An interactive Multiple Sclerosis Fitness Intervention Training (MS-FIT) with Pilates exercises. Development and usability of a Kinect-based system. (Preprint)

Abstract

Balance impairments are common in multiple sclerosis (MS) with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (e.g. depression) frequently associated with physical inactivity. An Italian network of fifteen Centres specialized in MS rehabilitation developed the MS-FIT exergame to autonomously train balance through Pilates exercises.

Here, we describe the design, development and usability testing of MS-FIT, a Kinect-based tool implementing Pilates exercises customized for MS.

MS-FIT has been developed through a User-Centered Design approach (design, prototype, user feedback and analysis) allowing gaining the target user’s perspective. A team composed of one physical therapist, two game programmers and one game designer provided the first version of MS-FIT that integrated knowledge and experience of the team with MS literature findings related to Pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D game engine software with Kinect Sensor V2 for Windows, implements exercises for breathing, posture and balance. Feedbacks from neurologists, physiatrists, physical therapists and people with MS (PwMS) were collected to customize the tool for a use in MS. The MS-FIT context is the travel around the world to visit some of the most important cities in order to learn aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a teacher of Pilates shows the user the exercises to be performed. Nine PwMS (4 females; mean age: 42.89 ± 11.97 years; mean disease duration 10.19 ± 9.18 years; Expanded Disability Status Scale: 3.17 ± 0.75) were involved in three outpatient user-test sessions of 30 minutes; the MS-FIT usability was assessed through an ad-hoc questionnaire (maximum value = 5; higher the score, higher the usability) evaluating easiness-to-use, playability, enjoyment, satisfaction and acceptance.

All nine PwMS completed the sessions of user-test and answered the ad-hoc questionnaire. The average score on each item ranged from 3.78 and 4.11, which indicated a high usability level. The feedbacks and suggestions provided by the 9 PwMS and by the 5 therapists involved in the user-test were implemented to refine the first prototype in order to release the MS-FIT 2.0.

MS-FIT is a highly usable tool and is a promising system for enhancing motivation and engagement of PwMS in performing exercise with the aim to improve their physical status.