Archives of Physical Medicine and Rehabilitation
journal homepage: www.archives-pmr.org
Archives of Physical Medicine and Rehabilitation 2021;102:1059-66
ORIGINAL RESEARCH
Effects of Virtual Reality and Task-Oriented Training
on Hand Function and Activity Performance in
Pediatric Hand Burns: A Randomized Controlled Trial
Fatma Alzahraa H. Kamel, PhD,a,b Maged A. Basha, PhDb,c
From the aDepartment of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt; bDepartment of Physical
Therapy, College of Medical Rehabilitation, Qassim University, Qassim, Buraidah, Saudi Arabia; and cDepartment of Physical Therapy, El-Sahel
Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt.
Abstract
Objective: To assess the efficacy of a motion-sensing, hands-free gaming device and task-oriented training (TOT) programs on improving hand
function, activity performance, and satisfaction in pediatric hand burns.
Design: A randomized controlled trial.
Setting: Outpatient rehabilitation center.
Participants: Fifty children with deep partial-thickness or full-thickness hand burns. (NZ50; mean age, 10.701.64y; range, 7-14y)
Interventions: Children were randomized into 1 of the following 3 groups: the motion-sensing, hands-free gaming device group that used
interactive video games plus traditional rehabilitation (TR); the TOT group that used real materials plus TR; and the control group that only
received TR, all groups received the interventions 3 days per week for 8 weeks.
Main Outcome Measures: We assessed the children at the baseline and after 8 weeks of intervention. The primary outcome measures were the
Jebsen-Taylor Hand Function Test, Duruoz Hand Index (DHI), and Canadian Occupational Performance Measure (COPM). The secondary
outcome measures were range of motion (ROM) of the digits, grip strength, and pinch strengths (tip, palmer, and lateral pinch).
Results: There was a significant increase in all measurements of the motion-sensing, hands-free gaming device and TOT groups compared with
that of the control group postintervention (P<.05). There was no significant change in Jebsen-Taylor Hand Function Test, COPM performance,
ROM, grip strength, and tip and lateral pinch strengths between the motion-sensing, hands-free gaming device group and TOT group (P>.05),
whereas there was a significant increase in DHI, COPM satisfaction, and palmer pinch strength (P<.05) in the motion-sensing, hands-free gaming
device group compared with the TOT group postintervention.
Conclusions: The motion-sensing, hands-free gaming device and TOT programs resulted in significant improvement in hand function, activity
performance and satisfaction, ROM of the digits, grip strength, and pinch strengths in pediatric hand burns compared with the traditional hand
rehabilitation.
Archives of Physical Medicine and Rehabilitation 2021;102:1059-66
ª 2021 by the American Congress of Rehabilitation Medicine
The severity and prevalence of hand burns is well recognized, with
rehabilitation implications and final outcomes well beyond what
can be measured by evaluating the affected percentage of total
body surface area on its own.1 The function of the hands is 1 of the
key determinants of the quality of life in pediatric hand burns
(PHB). PHB can induce different hand deformities and
Clinical Trial Registration No.: NCT04497103.
Disclosures: none.
contractures, and the functional skills gained after hand burn
disproportionately affects the child’s capacity to reintegrate
completely into their preinjured position in society.2-6 Despite
traditional rehabilitation (TR) of PHB, hand function can remain
impaired,7-10 and two-thirds of patients with full-thickness hand
burn injuries change careers because of their functional hand
disability.11
Virtual reality (VR) has been used in functional rehabilitation
of upper extremity defects, and task-specific training efficacy
increased through repetitive and positive feedback when tasks
0003-9993/21/$36 - see front matter ª 2021 by the American Congress of Rehabilitation Medicine
https://doi.org/10.1016/j.apmr.2021.01.087
1060
were ordered in a random training series.12,13 Xbox Kinecta is an
interactive and enjoyable training device that produces a virtual
rehabilitation scene that systemically manages the intensity of
training.14 In randomized controlled trials, Kinect-based VR
rehabilitation used in patients with burns,15,16 patients with
stroke,17 children with cerebral palsy,18 and children with
arthritis19 resulted in increased upper extremity function and activity performance and participation and has superior results on
outcomes compared with TR.
