Feasibility of Cognitive-Motor Exergames in Geriatric Inpatient Rehabilitation: A Pilot Randomized Controlled Study

Patrizia Altorfer, Manuela Adcock, Eling D de Bruin, Florian Graf, Eleftheria Giannouli, Patrizia Altorfer, Manuela Adcock, Eling D de Bruin, Florian Graf, Eleftheria Giannouli

Abstract

Objective: The aim of this pilot randomized clinical trial was to test the feasibility and efficacy of an exergame-based cognitive-motor training program in geriatric inpatients. Methods: The study participants were randomly allocated to either the exergame intervention group or the control group. The control group received the standard rehabilitation treatment offered in the clinic. In addition to the standard rehabilitation program, the intervention group conducted supervised exergame training on 5 days per week using the Dividat Senso, an exergame system specifically designed for older adults. The primary outcome was feasibility, as measured by e.g., adherence rate, attrition rate, occurrence of adverse events, System Usability Scale (SUS) and NASA-TLX score. Secondary outcomes included measures of physical and cognitive functioning such as comfortable walking speed, maximal walking speed, dual task walking speed, Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), Color-Word Interference test (D-KEFS), Trail Making test A and B (TMT), Go/No-Go test and Step Reaction Time test (SRTT). All secondary outcome measures were assessed pre- and post-intervention. Results: Thirty-nine persons were included in the study. Average adherence rate was 99%, there were no intervention-related dropouts and no adverse events. The mean System Usability Scale (SUS) score was 83.6 and the mean NASA-TLX score 45.5. Significant time-group interaction effects were found for the dual task walking speed, the Go/No-Go test and Step Reaction Time test (SRTT). Conclusion: Exergaming is a feasible, safe and effective cognitive-motor training approach in inpatient rehabilitation of geriatric patients. Incorporating exergaming in the rehabilitation program of geriatric patients offers potential to reduce fall risk factors and to increase patients' exercise motivation and rehabilitation success.

Keywords: balance training; cognitive training; exercise; exergaming; fall prevention; older adults; step training.

Conflict of interest statement

EB was a co-founder of Dividat, the spin-off company that developed the video step platform used for the training of the seniors and is associated to the company as an external advisor. No revenue was paid (or promised to be paid) directly to EB or his institution over the 36 months prior to submission of the work. MA works as a Head of Research at Dividat. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Altorfer, Adcock, de Bruin, Graf and Giannouli.

Figures

FIGURE 1
FIGURE 1
Flow diagram of screening and group allocation (based on Eldridge et al., 2016).
FIGURE 2
FIGURE 2
Feasibility outcomes. (A) Mean ratings ± standard deviation of each item of the NASA-TLX to assess training workload, (B) median and interquartile range of the ratings of each SUS item.
FIGURE 3
FIGURE 3
Boxplots of physical outcomes of each group at pre- and post-measurements. (A) Velocity for normal walking 10 m, (B) maximal velocity for walking 10 m, (C) velocity for walking 10 m while dual tasking, (D) Time required to stand up five times, (E) Total Score achieved in the Short Physical Performance Battery (SPPB), (F) Time required for the Timed Up and Go (TUG). *P < 0.05, **P < 0.01, ***P < 0.001.
FIGURE 4
FIGURE 4
Boxplots of cognitive outcomes of each group at pre- and post-measurements. (A) Reaction Time in the Go/No-Go Test on the Dividat Senso, (B) Reaction Time in the 6-Step Reaction Time test (SRTT) on the Dividat Senso, (C) Time required for the first Stroop task (Color Naming), (D) time required for the second Stroop task (Word Reading), (E) time required for the third Stroop task (Inhibition), (F) time required for the fourth Stroop task (Inhibition/Switching), (G) time required for the Trail Making Test (TMT) part A, (H) time required for the Trail Making Test (TMT) part B. *P < 0.05, **P < 0.01, ***P < 0.001.

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