Vetenskaplig sammanfattning

Purpose: Our aim was to describe experiences of using Nintendo Wii Fit for balance exercise,

from the perspectives of patients with multiple sclerosis (MS) and their physiotherapists (PT).

Methods: Individual interviews with 15 patients with MS were conducted, recruited from a

multi-centre study investigating the effects of balance exercising using Wii Fit. We also

conducted a single focus group interview with nine PT involved in the study. The interviews

were audio-recorded, transcribed, and analysed using content analysis. Results: Both patients

and PT said that exercising with Wii Fit games was fun, and that it challenged the patients’

physical and cognitive capacities. The competitive content in the games provided motivation to

continue playing. Patients and PT reported improved body control and, more importantly,

positive effects on balance and walking in daily life. The PT regarded Wii training as an effective

alternative to other balance training, but some felt unsure in how to manage the video game.

The patients regarded Wii training as a possible home training solution. Conclusions: Patients

with MS and their PT considered Wii Fit exercises to be fun, challenging, and self-motivating.

Exercising with Wii games can address balance impairments in MS, and can be performed at

home as well as in rehabilitation settings.

Background: The use of interactive video games is expanding within rehabilitation. The evidence base is, however,

limited.

Objective: Our aim was to evaluate the effects of a Nintendo Wii Fit® balance exercise programme on balance function

and walking ability in people with multiple sclerosis (MS).

Methods: A multi-centre, randomised, controlled single-blinded trial with random allocation to exercise or no exercise.

The exercise group participated in a programme of 12 supervised 30-min sessions of balance exercises using Wii games,

twice a week for 6–7 weeks. Primary outcome was the Timed Up and Go test (TUG). In total, 84 participants were

enrolled; four were lost to follow-up.

Results: After the intervention, there were no statistically significant differences between groups but effect sizes for the

TUG, TUGcognitive and, the Dynamic Gait Index (DGI) were moderate and small for all other measures. Statistically

significant improvements within the exercise group were present for all measures (large to moderate effect sizes) except

in walking speed and balance confidence. The non-exercise group showed statistically significant improvements for the

Four Square Step Test and the DGI.

Conclusion: In comparison with no intervention, a programme of supervised balance exercise using Nintendo Wii Fit®

did not render statistically significant differences, but presented moderate effect sizes for several measures of balance

performance.

Background. Evaluation of walking capacity and risk of falls in people with

multiple sclerosis often are performed in rehabilitation. The Dynamic Gait Index

(DGI) evaluates walking during different tasks, but the feasibility in identifying people

at risk for falls needs to be further investigated.

Objective. The objective of this study was to investigate (1) the construct validity

(known groups, convergent, and discriminant) of the DGI and (2) the accuracy of

predicting falls and establishing a cutoff point to identify fallers.

Design. This trial was a multicenter, cross-sectional study.

Methods. A convenience sample was composed of 81 people with multiple

sclerosis with subjective gait and balance impairment who were able to walk 100 m

(comparable to Expanded Disability Status Scale 1–6). Mean age of the participants

was 49 years; 76% were women. The 25-Foot Timed Walk Test, Timed “Up & Go”

Test, Four Square Step Test, Timed Sit-to-Stand Test, MS Walking Scale, Multiple

Sclerosis Impact Scale, and self-reported falls during the previous 2 months were used

for validation, to establish cutoff points for identifying fallers, and to investigate

predictive values.

Results. Significantly lower DGI scores (P
.001) were found for participants

reporting falls (n
31). High sensitivity (87%) in identifying fallers was found, with a

cutoff score
19. The positive predictive value was 50%, and the negative predictive

value was 87%. The positive likelihood ratio was 1.77, and the negative likelihood

ratio was 0.26. The convergent validity was moderate to strong (
0.58–0.80), with

the highest correlation coefficient found for the 25-Foot Timed Walk Test. Discriminant

validity was shown with low correlation for the psychological subscale of the

Multiple Sclerosis Impact Scale.

Limitations. The sample included ambulatory people participating in a randomized

controlled trial investigating balance training.

Conclusions. The DGI is a valid measure of dynamic balance during walking for

ambulatory people with multiple sclerosis.