Task-oriented training (TOT) concentrates on performance and
engagement in compliance with the recommendations of the International Classification of Functioning, Disability and Health. In
TOT the child learns problem-solving skills and successful alternative techniques by adjusting to various situations to accomplish
the activity. TOT literature reports that in neurologic and
musculoskeletal patients the use of problem-solving skills is superior to training requiring numerous repeated movement patterns
for increasing function and participation of the upper
extremity.19-22
VR has been used in burn studies mainly for pain management
and increase range of motion (ROM) in acute burns.15,16,23,24 No
studies in the existing literature have assessed the effect of Xbox
Kinect-based rehabilitation or TOT in PHB. The objective of this
work was to evaluate the efficacy of Xbox Kinect and TOT in PHB
in enhancing hand function, activity performance and satisfaction,
ROM of digits, grip strength, and pinch strengths.
Methods
Trial design
This was a randomized controlled trial conducted between May
2018 and September 2019. We recruited all participants from the
burn units of teaching hospitals in Cairo, Egypt. All of the children’s guardians signed an informed consent form. The Ethics
Committee granted approval for this study (The Research Ethics
Committee, Faculty of Physical Therapy, Cairo University), and
the study was conducted in compliance with the Declaration of
Helsinki. This study was registered in ClinicalTrials.gov
(NCT04497103).
Participants
The inclusion criteria involved individuals (mean age,
10.701.64y; range, 7-14y) with deep partial-thickness or fullthickness hand burns induced by either scaled or flame thermal
burn, involvement of >50% of the hand and wrist, total body
surface area involvement <30%, recent acute care discharge, and
List of abbreviations:
ADL activities of daily living
COPM Canadian Occupational Performance
Measure
DHI Duruoz Hand Index
JTHFT Jebsen-Taylor Hand Function Test
PHB pediatric hand burns
ROM range of motion
TOT task-oriented training
TR traditional rehabilitation
VR virtual reality
F.A.H. Kamel, M.A. Basha
spontaneous healing within 1 month or after 2 weeks of splitthickness or full-thickness skin graft. Individuals were excluded
from this study if they had infection, tendon injuries, muscle
injury, fracture, degenerative joint diseases, peripheral nerve diseases, juvenile arthritis, or pre-established psychological and
physical disorders (extreme aphasia, cognitive and developmental
deficits that can influence rehabilitation).
Randomization
We randomly allocated 50 patients with PHB into 1 of 3 groups:
the Xbox Kinect-based rehabilitation group (Xbox group)
(nZ17), TOT group (nZ16), or control group (nZ17).
Randomization was done using opaque, randomly-numbered envelopes. After baseline assessment, the individuals opened the
envelopes to determine their group placement. The randomization
was done by an independent physical therapist who was not
involved in this study at any stage.
Interventions
The TR program was carried out in 40-minute sessions 3 times
weekly for 8 weeks for all children in the 3 groups. TR included
immersion in paraffin, gentle massaging using moisturizing gel,
stretching exercises, ROM exercises, mobilizing techniques,
strength training (initially performed in static mode and advanced
dynamically in the fifth week by using elastic bands), desensitizing, and occupational therapy. In the home program parents and
children were taught how to splint/position themselves against
contractures, apply scar massage, exercise, use compression garments and inserts, and train themselves on their own.25
Baseline Canadian Occupational Performance Measure
(COPM) assessments were used to create personalized treatment
objectives for each child. Focusing on top-priority functional tasks
enabled the child to select the optimal motor strategies to achieve
functional requirements. We determined rehabilitation protocols
by considering the assessment outcomes and the child’s personality, roles, level of performance, and personal goals. An
individualized training protocol was developed after determining
the individual’s 5 most significant problems after activities
assessment and analysis. The Xbox and TOT groups conducted
on average 50-minute sessions 3 days a week for 8 weeks.
