Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study

Nolwenn Lapierre, Nathavy Um Din, Manuella Igout, Joël Chevrier, Joël Belmin, Nolwenn Lapierre, Nathavy Um Din, Manuella Igout, Joël Chevrier, Joël Belmin

Abstract

Background: Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames.

Objective: This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation.

Methods: This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis.

Results: The protocol (2019-11-22) has been approved by the Comité de Protection des Personnes Nord-Ouest I-Université de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022.

Conclusions: The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials.

Trial registration: ClinicalTrials.gov NCT04134988; https://ichgcp.net/clinical-trials-registry/NCT04134988.

International registered report identifier (irrid): DERR1-10.2196/24665.

Keywords: elderly; exergame; fall; fear; fear of falling; older adult; protocol; psychomotor therapy; randomized controlled trial; rehabilitation; risk; therapy.

Conflict of interest statement

Conflicts of Interest: None declared.

©Nolwenn Lapierre, Nathavy Um Din, Manuella Igout, Joël Chevrier, Joël Belmin. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 26.08.2021.

Figures

Figure 1
Figure 1
(A) The large screen displays an exergame. The Kinect camera is positioned above the screen to capture the movements of the participant; the computer with the Medimoov platform is on the left of the screen. (B) The harness protects the participants from injury if they fall during the session.
Figure 2
Figure 2
(A) Medimoov allows calibration of its games according to the participant’s abilities. The instructions for the movements to be performed are displayed on the screen. The orange circle indicates the participant’s maximum range of motion, and a feedback image reconstructing the movements captured by the Kinect is presented at the bottom of the screen. (B) Several games can be played. For one of the games, the participant leads a pirate ship to recover gold coins while avoiding rocks and enemy fire. (C) Each participant has a personal profile in which the psychomotor therapist can access the participant’s session and performance history.

