AAHS - Enhancing Patient Compliance Through Immersive Play: Investigating the Dual Analgesic and Motivational Role of AR Rhythm Games in Hand Therapy

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Enhancing Patient Compliance Through Immersive Play: Investigating the Dual Analgesic and Motivational Role of AR Rhythm Games in Hand Therapy
Regina WK Leung, MD, MHSc, B.Eng^¹, Steven Wang, B.Eng^²; Douglas Ross, MD, MEd^³
(¹)University of Western Ontario, Schulich School of Medicine, London, ON, Canada, (²)Western University, London, ON, Canada, (³)Plastic and Reconstructive Surgery, St. Joseph's Health Care Center, Western University, London, ON, Canada

Introduction

For the majority of hand surgery patients, dedicated hand therapy is a cornerstone of successful recovery playing a pivotal role in maximizing functional outcomes. However, studies demonstrate that up to 60% of patients fail to complete their prescribed hand therapy programs independently at home, often due to pain and lack of motivation, resulting in suboptimal outcomes. To address this critical compliance challenge, we drew on proven strategies from other fields: gaming to enhance motivation, music to reduce anxiety, and augmented/virtual reality (AR/VR) to distract from pain. The result is HoloRehab - development of an AR rhythm-based game that transforms conventional hand therapy into an interactive immersive experience where patients perform targeted hand exercises in sync with music. We hypothesize that HoloRehab can be an effective hand therapy modality by alleviating pain/discomfort and boost user motivation with the goal of improving patient hand therapy compliance and outcomes.

Methods

A randomized controlled pilot study was conducted with 20 healthy participants allocated to two groups: HoloRehab intervention (n=10) and traditional self-guided control (n=10) where each group performed the same repeating sequence of hand therapy exercises. Two experiments were completed to assess analgesic and motivational effects. Experiment 1 evaluated pain threshold by immersing participants' dominant hand in ice water (4-6°C) while the non-dominant hand completed exercises, measuring time to withdrawal as the primary outcome. Experiment 2 assessed fatigue/motivation threshold where participants completed exercises with resistance bands with time to fatigue as the primary outcome. Qualitative feedback on overall user engagement and experience was obtained.

Results

HoloRehab demonstrated significant analgesic effects in Experiment 1, with participants lasting significantly longer than controls (mean time to withdrawal: 6.94 vs 3.107 minutes, p=0.05; median: 6.44 vs 1.06 minutes, p=0.004). In Experiment 2, HoloRehab participants showed improved endurance, lasting longer than controls (mean: 8.29 vs 5.99 minutes, p=0.19; median: 8.4 vs 5.40 minutes, p=0.07). Qualitative analysis revealed that HoloRehab users were significantly more likely to forget they were exercising (3.6 vs 2.5, p=0.045), indicating enhanced engagement and distraction from exercise burden.

Conclusion

HoloRehab successfully integrates gaming, music, and AR immersion to create a promising new therapeutic modality for hand therapy. The significant improvements in pain tolerance and exercise endurance with enhanced user engagement suggest strong potential for improving patient compliance in hand therapy programs. These encouraging preliminary results support further application development and validation studies to optimize this innovative approach for clinical implementation in hand surgery recovery protocols.

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