title: Nintendo Wii Fit as an adjunct to physiotherapy following lower limb fractures: preliminary feasibility, safety and sample size considerations.
abstract: The Nintendo Wii Fit integrates virtual gaming with body movement, and may be suitable as an adjunct to conventional physiotherapy following lower limb fractures. This study examined the feasibility and safety of using the Wii Fit as an adjunct to outpatient physiotherapy following lower limb fractures, and reports sample size considerations for an appropriately powered randomised trial.
  
  
  
  Ambulatory patients receiving physiotherapy following a lower limb fracture participated in this study (n=18). All participants received usual care (individual physiotherapy). The first nine participants also used the Wii Fit under the supervision of their treating clinician as an adjunct to usual care. Adverse events, fracture malunion or exacerbation of symptoms were recorded. Pain, balance and patient-reported function were assessed at baseline and discharge from physiotherapy.
  
  
  
  No adverse events were attributed to either the usual care physiotherapy or Wii Fit intervention for any patient. Overall, 15 (83%) participants completed both assessments and interventions as scheduled. For 80% power in a clinical trial, the number of complete datasets required in each group to detect a small, medium or large effect of the Wii Fit at a post-intervention assessment was calculated at 175, 63 and 25, respectively.
  
  
  
  The Nintendo Wii Fit was safe and feasible as an adjunct to ambulatory physiotherapy in this sample. When considering a likely small effect size and the 17% dropout rate observed in this study, 211 participants would be required in each clinical trial group. A larger effect size or multiple repeated measures design would require fewer participants.
authors.affiliation: Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia; Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia. Electronic address: steven.mcphail@health.qld.gov.au.
authors.forename: S M
authors.initials: SM
authors.lastname: McPhail
authors.affiliation: The Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.
authors.forename: M
authors.initials: M
authors.lastname: O'Hara
authors.affiliation: Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Gane
authors.affiliation: The Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Tonks
authors.affiliation: Faculty of Health, Australian Catholic University, Brisbane, Queensland, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Bullock-Saxton
authors.affiliation: Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia; The Prince Charles Hospital, Metro North Health, Brisbane, Queensland, Australia.
authors.forename: S S
authors.initials: SS
authors.lastname: Kuys
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000534:rehabilitation*; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D018910:Video Games
keywords: Fracture; Game; Nintendo Wii; Physiotherapy; Rehabilitation; Safety