The Effect of Telerehabilitation-Based Structured Exercise Program on Posture, Pain, Fine Motor Skill, Hand Reaction, and Handgrip Strength in Adults with Video Game-Addiction: A Randomized Controlled Trial
Year 2024,
Issue: 24, 1004 - 1018, 30.12.2024
Hikmet Uçgun
,
Kaan Taha Çekiç
,
Özlem Aygün
,
Doğa Nur Erkek
,
Fetihan Mete
Beyzanur Korkutata
,
Onur Barış Ukil
,
Erdem Can Türkcan
Abstract
Aim: Playing video-games is characterized by a sedentary lifestyle and may cause many musculoskeletal problems. This study aimed to investigate the effect of telerehabilitation-based structured exercise program in adults with video-game addiction.
Method: Forty-four adults with video-game addiction were included in the study. The participants were randomly divided into experimental group (EG, n=22) and control group (CG, n=22). A telerehabilitation-based structured exercise program was given to EG and a brochure-based exercise program was given to CG. Both groups performed the exercises three days a week for 8-weeks. Posture, pain, fine motor skill, hand reaction, and handgrip strength were assessed before and after program.
Results: Both the EG and CG achieved significant improvements in enhancing posture and hand reaction and reducing pain (p<0.05). The improvements in hand reaction and pain were higher in the EG (p<0.05). The handgrip strength significantly increased only in the EG (p=0.014). Both the EG and CG failed to improve fine motor skill (p>0.05).
Conclusion: The present findings showed that a structured exercise program was effective in improving posture, pain, and hand reaction, but the telerehabilitation-based method was superior to the brochure-based method in improving pain and hand reaction. Furthermore, only the telerehabilitation-based exercise program was found to be successful in improving handgrip strength.
References
- 1. Wittek CT, Finserås TR, Pallesen S, et al. Prevalence and predictors of video game addiction: a study based on a national representative sample of gamers. Int J Ment Health Addict. 2016;14(5):672-686.
- 2. Limone P, Ragni B, Toto GA. The epidemiology and effects of video game addiction: A systematic review and meta-analysis. Acta Psychol (Amst). 2023;241:104047.
- 3. Saunders JB, Hao W, Long J, et al. Gaming disorder: Its delineation as an important condition for diagnosis, management, and prevention. J Behav Addict. 2017;6(3):271-279.
- 4. Satish Kumar CR, Sharma MK, Amudhan S, et al. Digital gaming, musculoskeletal, and related health hazards among adolescents and young adults. Indian J Psychiatry. 2023;65(6):698-700.
- 5. Tremblay MS, Aubert S, Barnes JD, et al. Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act. 2017;14(1):75.
- 6. Borecki L, Tolstych K, Pokorski M. Computer games and fine motor skills. Adv Exp Med Biol. 2013;755:343-348.
- 7. Jalink MB, Heineman E, Pierie JP, ten Cate Hoedemaker HO. Nintendo related injuries and other problems: review. BMJ. 2014;349:g7267.
- 8. Weinstein AM. Computer and video game addiction a comparison between game users and non-game users. The American Journal of Drug and Alcohol Abuse. 2010;36(5):268-276.
- 9. Zronek M, Sanker H, Newcomb J, Donaldson M. The influence of home exercise programs for patients with non-specific or specific neck pain: a systematic review of the literature. J Man Manip Ther. 2016;24(2):62-73.
- 10. Bachmann C, Oesch P, Bachmann S. Recommendations for improving adherence to home-based exercise: a systematic review. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 2018;28(01):20-31.
- 11. Cottrell MA, Galea OA, O'Leary SP, et al. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil. 2017;31(5):625-638.
- 12. Chen Y, Lu J, Wang L, Gao X. Effective interventions for gaming disorder: A systematic review of randomized control trials. Front Psychiatry. 2023;14:1098922.
- 13. Maden Ç, Bayramlar K, Arıcak OT, Yagli NV. Effects of virtual Reality-Based Training and aerobic training on gaming disorder, physical activity, physical fitness, and anxiety: A randomized, controlled trial. Mental Health and Physical Activity. 2022;23:100465.