References

    1. Peel Nm. Epidemiology of falls in older age. Can J Aging. 2011 Mar 15;30(1):7–19. doi: 10.1017/S071498081000070X. doi: 10.1017/s071498081000070x.
    1. Cuevas-Trisan Ramon. Balance problems and fall risks in the elderly. Phys Med Rehabil Clin N Am. 2017 Nov;28(4):727–737. doi: 10.1016/j.pmr.2017.06.006.S1047-9651(17)30053-0
    1. Vieira Edgar R, Palmer Richard C, Chaves Paulo H M. Prevention of falls in older people living in the community. BMJ. 2016 Apr 28;353:i1419. doi: 10.1136/bmj.i1419.
    1. Alekna Vidmantas, Stukas Rimantas, Tamulaitytė-Morozovienė Inga, Šurkienė Genė, Tamulaitienė Marija. Self-reported consequences and healthcare costs of falls among elderly women. Medicina (Kaunas) 2015;51(1):57–62. doi: 10.1016/j.medici.2015.01.008. S1010-660X(15)00009-9
    1. Filiatrault J, Belley A, Laforest S, Gauvin L, Richard L, Desrosiers J, Parisien M, Lorthios-Guilledroit A. Fear of falling among seniors: a target to consider in occupational and physical therapy practice? Phys Occup Ther Geriatr. 2013 Jun 13;31(3):197–213. doi: 10.3109/02703181.2013.797951. doi: 10.3109/02703181.2013.797951.
    1. Lach Helen W, Parsons Jill L. Impact of fear of falling in long term care: an integrative review. J Am Med Dir Assoc. 2013 Aug;14(8):573–7. doi: 10.1016/j.jamda.2013.02.019.S1525-8610(13)00110-2
    1. Denkinger Michael D, Lukas Albert, Nikolaus Thorsten, Hauer Klaus. Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: a systematic review. Am J Geriatr Psychiatry. 2015 Jan;23(1):72–86. doi: 10.1016/j.jagp.2014.03.002.S1064-7481(14)00086-4
    1. Gazibara Tatjana, Kurtagic Ilma, Kisic-Tepavcevic Darija, Nurkovic Selmina, Kovacevic Nikolina, Gazibara Teodora, Pekmezovic Tatjana. Falls, risk factors and fear of falling among persons older than 65 years of age. Psychogeriatrics. 2017 Jul;17(4):215–223. doi: 10.1111/psyg.12217.
    1. Tricco Andrea C, Thomas Sonia M, Veroniki Areti Angeliki, Hamid Jemila S, Cogo Elise, Strifler Lisa, Khan Paul A, Robson Reid, Sibley Kathryn M, MacDonald Heather, Riva John J, Thavorn Kednapa, Wilson Charlotte, Holroyd-Leduc Jayna, Kerr Gillian D, Feldman Fabio, Majumdar Sumit R, Jaglal Susan B, Hui Wing, Straus Sharon E. Comparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis. JAMA. 2017 Nov 07;318(17):1687–1699. doi: 10.1001/jama.2017.15006. 2661578
    1. Pereira CLN, Baptista F, Infante P. Role of physical activity in the occurrence of falls and fall-related injuries in community-dwelling adults over 50 years old. Disabil Rehabil. 2014;36(2):117–24. doi: 10.3109/09638288.2013.782355.
    1. Mirelman Anat, Herman Talia, Brozgol Marina, Dorfman Moran, Sprecher Elliot, Schweiger Avraham, Giladi Nir, Hausdorff Jeffrey M. Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition. PLoS One. 2012;7(6):e40297. doi: 10.1371/journal.pone.0040297. PONE-D-12-11361
    1. Martin Kara L, Blizzard Leigh, Srikanth Velandai K, Wood Amanda, Thomson Russell, Sanders Lauren M, Callisaya Michele L. Cognitive function modifies the effect of physiological function on the risk of multiple falls—a population-based study. J Gerontol A Biol Sci Med Sci. 2013 Sep;68(9):1091–7. doi: 10.1093/gerona/glt010.glt010
    1. Société Française de Gériatrie et Gérontologie. Haute Autorité de santé . Recommandations de bonnes pratiques professionnelles. Saint-Denis La Plaine: Service de documentation et information des publics; 2009. Sep, [2019-06-13]. Évaluation et prise en charge des personnes âgées faisant des chutes répétées. .
    1. Pereira Catarina, Rosado Hugo, Cruz-Ferreira Ana, Marmeleira José. Effects of a 10-week multimodal exercise program on physical and cognitive function of nursing home residents: a psychomotor intervention pilot study. Aging Clin Exp Res. 2018 May;30(5):471–479. doi: 10.1007/s40520-017-0803-y. doi: 10.1007/s40520-017-0803-y.10.1007/s40520-017-0803-y
