Video Game-Based Electromyographic Biofeedback Interventions in Patients With Knee Osteoarthritis: A Clinical Trial

Introduction: Exercise is considered the most effective, non-drug treatment for reducing pain and improving movement in patients with knee osteoarthritis (OA). The current study aimed to compare the efficacy of incorporating a Knee Biofeedback Rehabilitation Game for Osteoarthritis Therapy (KneeBRIGHT) (Barron Associates, Inc., Charlottesville, VA, USA) device into a 10-week rehabilitation course in patients diagnosed with knee OA. Methods: This clinical trial used a parallel, prospective, single-blind, randomized controlled design. Participants were randomly allocated to the KneeBRIGHT (n = 17) or the control (n = 17) group. Quadriceps muscle strength, perceived knee function using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) scale, and balance were measured prior to and immediately following the rehabilitation program. The KneeBRIGHT group did exercises using the electromyography (EMG)-based video games, while the control group performed the same traditional exercises without the video games. All patients attended a combination of in-clinic and home-based interventions for 10 weeks. Participants were interviewed at the end of the study. Results: Thirty-four patients participated in the study. The KneeBRIGHT group showed an improvement in KOOS quality of life (QOL) (p = 0.002), while the control group demonstrated improvements in KOOS symptoms (p < 0.001), pain (p = 0.009), activities of daily living (ADL; p = 0.005), KOOS sports (p = 0.002), and KOOS QOL (p = 0.016) compared to the baseline. No differences in quadriceps strength were found. The key themes from the interviews indicated that the KneeBRIGHT games are motivating and are an effective alternative to regular exercises. Conclusions: Patients exhibited improvements in perceived knee function and exhibited increased quadriceps strength using KneeBRIGHT games compared to traditional rehabilitation exercises. Playing video games may help maintain patient motivation and can be done at home independently, effectively reinforcing the therapeutic effect of exercises.