AUTHOR=Hardeman Lotte E. S. , Geerse Daphne J. , Hoogendoorn Eva M. , Nonnekes Jorik , Roerdink Melvyn 

TITLE=Remotely prescribed, monitored, and tailored home-based gait-and-balance exergaming using augmented reality glasses: a clinical feasibility study in people with Parkinson’s disease

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1373740

DOI=10.3389/fneur.2024.1373740

ISSN=1664-2295

ABSTRACT=BACKGROUND: Exergaming has the potential to increase adherence to exercise through play, individually tailored training and (online) remote monitoring. Reality DTx ® is a digital therapeutic software platform for augmented-reality glasses (AR) that enables a home-based gait-and-balance exergaming intervention specifically designed for people with Parkinson's disease (pwPD). OBJECTIVE: The primary objective was to evaluate the feasibility and potential efficacy of Reality DTx ® AR-exergaming intervention for improving gait, balance and walkingadaptability fall-risk indicators. The secondary objective was to evaluate potential AR-glasses superiority (Magic Leap 2 [ML2] vs. HoloLens 2 [HL2]). METHODS: This waitlist-controlled clinical feasibility study comprised three laboratory visits (baseline; pre-intervention; post-intervention), a home visit and a 6-week AR-exergaming intervention. Five complementary gait-and-balance exergames were remotely prescribed (default five sessions/week of 30 active minutes/session), monitored and tailored. Feasibility was assessed in terms of safety, adherence and user experience. During laboratory visits, gaitand-balance capacity was assessed using standard clinical gait-and-balance tests and advanced walking-adaptability fall-risk assessments. RESULTS: 24 pwPD participated. No falls and four near falls were reported. Session adherence was 104%. User Experience Questionnaire scores for Reality DTx ® ranged from above average to excellent, with superior scores for HL2 over ML2 for Perspicuity and Dependability. Intervention effects were observed for the Timed-Up-and-Go test (albeit small), the Five-Times-Sit-to-Stand test and walking speed. Walking-adaptability fall-risk indicators all improved post-intervention. CONCLUSIONS: Reality DTx ® is a safe, adherable, usable, well-accepted and potentially effective intervention in pwPD. These promising results warrant future RCTs on the (cost-)effectiveness of home-based AR exergaming interventions for improving gait, balance and fall risk. Trial registration: ClinicalTrials.gov, NCT05605249, Registered 4 November 2022, https://clinicaltrials.gov/ct2/show/NCT05605249