    1. Tallon G, Seilles A, Melia G, Andary S, Bernard P, Di Loreto I, Blain H. Effects of the serious game Medimoov on the functional autonomy of institutionalized older adults. Ann Phys Rehabil Med. 2015 Sep;58:e113–e114. doi: 10.1016/j.rehab.2007.276. doi: 10.1016/j.rehab.2015.07.276.
    1. Lister Cameron, West Joshua H, Cannon Ben, Sax Tyler, Brodegard David. Just a fad? Gamification in health and fitness apps. JMIR Serious Games. 2014 Aug 04;2(2):e9. doi: 10.2196/games.3413. v2i2e9
    1. Montero-Alía Pilar, Miralles-Basseda Ramón, López-Jiménez Tomás, Muñoz-Ortiz Laura, Jiménez-González Mercè, Prat-Rovira Josep, Albarrán-Sánchez José Luís, Manresa-Domínguez Josep Maria, Andreu-Concha Celia Maria, Rodríguez-Pérez M Carmen, Martí-Cervantes Juan José, Sañudo-Blanco Lidia, Sánchez-Pérez Carlos Andrés, Dolader-Olivé Sònia, Torán-Monserrat Pere. Controlled trial of balance training using a video game console in community-dwelling older adults. Age Ageing. 2019 Jul 01;48(4):506–512. doi: 10.1093/ageing/afz047. 5488656
    1. Tanaka Kazumoto, Parker JR, Baradoy Graham, Sheehan Dwayne, Holash John R, Katz Larry. A comparison of exergaming interfaces for use in rehabilitation programs and research. J Can Game Stud Assoc. 2012;6(9):69–81.
    1. Chao Ying-Yu, Scherer Yvonne K, Montgomery Carolyn A. Effects of using Nintendo Wii™ exergames in older adults: a review of the literature. J Aging Health. 2015 Apr;27(3):379–402. doi: 10.1177/0898264314551171. doi: 10.1177/0898264314551171.0898264314551171
    1. Ayed Ines, Ghazel Adel, Jaume-I-Capó Antoni, Moya-Alcover Gabriel, Varona Javier, Martínez-Bueso Pau. Feasibility of Kinect-based games for balance rehabilitation: a case study. J Healthc Eng. 2018;2018:7574860. doi: 10.1155/2018/7574860. doi: 10.1155/2018/7574860.
    1. Skjæret Nina, Nawaz Ather, Morat Tobias, Schoene Daniel, Helbostad Jorunn Lægdheim, Vereijken Beatrix. Exercise and rehabilitation delivered through exergames in older adults: an integrative review of technologies, safety and efficacy. Int J Med Inform. 2016 Jan;85(1):1–16. doi: 10.1016/j.ijmedinf.2015.10.008.S1386-5056(15)30051-4
    1. Bieryla K, Dold N. Feasibility of Wii Fit training to improve clinical measures of balance in older adults. Clinical Interv Aging. 2013 Jun;2013(8):775–781. doi: 10.2147/cia.s46164.
    1. Pichierri G, Murer K, de Bruin ED. A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial. BMC Geriatr. 2012 Dec 14;12:74. doi: 10.1186/1471-2318-12-74. 1471-2318-12-74
    1. MediMoov : jeu vidéo et capture de mouvement pour l'activité physique. NaturalPad. [2020-11-16].
    1. Chao Y, Scherer YK, Wu Y, Lucke KT, Montgomery CA. The feasibility of an intervention combining self-efficacy theory and Wii Fit exergames in assisted living residents: a pilot study. Geriatr Nurs. 2013 Sep;34(5):377–82. doi: 10.1016/j.gerinurse.2013.05.006.S0197-4572(13)00185-7
    1. Chan A, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche Peter C, Krleža-Jerić K, Hróbjartsson Asbjørn, Mann H, Dickersin K, Berlin JA, Doré Caroline J, Parulekar WR, Summerskill WS, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013 Feb 05;158(3):200–7. doi: 10.7326/0003-4819-158-3-201302050-00583. 1556168
    1. Chan A, Tetzlaff JM, Gøtzsche Peter C, Altman DG, Mann H, Berlin JA, Dickersin K, Hróbjartsson Asbjørn, Schulz KF, Parulekar WR, Krleza-Jeric K, Laupacis A, Moher D. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013 Jan 08;346(jan08 15):e7586–e7586. doi: 10.1136/bmj.e7586.
