects of the autonomous use of an exergame on patient outcomes in very short post THA period, and compare them with the standard treatment.

Methods: From 3rd February to 13th March 2020 at the “Città di Pavia” University Hospital (Pavia, Lombardy, Italy), 14 patients undergoing THA with programmed hospitalization were recruited. Inclusion criteria were: ≤ 75 years, absence of pathologies that limited walking and vision. On the first post-surgical day patients received an informative brochure on the study and they signed an informed consent. Then, they were assigned by randomization to one of the two study groups: Exergame (EG) and Control (CG). No statistically significant differences were found between the two groups. On first post-surgical day all participants learned the exercises. EG has also been trained to use the exergame based on inertial sensoristics (Kari, CoRehab, Trento, Italy). From the second day (T₀), up to and including the fourth (T₁), all participants carried out the same rehabilitative treatment. EG performed exercises autonomously using the exergame, CG assisted by the Physiotherapist. During the sessions the pleasantness and fatigue perceived during exercises were evaluated (Feeling Scale, Borg Scale). On T₀ participants carried out a series of assessments to measure functional capabilities (Timed Up and Go, Chair Stand Test, 20 meters, active and passive ROM of hip and knee), which was repeated in T₁ and tenth day (T₂), end of the study. Perceived usefulness and ease of use of the exergame were evaluated in EG with the Technology Acceptance Model (TAM). The statistical analysis was performed using ANOVA for repeated measurements with Jamovi 1.0.8 software.

Results: For all outcomes the results are significant in both groups only over time (p <.05). There is no intra and intergroup significance even if, both at T₁ and T₂, EG have improved more than CG. EG highlighted the perception of greater fatigue and less pleasantness compared to CG. All EG participants obtained the maximum score in the TAM.

Conclusion(s): In short term, the use of the exergame seems to have similar effects to those ones with the Physiotherapist. Perceptions reported by EG could be due to the greater physical and emotional involvement induced by the exergame. TAM results demonstrate the pleasantness and ease of use perceived by all participants in EG, who asked for keeping on using the exergame even after the end of the study.

Implications: When necessary exergames could be employed to decrease the risk of contagion related to physiotherapist / patient contact.

Funding, acknowledgements: No funding was received to conduct this study.

Keywords: Covid - 19, Total hip arthroplasty, Exergame

Topic: COVID-19

Did this work require ethics approval? No

Institution: N/A

Committee: N/A

Reason: It is not required because it is a pilot explorative study. It has been approved by the University Hospital Scientific Board.