Effectiveness of virtual reality technology on functional mobility of older adults: systematic review and meta-analysis

Effects of active exergames on physical performance in older people: an overview of systematic reviews and meta-analysis

This overview assessed the available body of published peer-reviewed systematic reviews and meta-analyses related to the effects of active exergames compared with active/passive control on physical performance outcomes in older people. The methodological quality and certainty of evidence were assessed using PRISMA, AMSTAR 2, and GRADE. The protocol was registered in PROSPERO (code: CRD42023391694). The main outcomes indicate that 4,477 records, five systematic reviews, and 10 meta-analyses were included. The AMSTAR-2 reported six meta-analyses with high methodological quality, four moderate quality, two systematic reviews with low quality, and three very-low quality. Meta-analysis was performed on balance using the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG) tests, on cardiorespiratory fitness using the 6-min walk test, and on upper and lower limbs muscle strength using the handgrip strength, knee extension, and 30-s chair stand tests. Significant differences in favor of the active exergames groups concerning active/passive groups were reported in BBS (SMD = 0.85; 95% CI = 0.12-1.58; I2 = 96%; p = 0.02), TUG (SMD = 1.44; 95% CI = 0.71-2.16; I2 = 97%; p < 0.0001), and 30-s chair stand test (SMD = 0.79; 95% CI = 0.33-1.25; I2 = 88%; p = 0.0008). However, no significant differences were reported in favor of the active exergames groups in 6-min walk (SMD = 0.93; 95% CI = -0.64 to 2.50; I2 = 95%; p = 0.24), handgrip strength (SMD = 0.67; 95% CI = -0.04 to 1.38; I2 = 84%; p = 0.06), and knee extension tests (SMD = 0.20; 95% CI = -0.05 to 0.44; I2 = 95%; p = 0.12) compared to active/passive control. However, it was impossible to perform a meta-analysis for the variables of walking speed as a fall risk due to the diversity of instruments and the small number of systematic reviews with meta-analysis. In conclusion, interventions utilizing active exergames have shown significant improvements in the static and dynamic balance and lower limb muscle strength of apparently healthy older people, compared to control groups of active/inactive participants, as measured by BBS, TUG, and 30-s chair stand tests. However, no significant differences were found in the 6-min walk, HGS, and knee extension tests.

Systematic review registration

PROSPERO, CRD42023391694.

Can Virtual Reality Help Improve Motor and Cognitive Function in Active Aging in Older Adults? A Scoping Review

BACKGROUND

Active aging is considered one of the most effective methods for a healthy aging process. There are numerous clinical practice guidelines that address this model and propose multiple strategies for its achievement through the improvement of motor and cognitive function. Virtual reality is emerging as a potential tool, with various modalities focused on promoting good health maintenance in older adults. The objectives of this review were to map the potential benefits of virtual reality for active aging and delve into adaptability and adherence in older individuals.

METHODS

A scoping review was conducted on studies published between 2013 and 2023 in English, Spanish, or Catalan, examining virtual reality interventions in older adults. The search was performed using the Medline, CINAHL, Scopus, and Web of Science databases. The methodological quality was assessed using CASPe and FLC 3.0 critical appraisal guidelines. The graphical data were reported narratively, grouping results based on the study characteristics and the impact of virtual reality.

RESULTS

The review process resulted in the inclusion of 22 articles out of the initial 459 following the application of the selection criteria. Most articles were randomized controlled trials (45.4%; n = 10), systematic reviews (40.9%; n = 9), observational studies (9%; n = 2), and pilot studies (4.5%; n = 1). The information was organized based on the virtual reality modality (immersive, non-immersive, and 360) and application area (motor, cognitive, and mental health).

CONCLUSIONS

Virtual reality (both immersive and non-immersive) is a valuable tool for promoting physical exercise in older adults, helping to prevent recurrent accidental falls. It also yields positive results for cognitive stimulation in healthy older individuals, improving memory, depression, and mental health in those with cognitive impairment. Virtual reality is generally well-received by older adults, achieving high adherence rates.