- 14. Mumcu HE, Yazici ÖF, Yilmaz O. Effect of 12-week recreational activity program on digital game addiction and peer relationships qualities in children. Acta Medica. 2021;37:2919.
- 15. Danielsen PA, Mentzoni RA, Låg T. Treatment effects of therapeutic interventions for gaming disorder: A systematic review and meta-analysis. Addict Behav. 2023;149:107887.
- 16. Saglam M, Arikan H, Savci S, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;111(1):278-284.
- 17. Wong U, Hodgins DC. Development of the game addiction inventory for adults (GAIA). Addiction Research & Theory. 2014;22(3):195-209.
- 18. BodyZone. PostureZone. https://bodyzone.com/posturezone/. Published 2017. Accessed 25 August 2024.
- 19. Pausić J, Pedisić Z, Dizdar D. Reliability of a photographic method for assessing standing posture of elementary school students. J Manipulative Physiol Ther. 2010;33(6):425-431.
- 20. Boland DM, Neufeld EV, Ruddell J, et al. Inter- and intra-rater agreement of static posture analysis using a mobile application. J Phys Ther Sci. 2016;28(12):3398-3402.
- 21. Huskisson EC. Measurement of pain. Lancet. 1974;2(7889):1127-1131.
- 22. Oxford Grice K, Vogel KA, Le V, et al. Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. Am J Occup Ther. 2003;57(5):570-573.
- 23. Nelson RJ, McCandlish CA, Douglas VD. Reaction times for hand movements made in response to visual versus vibratory cues. Somatosens Mot Res. 1990;7(3):337-352.
- 24. Ángel Latorre-Roman P, Robles-Fuentes A, García-Pinillos F, Salas-Sánchez J. Reaction times of preschool children on the ruler drop test: a cross-sectional study with reference values. Percept Mot Skills. 2018;125(5):866-878.
- 25. Hillman TE, Nunes QM, Hornby ST, et al. A practical posture for hand grip dynamometry in the clinical setting. Clin Nutr. 2005;24(2):224-228.
- 26. Rantanen T, Guralnik JM, Foley D, et al. Midlife hand grip strength as a predictor of old age disability. JAMA. 1999;281(6):558-560.
- 27. Hess JA, Hecker S. Stretching at work for injury prevention: issues, evidence, and recommendations. Appl Occup Environ Hyg. 2003;18(5):331-338.
- 28. Thompson PD, Arena R, Riebe D, Pescatello LS. ACSM's new preparticipation health screening recommendations from ACSM's guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep. 2013;12(4):215-217.
- 29. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-191.
- 30. Tunwattanapong P, Kongkasuwan R, Kuptniratsaikul V. The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial. Clin Rehabil. 2016;30(1):64-72.
- 31. Lam WK, Liu RT, Chen B, et al. Health risks and musculoskeletal problems of elite mobile esports players: a cross-sectional descriptive study. Sports Med Open. 2022;8(1):65.
- 32. Kim H. Exercise rehabilitation for smartphone addiction. J Exerc Rehabil. 2013;9(6):500-505.
- 33. Bayattork M, Sköld MB, Sundstrup E, Andersen LL. Exercise interventions to improve postural malalignments in head, neck, and trunk among adolescents, adults, and older people: systematic review of randomized controlled trials. J Exerc Rehabil. 2020;16(1):36-48.
- 34. Harman K, Hubley-Kozey CL, Butler H. Effectiveness of an exercise program to improve forward head posture in normal adults: a randomized, controlled 10-week trial. Journal of Manual & Manipulative Therapy. 2005;13(3):163-176.
- 35. Proskura P, Rutkowska-Kucharska A, Sobera M. Evaluation of the effects of a novel exercise program in the treatment of low back pain in women working in a seated position: A randomized trial. J Back Musculoskelet Rehabil. 2023;36(4):845-859.
- 36. Palanichamy T, Sharma MK, Sahu M, Kanchana DM. Influence of Esports on stress: A systematic review. Ind Psychiatry J. 2020;29(2):191-199.
- 37. Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014;155(12):2545-2550.