The TOT program involved the preparation of materials
required for the training, including exercise bands, coordination
tools, skill cubes, therapeutic putty, screw sets, Velcro cylinders,
buttons, clothes, rope, spoons, pencils, and so on. The training
progression took place by increasing the difficulty of tasks,
changing the number of repeats, increasing or decreasing activity
performance time, and modifying the materials being used (eg,
smooth/tough for resistive bands or therapeutic putty, picking up
objects of different sizes with Velcro cylinders, large/small buttons
for buttoning).
A physical therapist evaluated the Xbox games to detect
technical features that could have therapeutic uses, the conformity
of games according to the required activity, the pattern of movement required, and levels of complexity and transitions between
levels of complexity. We selected games for each child that related
to the 5 significant problems detected during the child-focused
analysis outcomes. During the training, the child was required to
copy the actions of the avatar on the screen. The closer the child’s
movements were to the fluency, position, and speed of the avatar’s
activity, the greater the child’s score. The Xbox Kinect games
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Rehabilitation of Pediatric Hand Burns
were then chosen based on the child’s performance level and the
rehabilitation plan designed under the guidance of a physiotherapist. Progression developed in the games through modifications
such as increased or decreased game time, increased focus on
endurance games, or the addition of more levels to increase difficulty.
1061
size was based on a pilot study of 5 individuals in each group.
Sample size calculation was conducted using G*POWER statistical software, version 3.1.9.2e and F test- MANOVA: Repeated
measures, within-between interaction.
Statistical analysis
Outcome measures
We conducted all measurements at baseline and after intervention
(after 8 weeks). The assessor, who was blinded to the treatment
allocation, collected the outcome measures. The primary outcome
measurements were the Jebsen-Taylor Hand Function Test
(JTHFT), Duruoz Hand Index (DHI), and COPM. Secondary
outcomes included total active ROM of the digits, grip strength,
and pinch strengths (tip, palmer, and lateral pinch).
The JTHFT is a standard and objective method designed to
measure the performance speed of standardized tests through 7
items reflecting different hand functions commonly used in daily
living activities. A slower time indicates a less desirable outcome,
with coefficients ranging from 0.6-0.99; this test is reliable and
valid. The test-retest reliability for the total time of both hands is
high (rZ0.97 and rZ0.98).26
DHI is an 18-item self-reported scale designed to evaluate
activity limitation of the hand in the kitchen, performing hygiene
or office activities, while dressing, and during other general activities. The children’s items were scored on a 6-point Likert scale.
The total scores ranged between 0-90, with a higher score indicating poor hand function.27
COPM is a personalized test intended to track variations in the
self-perception of a child’s occupational performance over time.
This is a commonly used measure applicable to all children with
perceived challenges in performing tasks of daily living in selfcare or social activity. The COPM includes 2 (performance and
satisfaction) scores of 10 each. The child is required to prioritize
up to 5 difficulties they find to be most significant or necessary
and rate their performance and satisfaction on a standard 10-point
scale. COPM is a valid, responsive, and reliable scale, and 1.9
improvements in score are considered clinically significant for
satisfaction and 1.4 for performance.28,29
Measurement of the total active ROM was carried out by a
hand-held steel finger goniometer.b During assessment, the evaluator requested the child flex every digit as much as he or she
could and assessed the overall active flexion. Next, extension
limitations were evaluated for zero-degree extension of the same
digits.30,31 For the statistical analysis, we used the data of each
digit’s total active ROM.