Effects of virtual reality-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: A meta-analysis

BACKGROUND

Virtual reality (VR)-based pulmonary rehabilitation has been used in the management of chronic obstructive pulmonary disease (COPD). The efficacy of VR-based pulmonary rehabilitation for improving lung function in patients with COPD is controversial. Therefore, the aim of this meta-analysis was to evaluate the efficacy of VR combined with pulmonary rehabilitation for lung function in patients with COPD.

METHODS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was performed in the Cochrane Library, EMBASE, Web of Science, PubMed, and China National Knowledge Infrastructure databases from inception to February 1, 2023. All included studies were randomized controlled trials that assessed VR combined with pulmonary rehabilitation for COPD patients. The effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (CI). The Cochrane Collaboration tool was used to assess the risk of bias. Publication bias was assessed by Egger test.

RESULTS

A total of 11 studies met the inclusion criteria and were included in this study. The combined effect size showed that VR combined with pulmonary rehabilitation was more effective than pulmonary rehabilitation alone at improving forced expiratory volume in 1 second% (SMD: 0.51; 95% CI 0.19,0.82; P = .002), forced expiratory volume in 1 second/forced vital capacity (SMD: 0.71; 95% CI 0.49,0.93; P < .001), dyspnea (SMD: -0.44; 95% CI -0.66, -0.22; P < .001), and 6-minute walking test (SMD: 059; 95% CI 0.39, 0.79; P < .001). In addition, the VR combined with pulmonary rehabilitation improved depression (SMD: -0.34; 95% CI -0.05, -0.03; P = .033) and anxiety mood (SMD: -0.57; 95% CI -1.11, -0.04; P = .036) compared with the pulmonary rehabilitation group.

CONCLUSION

This meta-analysis indicated that VR regimens could be used to enhance the therapeutic effect of pulmonary rehabilitation in patients with COPD. However, as a rapidly evolving field, more well-designed randomized controlled trials are needed to determine the impact of VR-based pulmonary rehabilitation on COPD patients.

Effects of digital-based interventions on muscular strength in adults: a systematic review, meta-analysis and meta-regression of randomized controlled trials with quality of evidence assessment

BACKGROUND

In the last three decades, both medical and sports science professionals have recognized the considerable potential of digital-based interventions (DBI) to enhance the health-related outcomes of their practitioners.

OBJECTIVES

This study aimed to investigate the effectiveness and potential moderators of DBI on measures of muscular strength.

METHODS

Six databases (PubMed/MEDLINE, Web of Science, SportDiscus, Embase, Cochrane Register of Controlled Trials and Google Scholar) were searched for eligible studies up to June 2022. The GRADE, PEDRO, and TIDieR checklists were used to assess the quality of evidence, methodology, and completeness of intervention descriptions, respectively.

RESULTS

A total of 56 studies were included in the meta-analysis (n = 2346), and participants were classified as healthy (n = 918), stroke survivors (n = 572), diagnosed with other neurological disorders (n = 683), and frail (n = 173). The DBI showed a small effect (standardized mean difference [SMD] = 0.28, 95% CI 0.21 to 0.31; p < 0.001) on strength, regardless of the type of intervention, control group, or tested body part. More specifically, while splitting the studies into different subgroups, a meta-analysis of 19 studies (n = 918) showed a small effect (SMD = 0.38, 95% CI 0.12 to 0.63; p = 0.003) on strength in the asymptomatic population. Similarly, small but positive effects of DBI were observed for stroke survivors (SMD = 0.34, 95% CI 0.13 to 0.56; p = 0.002), patients diagnosed with other neurological disorders (SMD = 0.17, 95% CI 0.03 to 0.32; p = 0.021), and the frail population (SMD = 0.25, 95% CI 0.0 to 0.5; p = 0.051). Sub-group analysis and meta-regression revealed that neither variable modified the effects of the DBI on measures of strength.

CONCLUSIONS

Overall, DBI may serve as an effective method to improve measures of strength in adults, regardless of their health status as well as the type of digital device, the presence of human-computer interaction, and the age of participants. In addition, the DBI was found to be more effective than traditional training or rehabilitation methods.KEY MESSAGESDigital-based intervention (DBI) is effective in improving measures of muscular strength in adults regardless of participants' health statusDBIs were equally effective for strength improvements in lower and upper limbsAlthough, DBIs were found to be effective in improving muscular strength, most studies did not follow strength training guidelines when prescribing the interventions.

