SLR - January 2016 - Raffaella Pascarella
Reference: Punt IM, Ziltener JL, Monnin D, Allet L. Wii Fit™ Exercise Therapy for the Rehabilitation of Ankle Sprains: Its Effect Compared With Physical Therapy or no Functional Exercises at All. Scand J Med Sci Sports. 2015 Jun 16.Scientific Literature Review
Reviewed By: Raffaella Pascarella, DPM
Residency Program: Cambridge Health Alliance
Podiatric Relevance: Lateral ankle sprains are among the most common sports-related injury and account for a high number of office and Emergency Department visits annually. Following the acute phase, many patients continue to experience pain and ankle instability, and often times, experience subsequent sprains. Providing a more flexible training time, and a more varied exercise regimen could keep patients more motivated as well as potentially reduce healthcare costs. Virtual reality devices (such as the Wii Fit) have been implemented in a number of orthopedic rehabilitation programs including patients with knee injuries and neurological disorders. These authors hypothesized that patients using a Wii Fit would achieve better results in all outcome measures compared with ankle sprain patients receiving no functional exercise treatment.
Methods: A single-blinded, randomized control trial with two intervention groups: physical therapy and Nintendo Wii Fit balance board, and one control group receiving no intervention was implemented. Patients ranged from age 18-64 and had sustained either a grade I or grade II lateral ankle sprain between April 2010 to September 2014 at the University Hospital of Geneva. Patients who had sustained a sprain on the ipsilateral ankle within the last 12 months, a grade III sprain with complete rupture of the ligament, and any neurological or musculoskeletal disorders were excluded. Patients were discharged from the Emergency Department with a semi-rigid Aircast, RICE protocol, and pain free movement for four weeks. Evaluation by a physical therapist four weeks after the injury included a self-reported function and pain level, along with number of previous sprains, work/sport activities, and BMI. After six weeks, patients underwent a second evaluation to determine the effect of different treatments. Patients in the Wii Fit group met with a physical therapist and received detailed instructions to perform specific exercises 2x/week for 30 min/session over six weeks at a preferred difficulty level. Patients allocated to conventional physical therapy underwent homogenous treatment protocols in nine, 30-minute sessions over six weeks. Primary outcomes were measured using the Foot and Ankle Ability Measure questionnaire (FAAM). Secondary outcomes were measured using a VAS scale for pain with walking and at rest, satisfaction with treatment, and delay in return to sport. Pearsons chi-square test was used to analyze relationships between categorical variables. ANOVAs were analyzed for FAAM, VAS and delay in return to sport.
Results: Three-hundred-eighty-one ankle sprain patients were assessed. Ninety patients met inclusion criteria and were randomized into each of the three groups. Patients in all groups improved their foot and ankle ability during the six-week follow-up (P<0.001). Patients who underwent Wii Fit showed an improvement in pain at rest; however, patients in all three groups had an improvement in pain with walking. Most patients had returned to sport prior to beginning any treatment. The majority (85 percent) of patients were very satisfied with their treatment. No difference was found among the groups regarding satisfaction and effectiveness.
Conclusion: After six weeks, all three groups showed an improvement in ADL and sport subscales of the FAAM questionnaire, as well as decreased pain with ambulation. The control group, which received no treatment, progressed comparably with the Wii Fit group. Interestingly, 56 percent of the patients who received no treatment believed it was an effective method of dealing with an ankle sprain. Based on the results, I believe that self-motivated, compliant, patients may benefit from using the Wii Fit in treatment of grade I and II ankle sprains. This data may also suggest that ankle sprains may not require specialized treatment in most cases, which may also effectively reduce healthcare costs and burden.