Feasibility of the Glenrose Grocery Game for Cognitive and Functional Outcomes in Older Inpatients

The Effects of Playing the Glenrose Grocery Game on the Specific Mental Functions Andfunctioning in Inpatient Older Adults: a Feasibility Study

Older adults could benefit from computer serious games as a strategy for improving not only their cognitive functions but also their functioning and performance in daily activities, which are often compromised with age. A computer serious game is one designed for a primary purpose other than pure entertainment. Few computer games had been developed to emulate instrumental activities of daily living (IADLs), such as money management (e.g., shopping or paying bills). To fill this gap, occupational therapists at the Glenrose Rehabilitation Hospital (GRH) developed the Glenrose Grocery Game (GGG).

At the time, the game had not yet been tested. Thus, the purpose of this feasibility study was to explore whether playing the GGG as part of the rehabilitation program at the GRH had an effect on specific mental functions (memory and attention), occupational performance in money management tasks, and satisfaction with occupational performance in older adults.

In this study, we compared the outcomes of 7 participants who played the GGG (intervention group) with those of 8 different participants who received the GRH standard of care (control group). Data analysis is being conducted. The results of the study:

Provided clinicians with evidence for implementing the GGG in interventions, which in turn may benefit inpatient clients at the GRH;

Informed stakeholders' decisions about clients' safe discharge and transition to home and community; and

Supported researchers in designing a larger and more robust study.

Study Overview

• Status: Terminated
• Conditions: Serious Games; Compensation Strategies
• Intervention / Treatment: Other: Standard cognitive rehabilitation; Other: Experimental: Glenrose Grocery Game sessions

Detailed Description

Occupational therapists at the Glenrose Rehabilitation Hospital (GRH) developed the Glenrose Grocery Game (GGG)-a serious game designed to simulate shopping, meal planning, and budgeting in a virtual environment. However, the GGG had not yet been tested for its impact on cognitive and occupational outcomes.

The purpose of this feasibility study was to explore the implementation and effects of the GGG as part of the rehabilitation program at GRH, assessing its impact on specific mental functions, occupational performance, and satisfaction with performance in older adults. The study also aimed to estimate the parameters needed to design a future randomized controlled trial (RCT).

Research Questions

Was the designed protocol feasible for conducting a future definitive RCT?

Did playing the GGG as part of the rehabilitation program at GRH affect mental functions, occupational performance, and satisfaction in older adults, compared to standard care?

How engaged were older adults while playing the GGG?

Methods Design A pretest-posttest control group design was used. The experimental group received sessions with the GGG, while the control group received standard care (i.e., compensatory strategies). The study followed the CONSORT guidelines for randomized pilot studies (Eldridge et al., 2016).

Participants

Inclusion Criteria:

Adults aged 50 or older

With or without cognitive impairment (MOCA ≥19)

Functional vision and hearing (with or without aids)

Functional upper extremity use

Required no more than one-person assist for mobility

Exclusion Criteria:

Diagnosed with influenza or a virus affecting cognitive performance

Unable to count, speak, or follow simple English instructions

Sample Size Based on power analysis (α = 0.05, power = 0.8, effect size = 1.2), a minimum of 32 participants was required. We aimed to recruit 16 participants per group to account for a 25% dropout rate.

Sampling and Allocation Stratified permuted block randomization was used, with stratification based on MOCA scores. Participants with MOCA scores between 19-24 were categorized as having moderate cognitive impairment; those with scores of 25-30 were considered to have mild/no impairment. Allocation was blinded to research staff administering and evaluating the intervention.

Recruitment Protocol OTs at GRH inpatient units identified eligible participants. Informed consent (or assent via substitute decision-makers) was obtained. Allocation and coding were conducted by the PI (AMRR), and group assignment remained blinded to those delivering and evaluating the intervention.

Independent Variable

GGG Intervention: Participants played the GGG, completing meal planning and grocery shopping tasks in a gamified format. Sessions (8 × 30 minutes over 4 weeks) were delivered by trained RAs using tablets or computers.

Standard Care: Included cognitive assessment, education, and compensatory strategies (e.g., journaling, memory logs). Interventions were tailored to comprehension level and included caregiver involvement when needed.

Dependent Variables

Specific Mental Functions:

Trail Making Test (TMT) Parts A and B

Walking and Remembering Test (WART)

Montreal Cognitive Assessment (MOCA)

Occupational Performance:

Objective: PASS Task H8 (Money Management: Shopping)

Subjective: Canadian Occupational Performance Measure (COPM)

Engagement:

8-point Likert engagement scale developed in a prior study (Ríos Rincón et al., 2017)

All tools have strong metric properties and are suitable for use with older adults.

Data Collection The experimental group received GGG sessions in a dedicated room at GRH. Engagement was assessed post-session. All participants completed pretest and posttest assessments, taking ~80 minutes total. Blinded evaluators (RA 2) conducted assessments; a second rater (RA 3) scored at least 25% of measures to ensure reliability.