Rehabilitation Technologies for Chronic Conditions: Will We Sink or Swim?

INTRODUCTION

Chronic conditions such as stroke, Parkinson's disease, spinal cord injury, multiple sclerosis, vestibular disorders, chronic pain, arthritis, diabetes, chronic obstructive pulmonary disease (COPD), and heart disease are leading causes of disability among middle-aged and older adults. While evidence-based treatment can optimize clinical outcomes, few people with chronic conditions engage in the recommended levels of exercise for clinical improvement and successful management of their condition. Rehabilitation technologies that can augment therapeutic care-i.e., exoskeletons, virtual/augmented reality, and remote monitoring-offer the opportunity to bring evidence-based rehabilitation into homes. Successful integration of rehabilitation techniques at home could help recovery and access and foster long term self-management. However, widespread uptake of technology in rehabilitation is still limited, leaving many technologies developed but not adopted.

METHODS

In this narrative review, clinical need, efficacy, and obstacles and suggestions for implementation are discussed. The use of three technologies is reviewed in the management of the most prevalent chronic diseases that utilize rehabilitation services, including common neurological, musculoskeletal, metabolic, pulmonary, and cardiac conditions. The technologies are (i) exoskeletons, (ii) virtual and augmented reality, and (iii) remote monitoring.

RESULTS

Effectiveness evidence backing the use of technology in rehabilitation is growing but remains limited by high heterogeneity, lack of long-term outcomes, and lack of adoption outcomes.

CONCLUSION

While rehabilitation technologies bring opportunities to bridge the gap between clinics and homes, there are many challenges with adoption. Hybrid effectiveness and implementation trials are a possible path to successful technology development and adoption.

Effectiveness of virtual reality-based balance and gait in older adults with fear of movement: A systematic review and meta-analysis

OBJECTIVE

To summarize the current evidence from randomized controlled trials (RCTs) regarding the effectiveness of Virtual Reality (VR) training and functional mobility in older adults with fear of movement. TYPE: Systematic review and meta-analysis of randomized clinical trials.

METHODOLOGY

An electronic search was performed using PubMed, Embase, Medline, SPORTDiscus, Scopus, and CINAHL. A data search from January 2015 to December 2022 and a manual electronic literature search were conducted to identify published RCTs. The effectiveness of VR-based balance training for balance and gait was evaluated in older adults with a fear of movement, which was measured by the Timed Up and Go (TUG) test and the Falls Efficacy Scale (FES). Three reviewers independently performed the study selection, and the quality assessment of the included studies was performed using the Physiotherapy Evidence Database (PEDro) scale. The reporting was based on the new Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines.

SYNTHESIS

The search product produced 345 results, from which 23 full text articles were studied. Seven RCTs of good methodological quality, including 265 participants, were included in the review. Overall, the studies reported that VR had a significant improvement on the TUG (Cohen's d = -0.91 [-1.38; -0.44], p = 0.001), while the FES was not significantly different (Cohen's d = -0.54 [-1.80; 0.71] p = 0.40). The average for PEDro scores (6.14) was good, and the risk of bias revealed that more than one-third of the studies correctly described the random sequence generation and allocation concealment procedures.

CONCLUSION

VR-based training is effective on balance or gait training based on the TUG; however, there were mixed results to improve FES scores following VR intervention. These inconsistent results might be limited due to variations in the studies, including heterogeneous training paradigms, sensitive outcome measures, small sample sizes, and short intervention durations, which limit the validity of our findings. Future investigations should compare different VR protocols to help establish better guidelines for clinicians.

Rehabilitation in Older Adults Affected by Immobility Syndrome, Aided by Virtual Reality Technology: A Narrative Review

Individual mobility deficit in older adults induces a variety of medical conditions, diminishing their functional capacity in pursuing activities of daily living. In immobility syndrome patients, such conditions are prone further deterioration through a drastically reduced scope of physical activity, owing mostly to poor self-motivation and the monotonous character of conventional rehabilitation regimens. As evidenced by published research, virtual reality technology solutions in rehabilitation management actually add significantly to patients' self-motivation, while promoting their active involvement in therapy through visual, auditory, and kinaesthetic stimuli. Effective rehabilitation training aided by virtual reality solutions helps patients acquire specific physical and cognitive skills to be subsequently emulated in the real-world environment. The extra added advantage lies in facilitating such training within patients' own home environments, combined with online monitoring of their progress, when not personally supervised by a physiotherapist, which also boosts the overall cost effectiveness of the therapeutic management itself. This narrative review appears to be the very first one principally focused on critically comparing individual immobilisation with immobility syndrome, especially through the application of the Authors' own substantial hands-on therapeutic experience in managing various rehabilitation schemes, specifically aided by diverse virtual reality technology solutions.