Hand grip strength was measured using a Jamar hydraulic
dynamometerc and pinch strengths (tip, palmer, and lateral pinch)
were assessed using a pinch dynamometer.d The assessment position was recommended by the American Society of Hand
Therapists. Each test was repeated 3 times with an interval of 30seconds between trials, and the mean value was documented
in kg.32
Sample size calculation
Sample size was calculated considering the difference in COPM
among the 3 groups to be 0.45 (effect size), significance levelZ0.05, and with 80% power. Sample size was calculated to be
17 individuals per group, with a 1:1:1 ratio. The presumed effect
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We carried out descriptive and analysis of variance tests to
compare the patients’ characteristics between groups. For comparison of categorical data sets between groups, the chi-square test
was used. The Shapiro-Wilk test was used to evaluate normal data
distribution, and Levene’s homogeneity test of variances was
performed to assess the homogeneity between groups. Mixed
model multivariate analysis of variance was conducted to compare
clinical outcomes within and between groups. For subsequent
multiple comparison, post hoc tests using the Bonferroni correction were implemented. The significance level was set to P<.05
for all statistical analyses. All statistical analyses were conducted
using SPSS version 22.f
Results
The patient flow diagram throughout the study is shown in
figure 1. Fifty children participated in this study and 4 children left
the intervention for various reasons and their measurements were
not included in the analysis. There were no significant differences
in the demographics and clinical characteristics of the children
(total body surface area, hospital stay, burn location, etiology of
burn) between the 3 groups at baseline evaluation
(P>.05) (Table 1).
Mixed design multivariate analysis was performed to evaluate
the difference between individuals in the 3 groups using the
amount of change in their scores on the outcome measures. Statistically significant multivariate effects were found for the
groups’ interventions, Wilk’s AZ0.16, F26,62Z3.64, P<.001,
ƞ2Z0.6; for time, Wilk’s AZ0.01, F13,31Z413.2, P<.001,
ƞ2Z0.99; and for the interaction between groups and time, Wilk’s
AZ0.01, F26,62Z22.75, P<.001, ƞ2Z0.91.
Eight-week univariate analysis of variances revealed significant change for JTHFT, F2,43Z25.18, P<.001, ƞ2Z0.54; for DHI,
F2,43Z62.61, P<.001, ƞ2Z0.74; for COPM performance,
F2,43Z16.93, P<.001, ƞ2Z0.44; for COPM satisfaction,
F2,43Z38.08, P<.001, ƞ2Z0.64; for thumb ROM, F2,43Z112.62,
P<.001, ƞ2Z0.84; for index ROM, F2,43Z52.87, P<.001,
ƞ2Z0.71; for middle finger ROM, F2,43Z34.02, P<.001,
ƞ2Z0.61; for ring finger ROM, F2,43Z43.68, P<.001, ƞ2Z0.67;
and for little finger ROM, F2,43 Z31.73, P<.001, ƞ2Z0.6; for grip
strength, F2,43 Z 68.0, P<.001, ƞ2Z0.76; for tip pinch strength,
F2,43 Z 97.49, P<.001, ƞ2Z0.82; for lateral pinch strength,
F2,43Z46.37, P<.001, ƞ2Z0.68; and for palmer pinch strength,
F2,43Z51.55, P<.001, ƞ2Z0.71.
Between-group comparison
There was no significant difference between the 3 groups in all
measurements preintervention (P>.05). However, there was a
significant increase in DHI, COPM satisfaction, and palmer pinch
strength in the Xbox group compared with the TOT group postintervention (P<.05); however, there was no significant change in
1062
F.A.H. Kamel, M.A. Basha
Fig 1
Patient flow diagram throughout the study.
JTHFT and COPM performance, ROM, grip strength, and tip and
lateral pinch strengths between the Xbox group and TOT group
(P>.05). In addition, there was a significant increase in all measurements of Xbox and TOT groups compared with that of the
control group postintervention (P<.05), as in tables 2 and 3.
Within-group comparison
There was a significant improvement in all measurements postintervention compared with baseline in the Xbox, TOT, and control groups (P<.001), with the exception being there was no
significant change in tip pinch strength in the control group
(PZ.06) (Table 4).
