Geriatric Disorder Clinical Trial
Official title:
Are Serious Games Promoting Mobility an Attractive Alternative to Conventional Self-training for Elderly People? A Randomized Controlled Trial.
The main objective of this study is to determine whether elderly people in rehabilitation
setting show higher adherence to self-training when using computer-based-learning games (i.e.
the so called serious games) than when performing conventional exercises. Secondly the study
explores to which extend balance and mobility performances vary according to the mode of
self-training.
The primary study hypothesis is that elderly people practice longer and more frequently with
serious games than with a conventional exercise booklet. The secondary hypothesis is that
patients experience a significant higher improvement in their balance capacity by using
serious games compared to patients performing conventional exercises.
Background:
The Swiss population, and in Europe in general, is getting older. Due to this evolving
demographic trend, the need to develop specific healthcare services for this age group is
becoming crucial. From the international literature, evidence-based findings have
demonstrated that physical abilities of elderly people can be increased, and institutional
placement and mortality can be reduced through specific inpatient rehabilitation programs
(Bachmann, Finger et al. 2010).
Adults 65 years and older should carry out aerobic physical activities for at least 150
minutes of moderate intensity or for 75 minutes of high intensity in a week. Besides it is
strongly recommended that senior adults perform strengthening exercises minimum twice a week
and activities promoting balance minimum thrice a week (WHO 2010; NIH 2013).
In order to increase the training intensity and thus the independence in activities of daily
living, older patients admitted in Kliniken Valens are instructed with a customized
self-training program, in addition to the usual rehabilitation services. As for
therapist-assisted sessions, this self-training program leads to significant improvement of
patient's physical performance (Olney, Nymark et al. 2006) and represents therefore a proven,
efficient and cost-effective intervention for inpatient settings. However, the compliance of
elderly people to execute self-training exercises varies considerably. These programs are
often considered as tedious and boring, and so prematurely stopped (Phillips, Schneider et
al. 2004). An alternative to increase patient's motivation could be through serious games
practice. Kliniken Valens has already experienced promising results with computer-based games
such as the Nintendo Wii® (Schnurr and Oesch 2012).
Methods:
In this study participants are categorized in 4 strata according to their Berg Balance Score
(BBS) (≤ 44 or ≥45) and their computer skills. Subsequently they are allocated randomly
either in the intervention group or in the control group. In addition to the usual
rehabilitation services provided in the clinic, participants of both groups are entitled to 2
additional time-slots (2 x 30 min/day) devoted to self-training and this during the 10 days
of the intervention period. This protocol ensures the same conditions for each participant to
perform or not self-training exercises. For safety measures, participants with a low BBS
(<45) perform the program in siting, whereas those with a higher BBS (≥45) practice in
standing position (in front of a bench). The time frame of the intervention phase (from t1 to
t2) lasts 10 working days and starts after self-training exercises have been instructed. In
other words, t1 equates to approximately day 4 after the patient's admission in the clinic
and t2 is 10 working days later, i.e. approximately day 16 after admission.
Intervention group:
The participants are instructed by experienced physiotherapists on serious games with
Kinect®. Additionally, participants wear the Fit Bit® (an activity tracker device) and are
encouraged to walk and climb stairs instead of using the escalator. Finally participants are
asked to write down in a logbook, the frequency and duration of their self-training sessions.
Control group:
As in the usual rehabilitation services, experienced physiotherapists arrange a customized
self-training program, instruct the exercises and deliver a hand-out. Additionally, patients
are encouraged to walk and climb stairs instead of using the escalator. Finally participants
are asked to write down in a logbook, the frequency and duration of their self-training
sessions.
Data collection:
Data on self-training's intensity (primary outcome) are extracted from the logbook at
post-intervention (t2) i.e. after the 10 working days of the intervention phase. The Berg
Balance Scale and the Falls Efficacy Scale (secondary outcomes) are completed by a blinded
researcher at pre- and post-intervention (before t1 and after t2) i.e. approximately at day
1-2 after admission and day 16-17 after admission.
Data analysis:
Data are analyzed using the statistical software for social sciences (SPSS). The statistical
analysis of the two groups is performed following a normal distribution of data, with an
unmatched t-test. For non-normal distributions, the Mann-Whitney U test is used.
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