Older Adults' Experiences and Perceptions of Immersive Virtual Reality: Systematic Review and Thematic Synthesis

BACKGROUND

Immersive virtual reality (IVR) can be defined as a fully computer-generated environment shown on a head-mounted display. Existing research suggests that key features of IVR can assist older adults in their everyday lives, providing opportunities for health promotion and tackling social isolation and loneliness. There has been a surge in qualitative studies exploring older adults' experiences and perceptions of IVR. However, there has been no systematic synthesis of these studies to inform the design of new, more accessible IVR technologies.

OBJECTIVE

This study aimed to systematically review and synthesize qualitative studies exploring older adults' experiences and perceptions of IVR.

METHODS

A systematic review and thematic synthesis were conducted following the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. In total, 2 reviewers completed title and abstract screening, full-text screening, data extraction, and quality appraisal. Thematic synthesis is derived from the qualitative method, thematic analysis. It involves 3 key steps: initial coding and grouping of these codes, the formation of descriptive themes from these codes, and going beyond these data to form analytical themes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research approach.

RESULTS

Overall, 13 studies were included in the final synthesis, including 224 participants across 9 countries and 5 continents. Confidence in the evidence ranged from high to moderate. Three descriptive themes were generated: practical aspects of IVR use, experiencing unique features of IVR, and perceptions of IVR. The findings from the descriptive themes suggested that there are several improvements that need to be made to existing IVR devices to facilitate older adults' use of this technology. However, older adults' responses to IVR were generally positive. Three analytical themes were generated: tolerating the bad to experience the good, buying in to IVR (don't judge a book by its cover), and "it proves to me I can do it." The analytical themes illustrated that older adults were willing to tolerate discomforts that accompany existing IVR technologies to experience features such as immersive social networking. There was a discrepancy between older adults' perceptions of IVR before use-which were generally negative-and after use-which were generally positive-and IVR provided a platform for older adults to access certain activities and environments more easily than in the real world because of limitations caused by aging.

CONCLUSIONS

This review offers insights into older adults' experiences and perceptions of IVR and suggests how a few improvements to its existing hardware and software as well as how it is first presented could offer new opportunities for older adults to take part in meaningful activities tailored to their needs and preferences.

TRIAL REGISTRATION

PROSPERO CRD42020200774; https://tinyurl.com/8f48w2vt.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1177/16094069211009682.

Development and evaluation of two brief digital health promotion game booths utilizing augmented reality and motion detection to promote well-being at a gerontechnology summit in Hong Kong

Background

The acceleration of population aging calls for simple and effective interventions catered for older people. Gerontechnology, the combination of gerontology and technology, can promote quality of life in older adults. However, public health-related events incorporating information communication technology (ICT) for older people have seldom been evaluated.

Objective

We reported the development and evaluation of two simple and brief digital health promotion games hosted at the annual Hong Kong Gerontech and Innovation Expo cum Summit (GIES) in 2018 and 2019 to promote well-being.

Methods

Two game booths (Dinosaur Augmented Reality photo-taking in 2018, Sit-and-Stand fitness challenge in 2019) were designed by our interdisciplinary team. Four gaming technologies were employed: augmented reality, chroma key (green screen), motion detection and 3D modeling. Immediately after the game, we administered a brief questionnaire survey to assess participant satisfaction, happiness and perceived benefits, and collected qualitative data through observations and informal interviews.