    1. Birimoglu Okuyan OC, Bigili N. Effect of tai chi chuan on fear of falling, balance and physical self-perception in elderly: a randomised controlled trial. Turk Geriatri Derg. 2017;20(3):232–241.
    1. Zhao Yanan, Chung Pak-Kwong, Tong Tomas K. Effectiveness of a community-based exercise program on balance performance and fear of falling in older nonfallers at risk for falling: a randomized, controlled study. J Aging Phys Act. 2016 Oct;24(4):516–524. doi: 10.1123/japa.2015-0224.2015-0224
    1. Kempen G, Yardley Lucy, van Haastregt Jolanda C M, Zijlstra G A Rixt, Beyer Nina, Hauer Klaus, Todd Chris. The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing. 2008 Jan;37(1):45–50. doi: 10.1093/ageing/afm157. doi: 10.1093/ageing/afm157.afm157
    1. Folstein Mf, Folstein Se, McHugh Pr. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. doi: 10.1016/0022-3956(75)90026-6.
    1. Programmes de récupération améliorée après chirurgie (RAAC) Haute Autorité de Santé. [2020-11-23]. .
    1. Maher Christopher G, Moseley Anne M, Sherrington Cathie, Elkins Mark R, Herbert Robert D. A description of the trials, reviews, and practice guidelines indexed in the PEDro database. Phys Ther. 2008 Sep;88(9):1068–77. doi: 10.2522/ptj.20080002. ptj.20080002
    1. Hauer Klaus A, Kempen Gertrudis I J M, Schwenk Michael, Yardley Lucy, Beyer Nina, Todd Chris, Oster Peter, Zijlstra G A Rixt. Validity and sensitivity to change of the falls efficacy scales international to assess fear of falling in older adults with and without cognitive impairment. Gerontology. 2011;57(5):462–72. doi: 10.1159/000320054. doi: 10.1159/000320054.000320054
    1. Huang T, Wang Woan-Shyuan. Comparison of three established measures of fear of falling in community-dwelling older adults: psychometric testing. Int J Nurs Stud. 2009 Oct;46(10):1313–9. doi: 10.1016/j.ijnurstu.2009.03.010. doi: 10.1016/j.ijnurstu.2009.03.010.S0020-7489(09)00121-7
    1. Eggenberger P, Theill N, Holenstein S, Schumacher V, de Bruin E. Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up. CIA. 2015 Oct;10:1711–1732. doi: 10.2147/cia.s91997.
    1. Lai Chien-Hung, Peng Chih-Wei, Chen Yu-Luen, Huang Ching-Ping, Hsiao Yu-Ling, Chen Shih-Ching. Effects of interactive video-game based system exercise on the balance of the elderly. Gait Posture. 2013 Apr;37(4):511–5. doi: 10.1016/j.gaitpost.2012.09.003. doi: 10.1016/j.gaitpost.2012.09.003.S0966-6362(12)00330-X
    1. Lee S, Shin S. Effectiveness of virtual reality using video gaming technology in elderly adults with diabetes mellitus. Diabetes Technol Ther. 2013 Jun;15(6):489–96. doi: 10.1089/dia.2013.0050.
    1. Stanmore Emma K, Mavroeidi Alexandra, de Jong Lex D, Skelton Dawn A, Sutton Chris J, Benedetto Valerio, Munford Luke A, Meekes Wytske, Bell Vicky, Todd Chris. The effectiveness and cost-effectiveness of strength and balance Exergames to reduce falls risk for people aged 55 years and older in UK assisted living facilities: a multi-centre, cluster randomised controlled trial. BMC Med. 2019 Feb 28;17(1):49. doi: 10.1186/s12916-019-1278-9. 10.1186/s12916-019-1278-9
    1. Lin Mau-Roung, Hwang Hei-Fen, Hu Ming-Hsia, Wu Hong-Dar Isaac, Wang Yi-Wei, Huang Fu-Chao. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people. J Am Geriatr Soc. 2004 Aug;52(8):1343–8. doi: 10.1111/j.1532-5415.2004.52366.x. doi: 10.1111/j.1532-5415.2004.52366.x.JGS52366
    1. van Iersel Marianne B, Munneke Marten, Esselink Rianne A J, Benraad Carolien E M, Olde Rikkert Marcel G M. Gait velocity and the Timed-Up-and-Go test were sensitive to changes in mobility in frail elderly patients. J Clin Epidemiol. 2008 Feb;61(2):186–91. doi: 10.1016/j.jclinepi.2007.04.016. doi: 10.1016/j.jclinepi.2007.04.016.S0895-4356(07)00210-7
