[논문]가상현실 게임을 적용한 물리치료가 무릎 수술 후 환자의 통증, 기능 변화, 삶의 질, 동기부여에 미치는 영향

김홍길; 정주현

doi:10.21598/jkpnfa.2023.21.3.345

가상현실 게임을 적용한 물리치료가 무릎 수술 후 환자의 통증, 기능 변화, 삶의 질, 동기부여에 미치는 영향
Effects of Physical Therapy Combined with Virtual Reality Games on Pain, Function, Quality of Life, And Engagement in Post-Knee-Surgery Patients 원문보기

PNF and movement, v.21 no.3, 2023년, pp.345 - 356

김홍길 (서면더존한방병원 물리치료실) , 정주현 (동의대학교 물리치료학과)

Abstract ▼ AI-Helper

Purpose: The aim of this study was to investigate the effects of physical therapy combined with a virtual reality (VR) game on pain, quality of life (QOL), engagement, and knee function in post-knee-surgery patients. Methods: Twenty-four patients who had undergone knee surgery four weeks or more before the study were recruited. Two withdrew from the study during the four-week experimental period, and a total of 22 patients were included in the final analysis. Routine physical therapy consisting of electrostimulation (10 min.) and therapeutic massage (10 min.) was the base intervention for all groups. The experimental group (n = 10) was additionally exposed to a VR game intervention, while the control group (n = 12) underwent an intervention involving similar motions as the experimental intervention but with no VR. The intervention for the experimental group used the game Rig Fit Adventure on Nintendo switch. Both groups underwent their respective interventions 3 times a week (35 min. per session) for 4 weeks. Pain was assessed using the numeric rating scale (NRS), and QOL was assessed using the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L). Engagement was assessed using the Korea flow state scale (K-FSS). Finally, knee movement and function were assessed based on knee flexion and extension, range of motion (ROM), and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Results: After the four-week physical therapy, both groups showed significant reductions in pain (on the NRS), increased knee ROM (flexion), better WOMAC scores, and increased EQ-5D-5L scores (p < 0.05), with the experimental group showing significantly better improvements in EQ-5D-5L and K-FSS scores (p < 0.05). Conclusion: The results of this study confirm that a VR-game-integrated intervention is effective for improving pain, QOL, engagement, and knee function in post-knee surgery patients and that VR-game-integrated interventions could be therapeutic alternatives for patients bedridden for prolonged periods with little motivation for rehabilitation.

주제어

표/그림 (7)

그림 Fig. 1. Study flow diagram. NRS: numeral rate scale, ROM: rang of motion, WOMAC: Western Ontario & mcmaster universities, EQ-5D-5L: EuroQol five-dimensional five-level questionnaire, GPT: general physical therapy, VRPT: virtual reality physical therapy, K-FSS: Korea flow state scale.
그림 Fig. 2. Function, quality of life, and engagement index A: Korea Version Western Ontario and MacMaster Universities Arthritis index (WOMAC). B: Korea Version EuroQol five-dimensional five-level questionnaire (EQ-5D-5L). C: Korea Version flow state scale(K-FSS).
그림 Fig. 3. Vertual reality exercise program. A: Revolved crescent lunge pose, B: Warrior 3 pose, C: Squat D: Knee-lift combo, E: Thigh rider, F: Squat hopping.
그림 Fig. 4. Vertual reality exercise program game screen.
표 Table 1. General characteristics of subjects (n=22)
표 Table 2. Comparison of ROM (°) after intervention and between two groups (n=22)
표 Table 3. Comparison of K- FSS (score) after intervention and between two groups (n=22)

참고문헌 (39)

Andriacchi TP, Mundermann A, Smith RL, et al. A framework？for the in vivo pathomechanics of osteoarthritis at？the knee. Annals of Biomedical Engineering.？2004;32(3):447-457.？

상세보기
Anwer S, Alghadir A, Brismee JM. Effects of orthopaedic？manual therapy in knee osteoarthritis: a systematic？review and meta-analysis. Physiotherapy. 2018;？104(3):264-276.？
Ayoade M, Baillie L. A novel knee rehabilitation system for？the home. Journal of Proceedings of the SIGCHI？Conference on Human Factors in Computing Systems.？2014;20:2521-2530？
Bilbao A, Garcia Perez L, Arenaza J. et al. Psychometric？properties of the EQ-5D-5L in patients with hip or？knee osteoarthritis: reliability, validity and？responsiveness. Quality of Life Research. 2018;？27:2897-2908.？