Results

Majority of 1,186 and 729 game booth participants in 2018 and 2019, respectively, were female (73.4% and 64.7%) and older adults (65.5 and 65.2%). Overall satisfaction toward the game booths was high (4.64 ± 0.60 and 4.54 ± 0.68 out of 5), with females and older adults reporting higher scores. Average personal and family happiness of participants in 2018 were 8.2 and 8.0 (out of 10). 90.3 and 18.4% of participants in 2019 chose one or more personal (e.g. enhance healthy living habits 62.4%, enhance personal happiness 61.6%) and family (e.g. enhance family happiness 15.6%, improve family relationships 10.8%) benefits of the game booth, respectively. Participants showed enthusiasm toward the technologies, and pride in their physical abilities in the fitness challenge.

Conclusion

Our report on the development and evaluation of brief game interventions with ICT showed high satisfaction and immediate perceived benefits in community participants. Females and older adults reported higher satisfaction. Simple tools measuring happiness and perceived benefits showed positive results. Older adults were receptive and enthusiastic about the new technologies. Our findings can inform researchers and organizers of similar events. More research on simple and enjoyable ICT interventions is needed to attract older adults and promote their well-being.

Trial registration

The research protocol was registered at the National Institutes of Health (Identifier number: NCT03960372) on May 23, 2019.

The Effectiveness of Virtual Reality Interventions on Smoking, Nutrition, Alcohol, Physical Activity and/or Obesity Risk Factors: A Systematic Review

To our knowledge, no systematic reviews have examined the effectiveness of virtual reality (VR) interventions across all smoking, nutrition, alcohol, physical activity, and/or obesity (SNAPO) risk factors. This systematic review assessed the effectiveness of VR interventions on reducing SNAPO risks compared to control groups or other interventions. MEDLINE, EMBASE, Scopus, PsycINFO, and CENTRAL were searched to identify eligible studies published to 7 October 2021. Two reviewers independently completed screening, data extraction and quality assessment. Twenty-six studies were included, five on smoking, twelve on physical activity (PA), six on obesity, one on PA and obesity, one on obesity and nutrition, and one on obesity, nutrition and PA. VR was effective for smoking cessation in three studies and for smoking reduction in four studies. Seven studies had significantly higher PA in the VR group, and one study found significantly higher PA in a comparator group. Two studies showed VR was more effective at reducing BMI or weight than comparators. Three multiple health risks studies showed mixed results. The remaining studies found no significant difference between VR and control/comparators. VR appears promising for the treatment of smoking, nutrition, PA, and obesity risks; however, further randomised trials are needed.

Effectiveness of exergaming-based interventions for mobility and balance performance in older adults with Parkinson's disease: systematic review and meta-analysis of randomised controlled trials

BACKGROUND

exergaming-based interventions (EbIs) have been proposed to improve older adults' mobility and balance performance. However, the effectiveness of such interventions for older adults with Parkinson's disease (OAPD) remains unclear.

METHODS

seven databases (Web of Science, Medline, Academic Search Premier, CINAHL Complete, PsycINFO, PsychARTICLE and PubMed) were searched up to 7 April 2022. We assessed mobility and balance performance between EbIs groups and control groups or traditional physical training interventions (TPTIs) groups by comparing the outcomes of the Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), gait velocity, stride length and Functional Gait Assessment (FGA).

RESULTS

we scanned 1,190 articles and meta-analysed 19 trials (sample size = 781). In general, the results revealed statistical differences between EbIs groups and TPTIs groups in the TUG [mean difference (MD) = -1.030 s; 95% confidence interval (CI) = -2.029 to -0.031; P = 0.043; high quality of evidence], 6MWT (MD = 63.483 m; 95% CI = 9.542 to 117.425; P = 0.021; moderate quality of evidence), BBS (MD = 2.129; 95% CI = -1.293 to 2.965; P < 0.001; high quality of evidence) and FGA (MD = 2.099 95% CI = -0.306 to 3.893; P = 0.022; moderate quality of evidence). No significant difference was discovered between EbIs groups and TPTIs groups in enhancing gait velocity and stride length.

CONCLUSIONS

EbIs are statistically better than TPTIs in improving OAPD's performance in TUG, 6MWT, BBS and FGA, whereas only the change between EbIs and TPTIs in 6MWT can reach the value of minimal clinically important difference. Further studies are needed to better assess the effectiveness of exergaming-based interventions.