    1. Guralnik J M, Simonsick E M, Ferrucci L, Glynn R J, Berkman L F, Blazer D G, Scherr P A, Wallace R B. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994 Mar;49(2):M85–94. doi: 10.1093/geronj/49.2.M85. doi: 10.1093/geronj/49.2.m85.
    1. Volpato Stefano, Cavalieri Margherita, Sioulis Fotini, Guerra Gianluca, Maraldi Cinzia, Zuliani Giovanni, Fellin Renato, Guralnik Jack M. Predictive value of the Short Physical Performance Battery following hospitalization in older patients. J Gerontol A Biol Sci Med Sci. 2011 Jan;66(1):89–96. doi: 10.1093/gerona/glq167. glq167
    1. Freire Aline Nascimento, Guerra Ricardo Oliveira, Alvarado Beatriz, Guralnik Jack M, Zunzunegui Maria Victoria. Validity and reliability of the short physical performance battery in two diverse older adult populations in Quebec and Brazil. J Aging Health. 2012 Aug;24(5):863–78. doi: 10.1177/0898264312438551. doi: 10.1177/0898264312438551.0898264312438551
    1. Fish J. Short Physical Performance Battery. In: Kreutzer J, DeLuca J, Caplan B, editors. Encyclopedia of Clinical Neuropsychology. New York, NY: Springer; 2011.
    1. Comalli P, Seymour W, Heinz W. Interference effects of Stroop color-word test in childhood, adulthood, and aging. J Genet Psychol. 1962 Mar;100:47–53. doi: 10.1080/00221325.1962.10533572. doi: 10.1080/00221325.1962.10533572.
    1. Bayard S, Erkes J, Moroni C. Test du Stroop Victoria - Adaptation francophone. Collège des Psychologues Cliniciens spécialisés en Neuropsychologie du Languedoc Roussillon (CPCN-LR) 2009. Nov, [2019-09-14]. .
    1. Siegrist M. Test-retest reliability of different versions of the Stroop test. J Psychol. 2010 Apr 02;131(3):299–306. doi: 10.1080/00223989709603516. doi: 10.1080/00223989709603516.
    1. Demakis George J. Frontal lobe damage and tests of executive processing: a meta-analysis of the category test, Stroop test, and trail-making test. J Clin Exp Neuropsychol. 2004 May;26(3):441–50. doi: 10.1080/13803390490510149. doi: 10.1080/13803390490510149.CK13R0QY7145HK3M
    1. Tombaugh T. Trail Making Test A and B: normative data stratified by age and education. Arch Clin Neuropsychol. 2004 Mar;19(2):203–214. doi: 10.1016/S0887-6177(03)00039-8. doi: 10.1016/s0887-6177(03)00039-8.
    1. Wagner Stefanie, Helmreich Isabella, Dahmen Norbert, Lieb Klaus, Tadic André. Reliability of three alternate forms of the trail making tests a and B. Arch Clin Neuropsychol. 2011 Jun;26(4):314–21. doi: 10.1093/arclin/acr024.acr024
    1. Poitrenaud J, Kalafat M, Israel L, Guez D. Une revue critique des instruments disponibles pour l'évaluation des médicaments promnésiants dans la maladie d'Alzheimer. La Revue de Médecine Interne. 1997 Jan;18(1):59–71. doi: 10.1016/S0248-8663(97)84396-2. doi: 10.1016/s0248-8663(97)84396-2.
    1. González-González Carina S, Toledo-Delgado Pedro A, Muñoz-Cruz Vanesa, Torres-Carrion Pablo V. Serious games for rehabilitation: gestural interaction in personalized gamified exercises through a recommender system. J Biomed Inform. 2019 Sep;97:103266. doi: 10.1016/j.jbi.2019.103266. S1532-0464(19)30185-6
    1. Aresti Bartolomé N, Méndez Zorrilla A, García Zapirain B. Can game-based therapies be trusted? Is game-based education effective? A systematic review of the Serious Games for health and education. 16th International Conference on Computer Games (CGAMES); 2011; Louisville, KY, USA. IEEE; 2011. Jul,
    1. James BD, Boyle PA, Bennett DA, Buchman AS. Total daily activity measured with actigraphy and motor function in community-dwelling older persons with and without dementia. Alzheimer Dis Assoc Disord. 2012;26(3):238–245. doi: 10.1097/WAD.0b013e31822fc3cb. doi: 10.1097/WAD.0b013e31822fc3cb.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera