title: A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial.
abstract: BACKGROUND
  The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed "Wii.n.Walk", an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA.
  
  
  OBJECTIVE
  The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group.
  
  
  METHODS
  This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants' homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks' duration. The primary outcome measure will be the "Two-Minute Walk Test" to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and unsupervised phases, and after 1-year follow up.
  
  
  RESULTS
  Study staff have been hired and trained at both sites and recruitment is currently underway. No participants have been enrolled yet.
  
  
  CONCLUSIONS
  Wii.n.Walk is a promising in-home telehealth intervention that may have useful applications for older adults with LLA who are discharged from rehabilitation or live in remote areas having limited or no access to existing rehabilitation programs.
  
  
  BACKGROUND
  Clinicaltrial.gov NCT01942798; http://clinicaltrials.gov/ct2/show/NCT01942798 (Archived by WebCite at http://www.webcitation.org/6V0w8baKP).
authors.affiliation: Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Bita
authors.identifier: http://orcid.org/0000-0001-9264-8186
authors.initials: B
authors.lastname: Imam
authors.forename: William C
authors.identifier: http://orcid.org/0000-0003-3060-0210
authors.initials: WC
authors.lastname: Miller
authors.forename: Heather C
authors.identifier: http://orcid.org/0000-0002-4552-1390
authors.initials: HC
authors.lastname: Finlayson
authors.forename: Janice J
authors.identifier: http://orcid.org/0000-0002-2093-0788
authors.initials: JJ
authors.lastname: Eng
authors.forename: Michael Wc
authors.identifier: http://orcid.org/0000-0002-5511-166X
authors.initials: MW
authors.lastname: Payne
authors.forename: Tal
authors.identifier: http://orcid.org/0000-0003-4124-7782
authors.initials: T
authors.lastname: Jarus
authors.forename: Charles H
authors.identifier: http://orcid.org/0000-0002-1614-2375
authors.initials: CH
authors.lastname: Goldsmith
authors.forename: Ian M
authors.identifier: http://orcid.org/0000-0001-7053-441X
authors.initials: IM
authors.lastname: Mitchell
keywords: adult; aged; amputation; randomized controlled trial; telemedicine; walking