Game-based rehabilitation improves upper limb movement capacity compared to task-based training in people post-stroke: Kinematic analyses from the EnteRtain randomized clinical trial

Background and aims: Although many gaming systems for early stroke rehabilitation capture kinematic data, studies on upper limb (UL) movement capacity analysis after virtual reality (VR)-based gaming interventions remain limited. This study is a secondary analysis of the EnteRtain randomized clinical trial and aims to examine the effects of gamified rehabilitation using a low-cost arm rehabilitation system compared to task-based training on UL movement capacity in individuals with acute or subacute stroke. Methods: This secondary analysis used data from a randomized, multicenter, single-blind clinical trial involving 120 participants (91 males) with unilateral stroke and an UL Brunnstrom motor recovery stage ⩾1 to ⩽5, recruited from four centers across India. Participants received either gamified training with the ArmAble TM device (experimental group; n = 64) or task-based training (control group; n = 56), alongside conventional therapy for 2 h/day, 6 days/week, over 2 weeks, followed by 4 weeks of home-based UL rehabilitation. Movement capacity outcomes (reach distance, time, and movement velocity) were assessed by blinded evaluators at 2 and 6 weeks and analyzed using a linear mixed-effects regression model. Results: At 6 weeks, the experimental group demonstrated significantly greater improvements compared to control group in movement velocity for reaches to both near (mean difference (95% confidence interval (CI)): −2.8 (−5.0, −0.75); p = 0.008) and far targets (−2.7 (−4.9, −0.51); p = 0.016). No significant differences were, however, observed at 2 weeks. Changes in reach distance and movement time were not statistically significant between the groups at any time point. Conclusion: Gamified rehabilitation with the ArmAble tm device enhanced UL movement velocity at 6 weeks compared to task-based training in individuals recovering from acute/subacute stroke. These findings support the use of ArmAble tm both as an engaging therapeutic tool and as a quantitative assessment platform for evaluating UL function post-stroke. Clinical trials registry number: CTRI/2020/09/027651