University of Oulu

Aartolahti E, Janhunen M, Katajapuu N, Paloneva J, Pamilo K, Oksanen A, Keemu H, Karvonen M, Luimula M, Korpelainen R, Jämsä T, Mäkelä K, Heinonen A. Effectiveness of Gamification in Knee Replacement Rehabilitation: Protocol for a Randomized Controlled Trial With a Qualitative Approach, JMIR Res Protoc 2022;11(11):e38434,

Effectiveness of gamification in knee replacement rehabilitation : protocol for a randomized controlled trial with a qualitative approach

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Author: Aartolahti, Eeva1; Janhunen, Maarit2; Katajapuu, Niina3;
Organizations: 1Institute of Rehabilitation, JAMK University of Applied Sciences, Jyväskylä, Finland
2Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
3Faculty of Health and Well-being, Turku University of Applied Sciences, Turku, Finland
4Department of Surgery, Central Finland Healthcare District and University of Eastern Finland, Jyväskylä, Finland
5Department of Orthopedics, Coxa Hospital for Joint Replacement, Tampere, Finland
6Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
7Faculty of Business and Engineering, Turku University of Applied Sciences, Turku, Finland
8Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland
9Research Unit of Population Health, University of Oulu, Oulu, Finland
10Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
11Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: JMIR Publications, 2022
Publish Date: 2023-06-28


Background: Exergames can provide encouraging exercise options. Currently, there is limited evidence regarding home-based exergaming in the postoperative phase of total knee replacement (TKR).

Objective: This study aimed to investigate the effects of a 4-month postoperative home-based exergame intervention with an 8-month follow-up on physical function and symptoms among older persons undergoing TKR compared with home exercise using a standard protocol. In addition, a concurrent embedded design of a mixed methods study was used by including a qualitative component within a quantitative study of exergame effects.

Methods: This was a dual-center, nonblinded, two-arm, parallel group randomized controlled trial with an embedded qualitative approach. This study aimed to recruit 100 patients who underwent their first unilateral TKR (aged 60–75 years). Participants were randomized to the exergame or standard home exercise arms. Participants followed a custom-made exergame program independently at their homes daily for 4 months. The primary outcomes at 4 months were function and pain related to the knee using the Oxford Knee Score questionnaire and mobility using the Timed Up and Go test. Other outcomes, in addition to physical function, symptoms, and disability, were game user experience, exercise adherence, physical activity, and satisfaction with the operated knee. Assessments were performed at the preoperative baseline and at 2, 4, and 12 months postoperatively. Exergame adherence was followed from game computers and using a structured diary. Self-reported standard exercise was followed for 4 months of intervention and physical activity was followed for 12 months using a structured diary. Qualitative data on patients’ perspectives on rehabilitation and exergames were collected through laddering interviews at 4 and 12 months.

Results: This study was funded in 2018. Data collection began in 2019 and was completed in January 2022. The COVID-19 pandemic caused an unavoidable situation in the study for recruitment, data collection, and statistical analysis. As of November 2020, a total of 52 participants had been enrolled in the study. Primary results are expected to be published by the end of 2022.

Conclusions: Our study provides new knowledge on the effects of postoperative exergame intervention among older patients with TKR. In addition, this study provides a new understanding of gamified postoperative rehabilitation, home exercise adherence, physical function, and physical activity among older adults undergoing TKR.

Trial Registration: NCT03717727;

International Registered Report Identifier (IRRID): RR1-10.2196/38434

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Series: JMIR research protocols
ISSN: 1929-0748
ISSN-E: 1929-0748
ISSN-L: 1929-0748
Volume: 11
Issue: 11
Article number: e38434
DOI: 10.2196/38434
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This study received financial support from the Päivikki and Sakari Sohlberg Foundation; Business Finland (grants: 5794/31/2016, 5941/31/2016, and 6057/31/2016); and Finnish partner companies (SE Innovations Oy [Senior Some Oy], Suunto Oy, PhysioTools Oy, GoodLife Technology Oy, Lingsoft Oy, eSeteli Palveluverkko Oy, PN Turku Oy, Ade Animations Design & Effects Oy, Adesante Oy, 4FeetUnder, Intechso, and Realmax Oy).
Copyright information: ©Eeva Aartolahti, Maarit Janhunen, Niina Katajapuu, Juha Paloneva, Konsta Pamilo, Airi Oksanen, Hannes Keemu, Mikko Karvonen, Mika Luimula, Raija Korpelainen, Timo Jämsä, Keijo Mäkelä, Ari Heinonen. Originally published in JMIR Research Protocols (, 28.11.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.