Efficacy of a technology-based client-centred training system in neurological rehabilitation: a randomised controlled trial

Abstract

Background: A client-centred task-oriented approach has advantages towards motivation and adherence to therapy in neurorehabilitation, but it is costly to integrate in practice. An intelligent Activity-based Client-centred Training (i-ACT), a low-cost Kinect-based system, was developed which integrates a client-centred and task-oriented approach. The objectives were (1) to investigate the effect of additional i-ACT training on functioning. And (2) to assess whether training with i-ACT resulted in more goal oriented training.

Methods: A single-blind randomised controlled trial was performed in 4 Belgian rehabilitation centres with persons with central nervous system deficits. Participants were randomly allocated through an independent website-based code generator using blocked randomisation (n = 4) to an intervention or control group. The intervention group received conventional care and additional training with i-ACT for 3 × 45 min/week during 6 weeks. The control group received solely conventional care. Functional ability and performance, quality of life (QoL), fatigue, trunk movement, and shoulder active range of motion (AROM) were assessed at baseline, after 3 weeks and 6 weeks of training, and 6 weeks after cessation of training. Data were analysed using non-parametric within and between group analysis.

Results: 47 persons were randomised and 45 analysed. Both intervention (n = 25) and control (n = 22) group improved over time on functional ability and performance as measured by the Wolf Motor Function Test, Manual Ability Measure-36, and Canadian Occupational Performance Measure, but no major differences were found between the groups on these primary outcome measures. Regarding QoL, fatigue, trunk movement, and shoulder AROM, no significant between group differences were found. High adherence for i-ACT training was found (i.e. 97.92%) and no adverse events, linked to i-ACT, were reported. In the intervention group the amount of trained personal goals (88%) was much higher than in the control group (46%).

Conclusions: Although additional use of i-ACT did not have a statistically significant added value regarding functional outcome over conventional therapy, additional i-ACT training provides more individualised client-centred therapy, and adherence towards i-ACT training is high. A higher intensity of i-ACT training may increase therapy effects, and should be investigated in future research.

Trial registration: ClinicalTrials.gov Identifier NCT02982811. Registered 29 November 2016.

Keywords: Client-centred; Efficacy; Rehabilitation; Task-oriented; Technology.

Fig. 1

Person with deficits’ interface during performance of the exercise “drinking from a cup”. The avatar on the left represents the therapist (i.e. recorded movement) while the avatar on the right represents the person with deficits. The green dot is the stability point for restriction of compensational movement. The pink dots are the targets for the right hand

Fig. 2

Flow chart (CONSORT). T0 Baseline, T1 after 3 weeks of training, T2 test moment after 6 weeks of training, T3 test moment 6 weeks after cessation of training