- 38. Özel M, Kaya Ciddi P. The effectiveness of telerehabilitation-based structured exercise therapy for chronic nonspecific neck pain: A randomized controlled trial. J Telemed Telecare. 2022:1357633x221095782.
- 39. Özden F, Özkeskin M, Tümtürk İ, Yalın Kılınç C. The effect of exercise and education combination via telerehabilitation in patients with chronic neck pain: A randomized controlled trial. Int J Med Inform. 2023;180:105281.
- 40. Özlü A, Ünver G, Tuna H, Erdoğan A. Effects of interactive telerehabilitation practices in office workers with chronic nonspecific neck pain: randomized controlled study. Telemed JE Health. 2024;30(2):438-447.
- 41. Abadiyan F, Hadadnezhad M, Khosrokiani Z, et al. Adding a smartphone app to global postural re-education to improve neck pain, posture, quality of life, and endurance in people with nonspecific neck pain: a randomized controlled trial. Trials. 2021;22(1):274.
- 42. Jiang C, Kundu A, Claypool M. Game Player Response Times versus Task Dexterity and Decision Complexity. In: Extended Abstracts of the 2020 Annual Symposium on Computer-Human Interaction in Play. 2020:277-281.
- 43. Kowal M, Toth AJ, Exton C, Campbell MJ. Different cognitive abilities displayed by action video gamers and non-gamers. Computers in Human Behavior. 2018;88:255-262.
- 44. Klasnja A, Milenovic N, Lukac S, et al. The effects of regular physical activity and playing video games on reaction time in adolescents. Int J Environ Res Public Health. 2022;19(15): 9278.
- 45. McNulty C, Jenny SE, Leis O, et al. Physical exercise and performance in esports players: an initial systematic review. Journal of Electronic Gaming and Esports. 2023;1(1):1-11.
- 46. Brorsson S, Nilsdotter A, Thorstensson C, Bremander A. Differences in muscle activity during hand-dexterity tasks between women with arthritis and a healthy reference group. BMC Musculoskelet Disord. 2014;15:154.
- 47. Knatauskaitė J, Pukėnas K, Trinkūnienė L, Budde H. Effects of different types of exercise training on fine motor skills and testosterone concentration in adolescents: a cluster randomized controlled trial. Int J Environ Res Public Health. 2021;18(16): 8243.
- 48. James S, Conrad M, Sengupta S. Development of an innovative telerehabilitation system to improve handgrip strength. Int J Telerehabil. 2022;14(2):e6497.
- 49. Turan Z, Topaloglu M, Ozyemisci Taskiran O. Is tele-rehabilitation superior to home exercise program in COVID-19 survivors following discharge from intensive care unit? - A study protocol of a randomized controlled trial. Physiother Res Int. 2021;26(4):e1920.
- 50. Kenis-Coskun O, Imamoglu S, Karamancioglu B, et al. Comparison of telerehabilitation versus home-based video exercise in patients with Duchenne muscular dystrophy: a single-blind randomized study. Acta Neurol Belg. 2022;122(5):1269-1280.
- 51. Suero-Pineda A, Oliva-Pascual-Vaca Á, Durán MR, et al. Effectiveness of a telerehabilitation tablet app in combination with face-to-face physiotherapy for people with wrist, hand or finger injuries: A pragmatic multicentre clinical trial. J Telemed Telecare. 2023:1357633x231172245.
- 52. Costa F, Janela D, Molinos M, et al. Impacts of digital care programs for musculoskeletal conditions on depression and work productivity: longitudinal cohort study. J Med Internet Res. 2022;24(7):e38942.