Data Analysis Data are currently being analyzed using SPSS under intention-to-treat principles. Descriptive statistics are being used to characterize the groups at pretest. Due to the small sample size, non-parametric tests (Wilcoxon signed-rank and Mann-Whitney U) are being used for within- and between-group comparisons for MOCA, TMT, WART, PASS, and COPM scores. Clinical significance in COPM scores is being evaluated using the two-point threshold (Law et al., 1998). Engagement data are being analyzed descriptively.

Potential Impact Findings from this study will provide clinicians with preliminary evidence regarding the GGG's impact on cognition, occupational performance, and engagement in older adults. If results are favorable, they will support the implementation of the GGG as a rehabilitation tool at GRH, benefiting inpatient clients. Insights will also help guide discharge planning and caregiver support and inform the design of a future, larger-scale RCT.

• Study Type: Interventional
• Enrollment (Actual): 15
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Edmonton, Alberta, Canada, T6G 2G4
      • Glenrose Rehabilitation Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Older adults aged 50 years and older
• With and without some level of cognitive impairment (Montreal Cognitive Assessment (MOCA) ≥19) (Nasreddine, Phillips, & Chertkow, 2011).
• Have a level of awareness to be able to interact with the game platform.
• Have functional vision and hearing with or without aides (glasses/hearing aides) to be able to interact with the game platform.
• Have functional upper extremity function to be able to interact with the game.
• Maximum mobility limitation of 1 person assist with mobility aid

Exclusion Criteria:

• Older adults who have Infuenza or another virus virus that affect their performance
• Unable to count, speak (name objects and say numbers) or comprehend simple instructions in English

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Standard of care for cognitive impairment; Compensatory strategy consists in recommendations made by Occupational Therapists to the client and caregivers for his/her safety while performing instrumental activities of daily living.	Other: Standard cognitive rehabilitation; Compensatory strategies
Experimental: Experimental: Glenrose Grocery Game sessions; Participants played the GGG, completing meal planning and grocery shopping tasks in a gamified format. Sessions (8 × 30 minutes over 4 weeks) were delivered by trained RAs using tablets or computers.	Other: Experimental: Glenrose Grocery Game sessions; Participants played the the Glenrose Grocery Game (a serious game), completing meal planning and grocery shopping tasks in a gamified format. Sessions (8 × 30 minutes over 4 weeks) were delivered by trained RAs using tablets or computers.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Montreal Cognitive Assessment (MOCA)	The MOCA is a widely used screening tool for detecting mild cognitive impairment. It assesses several cognitive domains, including memory, attention, language, visuospatial skills, and executive function. A score of 26 or above is considered normal.	From enrollment to the end of treatment at 4 weeks
Trail Making Test (TMT) Parts A and B	The TMT assesses visual attention, processing speed, mental flexibility, and executive function. Part A involves connecting numbered circles in sequence, while Part B alternates between numbers and letters (e.g., 1-A-2-B), requiring set-shifting ability.	From enrollment to the end of treatment at 4 weeks
Walking and Remembering Test (WART)	The WART is a dual-task assessment that evaluates divided attention and working memory. Participants walk a defined path while recalling and repeating a sequence of numbers, simulating real-world multitasking challenges.	From enrollment to the end of treatment at 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Engagement scale	This is an 8-item scale for engagement	After each session with the game from enrollment to the end of treatment at 4 weeks
Objective Measure - PASS Task H8 (Money Management: Shopping)	This task from the Performance Assessment of Self-Care Skills (PASS) evaluates a person's ability to complete a simulated shopping task, focusing on problem-solving, planning, and safety in money management.	From enrollment to the end of treatment at 4 weeks
Canadian Occupational Performance Measure (COPM)	The COPM is a client-centered tool that captures self-perceived performance and satisfaction with daily activities. Clients identify priority tasks, then rate their performance and satisfaction on a 10-point scale.	From enrollment to the end of treatment at 4 weeks

Collaborators and Investigators

• Sponsor: University of Alberta
• Collaborators: Glenrose Foundation

Study record dates

Study Major Dates

• Study Start (Actual): June 6, 2019
• Primary Completion (Actual): March 12, 2020
• Study Completion (Actual): March 12, 2020

Study Registration Dates

• First Submitted: August 6, 2025
• First Submitted That Met QC Criteria: May 7, 2026
• First Posted (Actual): May 13, 2026

Study Record Updates

• Last Update Posted (Actual): May 13, 2026
• Last Update Submitted That Met QC Criteria: May 7, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: older adults; mild cognitive impairment; in-patient; serious games; compensatory strategies
• Additional Relevant MeSH Terms: Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Cognitive Dysfunction
• Other Study ID Numbers: Pro00087258

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No