Digital game delivers reliable wrist range of motion measurements

The ReValidate! game, which uses a wearable device as a controller, yields reliable measurements of wrist range of motion (ROM), outperforming even healthcare professionals, according to a recent study.

“In this study, experienced healthcare professionals’ measurements show a poor inter-rater reliability using a universal goniometer in measuring active ROM of the wrist,” the researchers said. “In contrast, the wearable-controlled mobile game ReValidate!, which incorporates a digital goniometer, shows a higher reliability and validity in measuring active ROM of the wrist joint.”

Thirty-four patients with restricted wrist ROM were enrolled in the study, along with seven healthy volunteers. To first validate the internal goniometer of ReValidate!, healthy volunteers were asked to complete one level of the game twice with at least 30 minutes of rest in between; all volunteers were asked to achieve their own maximum ROM.

Right after gameplay, four blinded and experienced medical professionals measured the active ROM of the healthy volunteers with a universal goniometer. Meanwhile, external validity was assessed by comparing the game vs expert measurements of ROM in patients with various levels of restriction.

Test-retest measurements revealed overall good internal validity in the ReValidate! game, with intraclass correlation coefficients (ICC) ranging from poor (ICC, 0.376, 95 percent confidence interval [CI], –0.469 to 0.857) in the pronation-supination arc to good in the palmar-dorsal flexion (ICC, –0.693, 95 percent CI, –1.235 to 0.298) and radial-ulnar deviation (ICC, 0.863, 95 percent CI, 0.444–0.974) arcs. [Eur J Trauma Emerg Surg 2021;doi:10.1007/s00068-021-01657-5]

In contrast, there were large variations in the means and standard deviations of the measurements from medical professionals. In the palmar-dorsal flexion (ICC, 0.16, 95 percent CI, –0.45 to 0.76) and pronation-supination (ICC, 0.02, 95 percent CI, –0.21 to 0.56) arcs, inter-rater reliability was poor.

Comparing between game and expert measurements, the researchers saw reasonable agreement. Along the palmar-dorsal flexion arc, ReValidate! would consistently measure a value 1.5^o lower than the experts. In the radial-ulnar deviation arc, game measurements were 3.6^o lower.

“To support patients in their rehabilitation process while simultaneously improving patient monitoring, the serious game ReValidate! has been developed,” the researchers explained. “The game is controlled by two wearable motion sensors, placed proximally and distally of the wrist, so that they bridge the wrist joint.”

The game can be played on a smartphone or a tablet and requires the player to steer an underwater avatar through a course, using wrist motions as the controls. Aside from telemonitoring of wrist ROM, ReValidate! also records treatment adherence.

“This study shows that medical professionals, including surgeons and hand therapists, can rely on a commercially available off-the-shelf tool to reliably monitor the progress of their patients participating in a home-based rehabilitation programme, without requiring hospital visits for monitoring,” the researchers said.