Video Oyunu Bağımlılığı Olan Yetişkinlerde Telerehabilitasyon Tabanlı Yapılandırılmış Egzersiz Programının Postür, Ağrı, İnce Motor Beceri, El Reaksiyonu ve El Kavrama Kuvveti Üzerine Etkisi: Randomize Kontrollü Bir Çalışma
Year 2024,
Issue: 24, 1004 - 1018, 30.12.2024
Hikmet Uçgun
,
Kaan Taha Çekiç
,
Özlem Aygün
,
Doğa Nur Erkek
,
Fetihan Mete
Beyzanur Korkutata
,
Onur Barış Ukil
,
Erdem Can Türkcan
Abstract
Amaç: Video oyunları oynamak hareketsiz bir yaşam tarzıyla karakterizedir ve birçok kas-iskelet sistemi sorununa neden olabilir. Bu çalışma, video oyunu bağımlılığı olan yetişkinlerde telerehabilitasyon tabanlı yapılandırılmış egzersiz programının etkisini araştırmayı amaçlamıştır.
Yöntem: Çalışmaya 44 video oyunu bağımlılığı olan yetişkin dahil edildilmiştir. Katılımcılar rastgele deney grubu (DG, n=22) ve kontrol grubu (KG, n=22) olarak ayrıldı. DG'ye telerehabilitasyon tabanlı yapılandırılmış bir egzersiz programı ve KG'ye broşür tabanlı bir egzersiz programı verilmiştir. Her iki grup da egzersizleri haftada üç gün, 8 hafta boyunca yapmıştır. Postür, ağrı, ince motor becerisi, el reaksiyonu ve el kavrama gücü programdan önce ve sonra değerlendirilmiştir.
Bulgular: Hem DG hem de KG, postür ve el reaksiyonunu iyileştirmede ve ağrıyı azaltmada önemli gelişmeler elde etmiştir (p<0.05). El reaksiyonu ve ağrıdaki gelişmeler DG'de daha yüksekti (p<0,05). El kavrama gücü yalnızca DG'de önemli ölçüde artmıştır (p=0,014). Hem DG hem de KG ince motor becerilerini geliştirmede başarısız olmuştur (p>0,05).
Sonuç: Mevcut bulgular, yapılandırılmış bir egzersiz programının postürü, ağrıyı ve el reaksiyonunu iyileştirmede etkili olduğunu, ancak telerehabilitasyon tabanlı yöntemin ağrıyı ve el reaksiyonunu iyileştirmede broşür tabanlı yöntemden üstün olduğunu göstermiştir. Dahası, yalnızca telerehabilitasyon tabanlı egzersiz programının el kavrama gücünü iyileştirmede başarılı olduğu bulunmuştur.
References
- 1. Wittek CT, Finserås TR, Pallesen S, et al. Prevalence and predictors of video game addiction: a study based on a national representative sample of gamers. Int J Ment Health Addict. 2016;14(5):672-686.
- 2. Limone P, Ragni B, Toto GA. The epidemiology and effects of video game addiction: A systematic review and meta-analysis. Acta Psychol (Amst). 2023;241:104047.
- 3. Saunders JB, Hao W, Long J, et al. Gaming disorder: Its delineation as an important condition for diagnosis, management, and prevention. J Behav Addict. 2017;6(3):271-279.
- 4. Satish Kumar CR, Sharma MK, Amudhan S, et al. Digital gaming, musculoskeletal, and related health hazards among adolescents and young adults. Indian J Psychiatry. 2023;65(6):698-700.
- 5. Tremblay MS, Aubert S, Barnes JD, et al. Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act. 2017;14(1):75.
- 6. Borecki L, Tolstych K, Pokorski M. Computer games and fine motor skills. Adv Exp Med Biol. 2013;755:343-348.
- 7. Jalink MB, Heineman E, Pierie JP, ten Cate Hoedemaker HO. Nintendo related injuries and other problems: review. BMJ. 2014;349:g7267.
- 8. Weinstein AM. Computer and video game addiction a comparison between game users and non-game users. The American Journal of Drug and Alcohol Abuse. 2010;36(5):268-276.
- 9. Zronek M, Sanker H, Newcomb J, Donaldson M. The influence of home exercise programs for patients with non-specific or specific neck pain: a systematic review of the literature. J Man Manip Ther. 2016;24(2):62-73.
- 10. Bachmann C, Oesch P, Bachmann S. Recommendations for improving adherence to home-based exercise: a systematic review. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 2018;28(01):20-31.
- 11. Cottrell MA, Galea OA, O'Leary SP, et al. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil. 2017;31(5):625-638.