Discussion
Children differ from adults in their need for extra encouragement
strategies and rehabilitation programs because of their fear of
movement and often refusal to engage in rehabilitation programs
owing to pain, anxiety, and distress.24
The aim of this study was to investigate the impact of different
rehabilitation programs in PHB on hand function and activity
performance. The main results of the current study showed statistically significant differences between the Xbox and TOT
groups regarding DHI scores, COPM satisfaction, and palmer
pinch strength (P<.05), but no statistically significant differences
between the Xbox and TOT groups regarding JTHFT, activity
performance, ROM, grip strength, and tip and lateral pinch
strength (P>0.5). However, both the Xbox and TOT groups had
larger improvements than the control group in all outcomes.
Regarding within-group comparison, there were statistically significant differences after 8 weeks (P<.001) in all groups except for
tip pinch strength in the control group (P>0.5).
This study suggests that the similar improvements in several of
the outcome measures in the Xbox and TOT programs resulted
from many causes, including the 2 programs centered on identifying the 5 most significant problems in activities of daily living
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Rehabilitation of Pediatric Hand Burns
Table 1
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Baseline demographic characteristics of the 3 groups
Age (y)
Sex, n (%)
Female
Male
Weight (kg)
Height (cm)
Hand dominance, n (%)
Right
Left
TBSA (%)
Hospital stay (d)
Burn location, n (%)
Palmer
Dorsal
Circumference
Etiology of burn, n (%)
Flame
Scaled
Xbox Group (nZ17)
TOT Group (nZ16)
Control Group (nZ17)
Mean SD
Mean SD
Mean SD
P Value
10.561.98
10.281.4
11.241.41
.23
7 (41.18)
10 (58.82)
42.356.02
140.511.88
7 (43.75)
9 (56.25)
38.885.25
136.911.72
7 (41.18)
10 (58.82)
40.187.11
140.512.36
.99
13 (76.47)
4 (23.53)
22.353.59
34.654.46
13 (81.25)
3 (18.75)
24.562.66
37.52.61
13 (76.47)
4 (23.53)
23.883.82
35.822.86
.93
6 (35.3)
5 (29.4)
6 (35.3)
6 (37.5)
5 (31.3)
5 (31.3)
6 (35.3)
6 (35.3)
5 (29.4)
.99
7 (41.2)
10 (58.8)
6 (37.5)
10 (62.5)
7 (41.2)
10 (58.8)
0.97
.27
.62
.17
.07
NOTE. Data are mean SD unless otherwise stated. P values <.05 indicate statistical significance.
Abbreviation: TBSA, total body surface area.
(ADL) as an intervention plan by COPM; the child having an
active role in the program of rehabilitation vs TR; and the child
concentrating on enjoying the games instead of their involvement
in a treatment program, thereby decreasing pain and fear and
leading to higher activity performance.
The changes of DHI scores were statistically superior in the
Xbox group and may be demonstrated by increased strength of
the proximal muscles. One potential reason is that Xbox games
do not concentrate exclusively on the movement of fingers and
wrists but also involve repetitive movements aimed at the
proximal muscles, and proximal muscle stabilization is essential
for better performance in playing. Shoulder girdle stabilization
allows the force to transmit through the myofascial pathway for
optimal recruitment of the hand muscles33,34 and also gains in
pinch grip strength and handgrip strength.35 VR is supposed to
increase motor performance by encouraging brain plasticity and
brain reorganization via active engagement, feedback, and
movement repetition.36
The variation in COPM satisfaction after intervention has been
statistically significant in favor of the Xbox group, and this may be
attributed to Xbox trainings that are interactive, provide stimulation, immediate feedback, enhance engagement, and reward
accomplishments.15,16
To our knowledge, there are no studies comparing Xbox
Kinect-based VR and TOT for the rehabilitation of PHB;
however, there are a few studies that reported beneficial effects
of the Kinect-based VR in the rehabilitation of pediatric
burns.15,16 These studies reported that using the Xbox Kinect in
the treatment of upper limb burns is associated with a significant
decrease in pain and kinesiophobia, increased ROM and selfreported time spent exercising, greater satisfaction, and
improved function. In hand burn studies,9,37 one study reported
that, 8 weeks of interactive robot treatment in PHB resulted in
increased ROM, grip strength, and hand function.9 Joo et al
showed that 4 weeks of VR-based rehabilitation in adult burned
hand resulted in a significant increase in patient satisfaction,
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work, hand function, aesthetics, performance in ADL, and
decreased pain compared with TR.37
The TOT literature concentrates on patients with stroke and
patients with arthritis.19-22 These studies found that TOT resulted
in a significant increase in arm and hand function, participation in
ADL, exercise compliance, and the enjoyment of the participant in
participating and inspiring elements of TOT was demonstrated.
