This page will be used to detail research into osteoarthritis and physiotherapeutic exercise that will later form a basis for the controller and gameplay design.
Osteoarthritis is a chronic joint disease, symptomized by "pain and functional impairment [including] joint stiffness and dysfunction" (Wieland et al, 2005, p.331), predominately affecting older adults. Its effects are felt worldwide, with 30 to 50% of those over 65 years of age suffering from the condition in the United States (Lawrence et al, cited in Loeser, 2010) and one in ten adults having been clinically diagnosed with osteoarthritis in the United Kingdom (Swain et al, 2020). A loss of function in patients suffering from osteoarthritis negatively affects daily life and activities, and forces patients to alter and limit their activities as a result of pain and stiffness (Sinusas, 2012).
Although the condition is not curable, a wide range of treatments are available for the relief of pain and symptoms for those suffering from osteoarthritis, both pharmacological (such as nonsteroidal anti-inflammatory drugs) and nonpharmacological (such as weight loss and exercise) (NHS, n.d.), as well as surgical, complementary and alternative treatments (Sinusas, 2012). The goal of these therapies is to reduce pain, "improve joint and general function [and] overall improvement in health related quality of life" (McColl, 2008, p.108).
MacDermid et al (as cited in Valdes and Marik, 2010) averred that "pain reduction is the primary goal when treating hand [osteoarthritis] because it is the impairment that is most associated with decreased hand function" (p.349). Interventions and therapies that are exercise-only "may not reach patients whose primary concern is not physical activity or loss of function, but pain and aesthetic changes related to hand [osteoarthritis]" (Stoffer-Marx et al, 2018, p.7). Although hand exercises (motion and strengthening) may not provide aesthetic changes or alleviate pain, they are recommended "with the purpose of increasing pinch and grip strength, range of motion and stability of the first carpometacarpal joint" (Kloppenburg, 2014, p.3).
Nonpharmacological treatments are often the first-line of therapy for osteoarthritis (McColl, 2008), and this typically involves exercises simultaneously with other nonpharmacological or pharmacological therapies. Taming the Dragon's primary function is to provide physiotherapeutic hand exercises in a gamified environment that will aid in increasing grip strength, enabling a wider range of motion and support overall restoration of hand function.
Hand exercises, such as those in Figure One, seek to provide the aforementioned reduction of symptoms severity and will form a basis for the gameplay design.
Figure One: Hand Exercise Program provided to patients as part of a combined-intervention group; "DIP, distal interphalangeal joint; MCP, metacarpophalangeal joint; PIP, proximal interphalangeal joint" (Stoffer-Marx et al, 2018, p.5)
The controller design should also accommodate the aesthetic changes to hands and movability for hand exercises as pictured above, and this will be discussed within the Controller Design page.