- 12. Chen Y, Lu J, Wang L, Gao X. Effective interventions for gaming disorder: A systematic review of randomized control trials. Front Psychiatry. 2023;14:1098922.
- 13. Maden Ç, Bayramlar K, Arıcak OT, Yagli NV. Effects of virtual Reality-Based Training and aerobic training on gaming disorder, physical activity, physical fitness, and anxiety: A randomized, controlled trial. Mental Health and Physical Activity. 2022;23:100465.
- 14. Mumcu HE, Yazici ÖF, Yilmaz O. Effect of 12-week recreational activity program on digital game addiction and peer relationships qualities in children. Acta Medica. 2021;37:2919.
- 15. Danielsen PA, Mentzoni RA, Låg T. Treatment effects of therapeutic interventions for gaming disorder: A systematic review and meta-analysis. Addict Behav. 2023;149:107887.
- 16. Saglam M, Arikan H, Savci S, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;111(1):278-284.
- 17. Wong U, Hodgins DC. Development of the game addiction inventory for adults (GAIA). Addiction Research & Theory. 2014;22(3):195-209.
- 18. BodyZone. PostureZone. https://bodyzone.com/posturezone/. Published 2017. Accessed 25 August 2024.
- 19. Pausić J, Pedisić Z, Dizdar D. Reliability of a photographic method for assessing standing posture of elementary school students. J Manipulative Physiol Ther. 2010;33(6):425-431.
- 20. Boland DM, Neufeld EV, Ruddell J, et al. Inter- and intra-rater agreement of static posture analysis using a mobile application. J Phys Ther Sci. 2016;28(12):3398-3402.
- 21. Huskisson EC. Measurement of pain. Lancet. 1974;2(7889):1127-1131.
- 22. Oxford Grice K, Vogel KA, Le V, et al. Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. Am J Occup Ther. 2003;57(5):570-573.
- 23. Nelson RJ, McCandlish CA, Douglas VD. Reaction times for hand movements made in response to visual versus vibratory cues. Somatosens Mot Res. 1990;7(3):337-352.
- 24. Ángel Latorre-Roman P, Robles-Fuentes A, García-Pinillos F, Salas-Sánchez J. Reaction times of preschool children on the ruler drop test: a cross-sectional study with reference values. Percept Mot Skills. 2018;125(5):866-878.
- 25. Hillman TE, Nunes QM, Hornby ST, et al. A practical posture for hand grip dynamometry in the clinical setting. Clin Nutr. 2005;24(2):224-228.
- 26. Rantanen T, Guralnik JM, Foley D, et al. Midlife hand grip strength as a predictor of old age disability. JAMA. 1999;281(6):558-560.
- 27. Hess JA, Hecker S. Stretching at work for injury prevention: issues, evidence, and recommendations. Appl Occup Environ Hyg. 2003;18(5):331-338.
- 28. Thompson PD, Arena R, Riebe D, Pescatello LS. ACSM's new preparticipation health screening recommendations from ACSM's guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep. 2013;12(4):215-217.
- 29. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-191.
- 30. Tunwattanapong P, Kongkasuwan R, Kuptniratsaikul V. The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial. Clin Rehabil. 2016;30(1):64-72.
- 31. Lam WK, Liu RT, Chen B, et al. Health risks and musculoskeletal problems of elite mobile esports players: a cross-sectional descriptive study. Sports Med Open. 2022;8(1):65.
- 32. Kim H. Exercise rehabilitation for smartphone addiction. J Exerc Rehabil. 2013;9(6):500-505.
- 33. Bayattork M, Sköld MB, Sundstrup E, Andersen LL. Exercise interventions to improve postural malalignments in head, neck, and trunk among adolescents, adults, and older people: systematic review of randomized controlled trials. J Exerc Rehabil. 2020;16(1):36-48.
- 34. Harman K, Hubley-Kozey CL, Butler H. Effectiveness of an exercise program to improve forward head posture in normal adults: a randomized, controlled 10-week trial. Journal of Manual & Manipulative Therapy. 2005;13(3):163-176.