상세보기
Bruun Olsen V, Heiberg, KE, Mengshoel AM. Continuous？passive motion as an adjunct to active exercises in？early rehabilitation following total knee arthroplasty-a？randomized controlled trial. Disability and？Rehabilitation. 2009;31(4):277-283.？

상세보기
Calmbach WL, Hutchens M. Evaluation of patients presenting？with knee pain: Part II. Differential diagnosis.？American Family Physician. 2003;68(5):917-922.？

상세보기
Collins NJ, Misra D, Felson D T, et al. E. M. Measures of？knee function: International Knee Documentation？Committee (IKDC) Subjective Knee Evaluation Form,？Knee Injury and Osteoarthritis Outcome Score？(KOOS), Knee Injury and Osteoarthritis Outcome？Score Physical Function Short Form (KOOS-PS),？Knee Outcome Survey Activities of Daily Living？Scale (KOS-ADL), Lysholm Knee Scoring Scale,？Oxford Knee Score (OKS), Western Ontario and？McMaster Universities Osteoarthritis Index？(WOMAC), Activity Rating Scale (ARS), and Tegner？Activity Score (TAS). Arthritis Care & Research.？2011;63(11): 208-228.？
Cuesta Gomez A, Martin Diaz P, Sanchez Herrera Baeza P,？et al. Nintendo Switch Joy-Cons' Infrared Motion？Camera Sensor for Training Manual Dexterity in？People with Multiple Sclerosis: A Randomized？Controlled Trial. Journal of Clinical Medicine.？2022;11(12):3261.？

상세보기
Dockx K, Bekkers EM, Van den Bergh V, et al. A. Virtual？reality for rehabilitation in Parkinson's disease.？Cochrane Database of Systematic Reviews. 2016;(12):？1465-1858？
Elshazly FA. A Nambi, GS & Elnegamy TE. Comparative？study on virtual reality training (VRT) over sensory？motor training (SMT) in unilateral chronic？osteoarthritis-A randomized control trial.？International Journal of Medical Research Health？Sciences. 2016;5(8):7-16.？
Fung V, Ho A, Shaffer J, et al. Use of Nintendo Wii Fit™？in the rehabilitation of outpatients following total？knee replacement: a preliminary randomised？controlled trial. Physiotherapy. 2012;98(3):183-188.？
Gademan MG, Hofstede SN, Vliet Vlieland TP, et al. Indication？criteria for total hip or knee arthroplasty in？osteoarthritis: a state-of-the-science overview. BMC？Musculoskeletal Disorders. 2016;17(1):1-11.？
Gianola S, Stucovitz E, Castellini G, et al. Effects of early？virtual reality-based rehabilitation in patients with？total knee arthroplasty: a randomized controlled trial.？Medicine. 2020;99(7).？
Giggins OM, Persson UM, Caulfield B. Biofeedback in？rehabilitation. Journal of neuroengineering and rehabilitation. 2013;10:60.？

상세보기
Howard MC. A meta-analysis and systematic literature review？of virtual reality rehabilitation programs. Computers？in Human Behavior. 2017;70:317-327.？

상세보기
Khushnood K, Altaf S, Sultan N, et al. Role Wii Fit exer-games？in improving balance confidence and quality of life？in elderly population. Journal of the Pakistan Medical？Association. 2021;71:2130-2134.？
Kim J, Lee M & Yim J. A new approach to transcranial？direct current stimulation in improving cognitive？motor learning and hand function with the Nintendo？switch in stroke survivors. Medical Science Monitor:？International Medical Journal of Experimental and？Clinical Research. 2019;25:9555-9557？

상세보기
Kim J, Son J, Ko N, et al. Unsupervised virtual reality-based？exercise program improves hip muscle strength and？balance control in older adults: a pilot study. Archives？of Physical Medicine and Rehabilitation. 2013;？94(5):937-943.？

상세보기
Kim SH, Hwang JS, Kim TW, et al. Validity and reliability？of the EQ-5D for cancer patients in Korea. Supportive？Care in Cancer. 2012;20:3155-3160.？