The results of this study are in agreement with studies that used
purposeful activities in patients with pediatric burns.10,38 Omar
et al reported increased ROM of finger digits, decreased pain,
more motivation and enjoyment, and improved functional activity
and performance of hands in ADL when patients with PHB
engaged in 3 weeks of purposeful exercises on the principle of
game playing rather than TR.10
Study limitations
Although the findings of this study are promising, there are other
limitations that should be addressed. First, we believe that Xbox
Kinect and TOT could increase children’s motivation and reduce the
avoidance of fear, yet we did not investigate children kinesiophobia
or motivation, which may affect adherence to treatment. Second,
absence of control over the home training may affect outcomes.
Third, the limited sample size compromises our findings’ accuracy.
Fourth, the fairly short follow-up duration did not determine whether
the changes will continue long term. Therefore, more trials are
needed to determine the long-term impact. Fifth, the children were
not blinded and were aware of the kind of therapy they received.
More trials that include hand rehabilitation are needed for
patients with fourth-degree burns with severe neuromuscular injuries. One of the most advantageous aspects of Xbox Kinect and
TOT for promoting physical activity and therapy is that they could
be played at home and are completely unaffected by difficulties
(ie, climate, availability, and transportation) that generally limit
involvement in other types of physical activity. More studies are
1064
Table 2
F.A.H. Kamel, M.A. Basha
Clinical characteristics of the 3 Groups at baseline and after 8 weeks of intervention
Characteristics
JTHFT (s)
Baseline
8-weeks
DHI
Baseline
8-weeks
COPM -performance
Baseline
8-weeks
COPM -satisfaction
Baseline
8-weeks
Thumb ROM (deg.)
Baseline
8-weeks
Index ROM (deg.)
Baseline
8-weeks
Middle ROM (deg.)
Baseline
8-weeks
Ring ROM (deg.)
Baseline
8-weeks
Little ROM (deg.)
Baseline
8-weeks
Grip strength (kg)
Baseline
8-weeks
Tip pinch (kg)
Baseline
8-weeks
Lateral pinch (kg)
Baseline
8-weeks
Palmer pinch (kg)
Baseline
8-weeks
Xbox Group (nZ17)
TOT Group (nZ14)
Control Group (nZ15)
F-Value
P Value
173.1814.7
131.5310.49
179.2115.1
139.4314.11
181.3313.19
158.2714.43
1.41
17.47
.26
.0001
35.356.24
13.473.53
37.077.7
20.797.45
40.04.98
31.076.03
2.15
37.18
.13
.0001
3.121.45
7.651.27
2.571.22
6.791.05
2.931.28
5.41.24
0.66
14.11
.52
.0001
2.241.03
8.181.01
2.070.62
6.211.25
2.330.98
4.531.30
37.77
0.16
.74
.0001
75.0616.92
105.0613.64
72.4314.12
98.7114.46
69.4714.72
80.413.84
0.53
13.12
.6
.0001
165.5313.89
187.5314.63
164.5713.68
185.010.81
162.818.81
170.017.25
0.12
6.52
.88
.003
166.2915.7
186.014.18
163.2916.17
185.3611.47
160.9318.64
170.1318.02
0.41
5.57
.67
.007
178.8215.4
195.8212.48
175.0713.89
194.2112.66
171.8717.01
178.9316.27
0.81
6.91
.45
.003
163.3517.71
182.5913.72
166.013.09
183.2912.93
159.3317.01
167.616.77
0.63
5.59
.54
.007
19.883.14
26.063.42
18.213.04
24.712.87
19.43.38
21.43.5
1.07
8.31
.35
.0008
1.570.27
2.560.36
1.510.33
2.760.41
1.650.27
1.750.27
0.85
34.28
0.43
.0001
3.180.38
4.190.3
3.050.27
3.990.32
3.090.34
3.410.31
0.63
26.65
.54
.0001
2.420.34
3.610.39
2.270.55
3.010.59
2.150.37
2.470.36
1.7
25.87
.019
.0001
NOTE. Data are mean SD. P values <.05 indicate statistical significance.