- 35. Proskura P, Rutkowska-Kucharska A, Sobera M. Evaluation of the effects of a novel exercise program in the treatment of low back pain in women working in a seated position: A randomized trial. J Back Musculoskelet Rehabil. 2023;36(4):845-859.
- 36. Palanichamy T, Sharma MK, Sahu M, Kanchana DM. Influence of Esports on stress: A systematic review. Ind Psychiatry J. 2020;29(2):191-199.
- 37. Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014;155(12):2545-2550.
- 38. Özel M, Kaya Ciddi P. The effectiveness of telerehabilitation-based structured exercise therapy for chronic nonspecific neck pain: A randomized controlled trial. J Telemed Telecare. 2022:1357633x221095782.
- 39. Özden F, Özkeskin M, Tümtürk İ, Yalın Kılınç C. The effect of exercise and education combination via telerehabilitation in patients with chronic neck pain: A randomized controlled trial. Int J Med Inform. 2023;180:105281.
- 40. Özlü A, Ünver G, Tuna H, Erdoğan A. Effects of interactive telerehabilitation practices in office workers with chronic nonspecific neck pain: randomized controlled study. Telemed JE Health. 2024;30(2):438-447.
- 41. Abadiyan F, Hadadnezhad M, Khosrokiani Z, et al. Adding a smartphone app to global postural re-education to improve neck pain, posture, quality of life, and endurance in people with nonspecific neck pain: a randomized controlled trial. Trials. 2021;22(1):274.
- 42. Jiang C, Kundu A, Claypool M. Game Player Response Times versus Task Dexterity and Decision Complexity. In: Extended Abstracts of the 2020 Annual Symposium on Computer-Human Interaction in Play. 2020:277-281.
- 43. Kowal M, Toth AJ, Exton C, Campbell MJ. Different cognitive abilities displayed by action video gamers and non-gamers. Computers in Human Behavior. 2018;88:255-262.
- 44. Klasnja A, Milenovic N, Lukac S, et al. The effects of regular physical activity and playing video games on reaction time in adolescents. Int J Environ Res Public Health. 2022;19(15): 9278.
- 45. McNulty C, Jenny SE, Leis O, et al. Physical exercise and performance in esports players: an initial systematic review. Journal of Electronic Gaming and Esports. 2023;1(1):1-11.
- 46. Brorsson S, Nilsdotter A, Thorstensson C, Bremander A. Differences in muscle activity during hand-dexterity tasks between women with arthritis and a healthy reference group. BMC Musculoskelet Disord. 2014;15:154.
- 47. Knatauskaitė J, Pukėnas K, Trinkūnienė L, Budde H. Effects of different types of exercise training on fine motor skills and testosterone concentration in adolescents: a cluster randomized controlled trial. Int J Environ Res Public Health. 2021;18(16): 8243.
- 48. James S, Conrad M, Sengupta S. Development of an innovative telerehabilitation system to improve handgrip strength. Int J Telerehabil. 2022;14(2):e6497.
- 49. Turan Z, Topaloglu M, Ozyemisci Taskiran O. Is tele-rehabilitation superior to home exercise program in COVID-19 survivors following discharge from intensive care unit? - A study protocol of a randomized controlled trial. Physiother Res Int. 2021;26(4):e1920.
- 50. Kenis-Coskun O, Imamoglu S, Karamancioglu B, et al. Comparison of telerehabilitation versus home-based video exercise in patients with Duchenne muscular dystrophy: a single-blind randomized study. Acta Neurol Belg. 2022;122(5):1269-1280.
- 51. Suero-Pineda A, Oliva-Pascual-Vaca Á, Durán MR, et al. Effectiveness of a telerehabilitation tablet app in combination with face-to-face physiotherapy for people with wrist, hand or finger injuries: A pragmatic multicentre clinical trial. J Telemed Telecare. 2023:1357633x231172245.
- 52. Costa F, Janela D, Molinos M, et al. Impacts of digital care programs for musculoskeletal conditions on depression and work productivity: longitudinal cohort study. J Med Internet Res. 2022;24(7):e38942.