상세보기
Kim YB, Choi HS, Kang EM, et al. Trends of Total Knee？Arthroplasty According to Age Structural Changes？in Korea from 2011 to 2018. International Journal？of Environmental Research and Public Health.？2021;18(24):13397？
Klussmann A, Gebhardt H, Nubling M, et al. Individual and？occupational risk factors for knee osteoarthritis: results？of a case-control study in Germany. Arthritis Research？& Therapy. 2010;12(3):1-15.？
Laver KE, Lange B, George S, et al. Virtual reality for stroke？rehabilitation. Cochrane Database of Systematic？Reviews. 2017;11:23-25？
Lee JH, Park JH. Validity and Reliability of a Korean Version？of the Flow State Scale for Occupational Therapeutic？Science for Rehabilitation. 2021;10(4):53-63.？
Lee M, Suh D, Son J, et al. Patient perspectives on virtual？reality-based rehabilitation after knee surgery:？Importance of level of difficulty. Journal of？Rehabilitation Research & Development. 2016.？
Mitchell HL, Hurley MV. Management of chronic knee pain:？a survey of patient preferences and treatment received.？BMC Musculoskeletal Disorders. 2008;9:1-7.？
Rakel BA, Zimmerman MB, Geasland K, et al. Transcutaneous？electrical nerve stimulation for the control of pain？during rehabilitation after total knee arthroplasty: a？randomized, blinded, placebo-controlled trial. Journal？of Pain. 2014;155(12):2599-2611.？
Ravi D, Kumar N, Singhi P. Effectiveness of virtual reality？rehabilitation for children and adolescents with？cerebral palsy: an updated evidence-based systematic？review. Physiotherapy, 2017; 103(3):245-258.？
Roos EM, Toksvig Larsen S. Knee injury and Osteoarthritis？Outcome Score (KOOS)-validation and comparison？to the WOMAC in total knee replacement. Health？and Quality of Life Outcomes. 2003;1(1):1-10.？
Sandlund M, Dock K, Hager CK, et al. Motion interactive？video games in home training for children with cerebral？palsy: parents' perceptions. Disability and？Rehabilitation. 2012;34(11):925-933.？

상세보기
Sarzi Puttini P, Cimmino MA, ScarpaR, et al. Osteoarthritis:？an overview of the disease and its treatment strategies.？Journal of Seminars in arthritis and rheumatism.？2005;35(1):1-10？
Sato T, Shimizu K, Shiko Y, et al. Effects of Nintendo Ring？Fit Adventure Exergame on Pain and Psychological？Factors in Patients with Chronic Low Back Pain.？Games for Health Journal. 2021;10.？

상세보기
Song MY, Jo HG, Sul JU, et al. Proposal of east-west integrative？medicine manual for rehabilitation after knee surgery.？Journal of Korean Medicine Rehabilitation. 2018;？28(1):97-107.？
Su CH. Developing and evaluating effectiveness of 3D game-based rehabilitation system for Total Knee？Replacement Rehabilitation patients. Multimedia？Tools and Applications. 2016; 75:10037-10057.？

상세보기
Thomas S, Fazakarley L, Thomas PW, et al. A pilot randomised？controlled trial of a home gaming system (Nintendo？Wii) to increase activity levels, vitality and well-being？in people with multiple sclerosis. BMJ Open.？2017;7(9).？
Tore NG, Oskay D, Haznedaroglu S. The quality of？physiotherapy and rehabilitation program and the？effect of telerehabilitation on patients with knee？osteoarthritis. Clinical Rheumatology. 2023;42(3):？903-915.？
Van Middelkoop, M Bennell, KL Callaghan et al. International？patellofemoral osteoarthritis consortium: consensus？statement on the diagnosis, burden, outcome measures,？prognosis, risk factors and treatment. Journal of？Seminars in Arthritis and Rheumatism. 2018;47(5):？666-675？
Vieira C, Ferreira da Silva PaisVieira C, Novais J Perrotta？A. Serious game design and clinical improvement？in physical rehabilitation: systematic review. JMIR？Serious Games. 2021;9(3).？

상세보기
Vincent KR. Resistance Exercise for Knee Osteoarthritis.？Physical Medicine and Rehabilitation. 2012;4(5):？45-52.？
Weiss PL, Rand D, Katz N Kizony R. Video capture virtual？reality as a flexible and effective rehabilitation tool.？Journal of Neuroengineering and Rehabilitation.？2004;1:1-12.

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format