needed to investigate if Xbox Kinect and TOT will be beneficial
for training patients with PHB at home.
Conclusion
In conclusion, Xbox Kinect and TOT are interactive and enjoyable
training methods that may be clinically-effective rehabilitation tools
for functional treatment in patients with PHB, can be easily adapted to
changes in performance, and are reported to produce improvement in
hand function and activity performance and satisfaction in children
with hand burns.
c. Jamar Hydraulic Hand Dynamometer; Fabrication Enterprises Inc.
d. Jamar Pinch Gauge Dynamometer, model no. PG-30; B and L
Engineering.
e. G)POWER statistical software, version 3.1.9.2; HeinrichHeine-Universitat.
f. SPSS for Windows, version 22.0; IBM Corp.
Keywords
Burns; Rehabilitation; Virtual reality
Suppliers
Corresponding author
a. Xbox Kinect; Microsoft Corporation.
b. Baseline 1 Finger Goniometer; Fabrication Enterprises Inc.
Maged A. Basha, PhD, Department of Physical Therapy, El-Sahel
Teaching Hospital, General Organization for Teaching Hospitals
www.archives-pmr.org
Between-group effects of all outcome measures after 8 weeks of intervention.
Xbox vs TOT
Xbox vs Control
TOT vs Control
Outcomes
MD (99% CI)
P Value
MD (99% CI)
P Value
MD (99% CI)
P Value
Partial ƞ2
JTHFT (s)
DHI
COPM performance
COPM satisfaction
Thumb ROM (deg.)
Index ROM (deg.)
Middle ROM (deg.)
Ring ROM (deg.)
Little ROM (deg.)
Grip strength (kg)
Tip pinch (kg)
Lateral pinch (kg)
Palmer pinch (kg)
e7.9
e7.32
0.86
1.96
6.35
2.53
0.64
1.61
e0.7
1.35
e0.19
0.2
0.61
.3
.003
.16
.0001
.64
.99
.99
.99
.99
.79
.42
.11
.002
e26.7
e17.6
2.25
3.64
24.66
17.53
15.87
16.89
14.99
4.66
0.82
0.78
1.15
.0001
.0001
.0001
.0001
.0001
.004
.01
.004
.017
.0007
.0001
.0001
.0001
e18.8
e10.3
1.39
1.68
18.31
15.0
15.22
15.28
15.69
3.31
1.01
0.59
0.54
.001
.0001
.01
.001
.003
.02
.03
.01
.018
.03
.0001
.0001
.007
0.45
0.63
0.4
0.64
0.38
0.23
0.21
0.24
0.21
0.28
0.62
0.55
0.55
(e19.59, 3.79)
(e12.50, e2.13)
(e0.22, 1.94)
(0.9, 3.03)
(e6.21, 18.89)
(e10.56, 15.62)
(e12.70, 13.99)
(e10.87, 14.09)
(e13.79, 12.4)
(e1.61, 4.30)
(e0.51, 0.13)
(e0.08, 0.48)
(0.2, 1.01)
(e38.21, e15.27)
(e22.67, e12.50)
(1.19, 3.31)
(2.6, 4.69)
(12.34, 36.98)
(4.68, 0.38)
(2.77, 28.97)
(4.64, 29.14)
(2.14, 27.84)
(1.76, 7.56)
(0.51, 1.13)
(0.51, 1.06)
(0.75, 1.54)
(e30.87, e6.80)
(e15.62, e4.94)
(0.28, 2.5)
(0.58, 2.78)
(5.39, 31.24)
(1.53, 28.48)
(1.48, 28.97)
(2.43, 28.13)
(2.20, 29.17)
(0.27, 6.36)
(0.68, 1.14)
(0.3, 0.87)
(0.12, 0.96)
Rehabilitation of Pediatric Hand Burns
www.archives-pmr.org
Table 3
NOTE. P values <.05 indicate statistical significance.
