Aging Clinical Trial
Official title:
Integrated Web-Based Customer Engagement, Physical Exercise, and Coaching Platform for Older Adults
The fast-growing older population coupled with the worsening shortage of caregivers and nurses will soon present our nation with severe societal and economic challenges. Older adults often struggle to maintain quality of life and independence in the presence of chronic diseases and isolation. Physical exercise and socialization have been shown to reduce chronic disease, depression, falls and to improve quality of life in older adults. Motivation and feedback are essential to continued engagement in a wellness program, but doing so through the traditional manner of in-person coaching can be prohibitively expensive. Vigorous Mind (VM) has been providing a web-based platform to promote sustained engagement in older adults primarily in senior living facilities. The platform provides dynamic and tailored content including reminiscence activities, favorite music and video, adaptive computer games and communication. With the help of the Consortium on Technology for Proactive Care, the investigators will enhance the current VM system with an additional interactive physical exercise module and a health coach with automated tailored messaging and incentives for continued engagement and adherence. This will optimize the VM system for home-based deployment, thus expanding the reach and impact of VM to potentially delay or even prevent institutionalization among older adults living independently.
The goal of the proposed project is to test the feasibility of deploying an economically
feasible, machine-assisted, home-based wellness coaching system for older adults. Our
approach consists of four sub-phases: (1) development, (2) usability, (3) preliminary
deployment, and (4) pilot evaluation and analysis. The investigators estimate that the
investigators will complete this project plan within 9 calendar months.
Sub-phase 1: Development [3 months and 3 weeks]. During sub-phase 1, the investigators will
focus on software development activities at both VM and NU. There are 2 deliverables
resulting from this sub-phase:
Build coaching interface. VM has an administrator interface that facilitates the design,
assignment to users and adherence monitoring of a cognitive exercise plan. Using NU's
experience and expertise, our developers will broaden the VM functionality to include a
physical exercise module that allows assignment of exercise plans to users, monitoring of
users' adherence and social interactions, as well as the delivery of tailored feedback and
encouragement. The reward system of VM which currently rewards engagement in a variety of
activities will be adapted to also reward physical activity. VM will create a new user type
for the coach that allows for data sharing and an ability to communicate with family and/or
caregivers in addition to the participant.
Integrate GymCentral into VM. Developed by researchers at the University of Trento in Italy
(an international member of the CTPC), the primary software developer is now a postdoctoral
fellow at NU and key personnel on this grant application. GymCentral is a virtual training
platform (virtual gym) specifically designed for older adults. The virtual gym delivers video
exercises in a "classroom" where trainees can see the presence of other trainees as avatars
and communicate with them. The virtual gym aims to boost older adults' social interaction and
motivate them to adhere to physical exercises. Our team of developers will integrate this
system with the VM platform so that GymCentral can be deployed and collect engagement data
within the VM system.
Sub phase 2: Usability [1 month]. In sub-phase 2, VM will connect with several of its
independent living community's clients that have agreed to help recruit 5 independently
living older adults who have and use computers for a pilot study (recruiting details
specified below). This group will serve as the early usability testers for the home version
of the VM system (VM@Home) and provide iterative feedback for our developers. Each of these 5
individuals will be given VM@Home to use on their home computers for one month. During this
month, each participant will be provided a wearable wrist accelerometer (e.g., Misfit), along
with training on the devices and on VM@Home, engage regularly with the platform, and be
contacted weekly by a health coach. The investigators plan to use an innovative remote
usability testing approach developed and tested by our collaborator Dr. Jimison. The
developer and tester team will periodically contact the participants, especially if any
anomalies are detected. During the remote sessions, participants will be asked to interact
with the VM modules (calendaring, messaging, brain games, and Web entertainment) and the new
physical exercise module. The iterative usability feedback will be used to adapt the design
of the system for deployment in Sub-phase 3.
Sub-phase 3: Pilot Test [3 months]. After usability testing has been completed and necessary
changes implemented, the investigators will ramp up recruitment activities through existing
VM clients who have agreed to participate in the study with the goal of deploying VM@Home in
an additional 15 homes of independently living older adults in independent-living
communities. The five individuals who were recruited for sub-phase 2 will be offered the
opportunity to continue in the study as champions of the technology, for which the
investigators will provide additional training and support. As champions, they will mentor
those of the other 15 users who will need assistance. During this sub-phase, the
investigators will measure system use (continuously), level of physical activity (daily from
wearable), level of socialization (daily from monitoring and by survey at baseline and each
month), and mood, self-efficacy, and user satisfaction all by self-report at baseline and
each month.
At the end of the three months, the investigators will also debrief with each participant
with a semi-structured interview to obtain overall feedback and suggestions. These debriefing
sessions will help investigators and developers to enhance design specifications for a
robust, reliable and effective integrated engagement and coaching system to provide guidance
for the further development and testing in a much larger population in Phase II. This will
include exploring best options for including reward systems for active participation.
Sub-phase 4: Analysis [1 month]. Although the investigators will be routinely analyzing the
monitoring data from system use and daily activity feedback from the wearable activity
tracker throughout the project for coaching purposes, the last month of the project will be
devoted to analyzing the full set of primary and secondary outcomes, as well as the
qualitative debriefing interviews. The results from this pilot will prepare us for a more
expanded and more powerful intervention in our follow-on Phase II proposal.
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