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The hand is one of the most functional and frequently injured parts of the body. Without proper recovery, patients can face significant impairments performing everyday tasks. Hand therapy is the cornerstone of hand rehabilitation, but the painful, repetitive, and monotonous nature of prescribed exercises leads to poor patient motivation and adherence, ultimately compromising long-term recovery outcomes.
New technologies such as virtual reality (VR) and augmented reality (AR) have emerged as interactive and engaging modalities for rehabilitation, and can even reduce pain by distracting patients during exercises. However, mixed reality (MR), which is a new modality combining VR and AR has not been well studied for its ability to reduce pain in hand rehabilitation. Therefore, we developed HoloRehab, a mixed reality video game for hand rehabilitation, built for the Microsoft HoloLens 2 headset. This device allow users to see and interact with realistic 3D holograms projected into their physical environment.
This pilot study will evaluate whether using HoloRehab can reduce discomfort and improve the exercise experience compared to traditional self-guided hand therapy exercises. After development of a prototyped game, we will run a pilot study involving 20 healthy participants assigned to either the mixed reality intervention or a traditional exercise group. Outcomes will include measures of discomfort, fatigue, and user experience.
Findings from this study will inform further development of the HoloRehab system.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Traditional Rehabilitation | Active Comparator | Participants in the traditional rehabilitation group perform self-guided finger range of motion exercises according to a provided guide, without any gaming component. |
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| HoloRehab Gaming Rehablitation | Experimental | Participants in the HoloRehab Gaming Rehabilitation group perform the same finger range of motion exercises compared to traditional rehabilitation group, but through the medium of an extended reality rhythm video game with Microsoft HoloLens 3. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cold pressor test | Other | Participants submerge their dominant hand in a cold-water bath while performing hand exercises with their non-dominant hand. |
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| Measure | Description | Time Frame |
|---|---|---|
| Time to cold water withdrawal | The duration (seconds) that participants keep their hand submerged in a cold water bath before voluntarily withdrawing due to discomfort. | Assessed continuously during the cold pressor test, from hand immersion until voluntary withdrawal or a maximum of 15 minutes. |
| Time to fatigue failure | The duration (seconds) that participants continue performing hand exercises against resistance bands before voluntarily stopping due to fatigue. | Assessed continuously during resisted hand exercise, from exercise initiation until voluntary cessation due to fatigue or a maximum of 15 minutes. |
| Discomfort Rating After Cold Water Withdraw | Participant-reported level of hand discomfort immediately following the cold pressor test, measured on a 1-10 numerical rating scale. | Assessed immediately following completion of the cold pressor test (within 1 minute of hand withdrawal). |
| Discomfort Rating After Resisted Exercise | Participant-reported level of hand discomfort immediately following resisted hand exercises, measured on a 1-10 numerical rating scale. | Assessed immediately following completion of the resisted exercise task (within 1 minute of exercise cessation). |
| Measure | Description | Time Frame |
|---|---|---|
| User experience | Participant-reported overall satisfaction, usability, comfort, enjoyment, and perceived effectiveness of the assigned exercise modality, assessed using a post-intervention questionnaire consisting of Likert-scale items. For participants in the intervention arm, this includes experience with the HoloRehab game and the HoloLens 2 headset. | Assessed once immediately following completion of all study procedures during the single study visit (approximately 45 minutes after intervention initiation). |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Western Ontario | London | Ontario | N6A 3K7 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35525050 | Background | Neiman NR, Falkson SR, Rodriguez ST, Wang EY, Hemphill SF, Khoury ME, Kist MN, Jackson CD, Caruso TJ. Quantifying virtual reality pain modulation in healthy volunteers: A randomized, crossover study. J Clin Anesth. 2022 Sep;80:110876. doi: 10.1016/j.jclinane.2022.110876. Epub 2022 May 4. | |
| 16694857 | Background |
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No, individual participant data will not be shared, and is retained and used only by the study team. Use of data is described in detail during the informed consent process, and will be stored securely in accordance with institutional research ethics requirements. Due to our small sample size, there is a risk that participants can be re-identified even after de-identification if IPD is shared.
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| ID | Term |
|---|---|
| D055070 | Resistance Training |
| ID | Term |
|---|---|
| D005081 | Exercise Therapy |
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
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|
| Exercise under resistance | Other | Participants perform hand exercises against finger extension resistance bands attached to the non-dominant hand. |
|
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| Wolf S, Hardy JD. STUDIES ON PAIN. OBSERVATIONS ON PAIN DUE TO LOCAL COOLING AND ON FACTORS INVOLVED IN THE "COLD PRESSOR" EFFECT. J Clin Invest. 1941 Sep;20(5):521-33. doi: 10.1172/JCI101245. No abstract available. |
| 20926408 | Background | Birnie KA, Noel M, Chambers CT, von Baeyer CL, Fernandez CV. The cold pressor task: is it an ethically acceptable pain research method in children? J Pediatr Psychol. 2011 Nov-Dec;36(10):1071-81. doi: 10.1093/jpepsy/jsq092. Epub 2010 Oct 5. |
| 18325675 | Background | Mott J, Bucolo S, Cuttle L, Mill J, Hilder M, Miller K, Kimble RM. The efficacy of an augmented virtual reality system to alleviate pain in children undergoing burns dressing changes: a randomised controlled trial. Burns. 2008 Sep;34(6):803-8. doi: 10.1016/j.burns.2007.10.010. Epub 2008 Mar 5. |
| 38587725 | Background | Moreau S, Therond A, Cerda IH, Studer K, Pan A, Tharpe J, Crowther JE, Abd-Elsayed A, Gilligan C, Tolba R, Ashina S, Schatman ME, Kaye AD, Yong RJ, Robinson CL. Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review. Curr Pain Headache Rep. 2024 Sep;28(9):893-928. doi: 10.1007/s11916-024-01246-2. Epub 2024 Apr 8. |
| 34154898 | Background | Ali RR, Selim AO, Abdel Ghafar MA, Abdelraouf OR, Ali OI. Virtual reality as a pain distractor during physical rehabilitation in pediatric burns. Burns. 2022 Mar;48(2):303-308. doi: 10.1016/j.burns.2021.04.031. Epub 2021 May 5. |
| 33011296 | Background | Pereira MF, Prahm C, Kolbenschlag J, Oliveira E, Rodrigues NF. Application of AR and VR in hand rehabilitation: A systematic review. J Biomed Inform. 2020 Nov;111:103584. doi: 10.1016/j.jbi.2020.103584. Epub 2020 Oct 2. |
| 39159237 | Background | Zhang C, Yu S. The Technology to Enhance Patient Motivation in Virtual Reality Rehabilitation: A Review. Games Health J. 2024 Aug;13(4):215-233. doi: 10.1089/g4h.2023.0069. |
| 38350808 | Background | Khamees KM, Deldar K, Yazarlu O, Tuama AM, Ganji R, Mazlom SR, Froutan R. Effect of augmented reality-based rehabilitation of hand burns on hand function in children: A randomized controlled trial. J Hand Ther. 2025 Apr-Jun;38(2):235-245. doi: 10.1016/j.jht.2023.10.009. Epub 2024 Feb 12. |
| D005791 |
| Patient Care |
| D013812 | Therapeutics |
| D026741 | Physical Therapy Modalities |
| D064797 | Physical Conditioning, Human |
| D015444 | Exercise |
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |