The influence of scaffolding on intrinsic motivation and autonomous adherence to a game-based, sparsely supervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial.
Gerard Fluet, Qinyin Qiu, Amanda Gross and 4 others
PMID 39138516WHAT IT FOUND
Scaffolding game difficulty did not improve adherence or motivation compared to hidden algorithmic adjustment.
However, both sparsely supervised home programs produced clinically meaningful gains in arm function and daily activities. The game design mechanism was not the driver of recovery.
Key findings
01The primary outcome was null: scaffolding did not result in statistically significant differences in total training time or number of sessions compared to algorithm-controlled difficulty.
02Both groups achieved statistically significant improvements in upper extremity motor function and activities of daily living, with no difference between the two game designs.
03Adherence was not correlated with clinical outcomes; training time did not predict how much function improved.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Small sample size (28 analysed) limits statistical power, particularly for detecting differences in adherence. No follow-up testing was conducted to determine if gains were retained after the 12-week program ended. Participants were volunteers who likely had a positive attitude toward technology, limiting generalizability to those averse to digital health tools. Adherence rates were modest overall, and dropout rates were 11-13%, with setup and technical difficulties cited as reasons.
Declared interests
Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Disability, Independent Living and Rehabilitation Research, and the National Institute of Neurological Disorders and Stroke.
The easy way to misread this
Do not interpret the lack of difference between game designs as evidence that game-based rehab is ineffective. The study shows that both approaches worked to improve function. Also, do not assume that increasing training time will automatically lead to better outcomes, as no correlation was found between total minutes and clinical improvement.