The effects of exergaming on pain, postural control, technology acceptance and flow experience in older people with chronic musculoskeletal pain: a randomised controlled trial

Objective: Older people with chronic musculoskeletal pain are at risk of falls. The primary aim of this study was to investigate the effects of exergaming on pain and postural control in older people with chronic musculoskeletal pain. Secondary aims were to test if their perceptions of usability of the technology and experience of flow changed upon completing the intervention. The interventions comprised the Interactive Rehabilitation and Exercise System (IREX®) and traditional gym-based exercise with no virtual stimuli (TGB). The primary outcome measures were pain and postural control, whereas secondary outcomes consisted of technology acceptance, flow experience and physiological measures of perceived physical exertion (BORG RPE) expended mental effort (SMEQ) and heart rate (HR). Methods: 54 older adults (age: 71 ± 5 years) with chronic musculoskeletal pain were randomised (stratified, blind card) to one of two groups: (a) exergaming using IREX® and (b) TGB exercise. Both groups completed two 40-minute exercise sessions (matched for intensity, duration and movement patterns) a week for six weeks. The sensory, emotional and motivational dimension of pain was measured using the Multidimensional Affect and Pain Survey (MAPS) questionnaire. Perceived pain intensity was measured with a numeric pain rating scale. Postural control was measured as sway using a Kistler™ force platform. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology (UTAUT) and flow experience with the Flow State Scale (FSS) questionnaires. Physiological measures of perceived physical exertion (BORG RPE), expended mental effort (SMEQ) and heart rate (HR) were recorded during all sessions. Results: The exergaming group demonstrated significant reductions in pain intensity and thermal pain including a near significant approach in physical engagement (a well-being aspect of pain) when compared to the TGB group. Although no intervention effects on postural control were found, the exergaming group showed significant improvements in three postural control measures (AP SD, ML SD and AP range) over time whereas significant improvements in ML range were found in the TGB group. In terms of technology acceptance, significant intervention effects on social influence and behavioural intention were found in the TGB group instead, although increases of acceptance over time were observed in both groups. With respect to flow experience, concentration at task was significantly influenced in the control group (TGB) and significant increases in flow variables over time were observed in both groups (TGB and exergaming). Whilst no intervention effects were found in all of the physiological measures, both exercise groups showed significant increases over time in perceived physical exertion and expended mental effort. Conclusion: Overall, our findings supported the potential of exergaming to alleviate pain and improve balance in older people with chronic musculoskeletal pain. Both forms of exercise are acceptable, intrinsically motivating and show evidence of benefit to older people with chronic musculoskeletal pain. Trial registration: ClinicalTrials.gov Identifier: NCT04029285 (retrospectively registered, July 23, 2019) https://clinicaltrials.gov/ct2/show/study/NCT04029285?term=Alasdair+Macsween&draw=2&rank=2