Abbreviations: CI, confidence interval; deg., degrees; MD, mean difference; ƞ2, eta squared.
Table 4
Within-group changes for all outcome measures from baseline to 8 weeks of intervention
JTHFT(s)
DHI
COPM performance
COPM satisfaction
Thumb ROM (deg.)
Index ROM (deg.)
Middle ROM (deg.)
Ring ROM (deg.)
Little ROM (deg.)
Grip strength (kg)
Tip pinch (kg)
Lateral pinch (kg)
Palmer pinch (kg)
Xbox Group (nZ17)
TOT Group (nZ14)
Control Group (nZ15)
Change From Baseline to 8 wks
Change From Baseline to 8 wks
Change From Baseline to 8 wks
MD (99% CI)
P Value
MD (99% CI)
P Value
MD (99% CI)
P Value
41.65
21.88
e4.53
e5.94
e30.0
e22.0
e19.71
e17.0
e19.25
e6.18
e0.99
e1.01
e1.19
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
39.79
16.29
e4.21
e4.14
e26.29
e20.43
e22.07
e19.14
e17.29
e6.5
e1.24
e0.94
e0.74
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
23.07
9.93
e2.47
e2.2
e10.93
e7.2
e9.2
e7.07
e8.27
e2.0
e0.09
e0.31
e0.32
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.0001
.06
.0001
.0001
(37.74, 45.55)
(20.28, 23.48)
(e5.05, e4.01)
(e6.53, e5.35)
(e31.83, e28.17)
(e24.14, e19.86)
(e21.92, e17.49)
(e18.84, e15.16)
(e21.23, e17.24)
(e6.75, e5.6)
(e1.11, e0.88)
(e1.11, e0.9)
(e1.31, e1.07)
(18.91, 27.22)
(7.23, 10.64)
(e3.02, e1.92)
(e2.83, e1.57)
(e12.89, e8.98)
(e9.48, e4.92)
(e11.56, e6.84)
(e9.03, e5.11)
(e10.39, e6.14)
(e2.62, e1.39)
(e0.22, e0.03)
(e0.43, e0.2)
(e0.45, e0.19)
1065
NOTE. P values <.05 indicate statistical significance.
Abbreviations: CI, confidence interval; deg., degrees; MD, mean difference.
(35.48, 44.09)
(14.52, 18.05)
(e4.79, e3.64)
(e4.8, e3.49)
(e28.32, e24.27)
(e22.79, e18.07)
(e24.51, e19.63)
(e21.17, e17.12)
(e19.49, e15.09)
(e7.14, e5.86)
(e1.37, e1.12)
(e1.06, e0.82)
(e0.87, e0.61)
1066
and Institutes, 2 Youssef Karam St., Borham, Elsahel, Cairo
Governorate 11697, Cairo, Egypt. E-mail addresses:
bashamaged@gmail.com and M.Basha@qu.edu.sa.
Acknowledgment
We thank Shady A. Basha, MSc, PT for assisting with data
collection and performing the randomization.
F.A.H. Kamel, M.A. Basha
20.
21.
22.
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