Movement characteristics during customized exergames after total knee replacement in older adults

Introduction

There is limited understanding of how older adults can reach kinematic goals in rehabilitation while performing exergames and conventional exercises, and how similar or different the kinematics during exergaming are when compared with conventional therapeutic exercise with similar movement. The aim of this study was to describe the movement characteristics performed during exercise in custom-designed exergames and conventional therapeutic exercises among patients who have undergone unilateral total knee replacement (TKR). In addition, the secondary aim was to assess the relation of these exercise methods, and to assess participants' perceived exertion and knee pain during exergaming and exercising.

Materials and methods

Patients up to 4 months after the TKR surgery were invited in a single-visit exercise laboratory session. A 2D motion analysis and force plates were employed to evaluate movement characteristics as the volume, range, and intensity of movement performed during custom-designed knee extension-flexion and weight shifting exergames and conventional therapeutic exercises post TKR. The perceived exertion and knee pain were assessed using the Borg Rating of Perceived Exertion and Visual Analog Scale, respectively.

Results

Evaluation of seven patients with TKR [age median (IQR), 65 (10) years] revealed that the volume and intensity of movement were mostly higher during exergames. Individual goniometer-measured knee range of motion were achieved either with exergames and conventional therapeutic exercises, especially in knee extension exercises. The perceived exertion and knee pain were similar after exergames and conventional therapeutic exercises.

Conclusions

During custom-designed exergaming the patients with TKR achieve the movement characteristics appropriate for post-TKR rehabilitation without increasing the stress and pain experienced even though the movement characteristics might be partly different from conventional therapeutic exercises by the volume and intensity of movement. Physical therapists could consider implementing such exergames in rehabilitation practice for patients with TKR once effectiveness have been approved and they are widely available.

A Serious Game for Performing Task-Oriented Cervical Exercises Among Older Adult Patients With Chronic Neck Pain: Development, Suitability, and Crossover Pilot Study

Background

There is sparse research on the effectiveness of therapeutic exercise for the treatment of neck pain in older adult populations. Moreover, there is a lack of research on the use of serious games or virtual reality for the treatment of neck pain in this population.

Objective

The primary aim of this study was to develop and assess the suitability of a serious game for performing task-oriented cervical exercises in patients with neck pain.

Methods

A serious game was designed based on the key features identified by previous studies that designed serious video games for physical and cognitive rehabilitation or exercise. The game in this study was designed to provide an interactive scenario, with the main functionality of the software solution to control a virtual airplane to reach targets using head motions. At the end of the exercise, the application stores the targets reached and missed and the airplane’s trajectory. A crossover pilot study was carried out for preliminary evaluation of the suitability of the technology in the older adult population. Men and women over 65 years of age with chronic neck pain were included. Subjects were randomly assigned to two study arms; each arm consisted of a sequence of two 4-week treatments with an intermediate washout period of 4 weeks. The total study duration was 16 weeks due to a final follow-up measure 4 weeks after the end of all treatments. Treatment A consisted of the use of the serious game developed in this study, and treatment B consisted of conventional exercises. Subjects allocated to the A-B study arm received treatment A first, followed by treatment B, and vice versa in the B-A arm. The following variables were assessed: Suitability Evaluation Questionnaire (SEQ) scores, Visual Analog Scale scores, and the number of targets reached in the serious game.

Results

A total of 18 subjects were assessed for eligibility. A total of 13 subjects, aged between 71 and 92 years (mean 81.85, SD 6.82), were finally included and completed the study protocol. The global mean SEQ score was 50.38 (SD 5.35) out of 65 points, showing good suitability of the serious game. Most patients considered the experience very enjoyable and “real” in terms of the virtual environment and found the information provided to be clear. Also, they believed that the game could be very helpful for their rehabilitation. None of the patients felt any neck pain or discomfort when playing the game, and only 2 patients out of 13 (15%) reported some degree of dizziness, eye discomfort, or disorientation, which did not limit their capacity to finish the session.

Conclusions

The serious game developed in this study showed good suitability for use in adults over 70 years of age with chronic neck pain. The game was a safe method for performing task-oriented cervical exercises, and patients reported very high levels of satisfaction and acceptance after the use of this technology.

Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder - A Methodological Paper

Background: Utilizing information technology (IT) systems, for example in form of computerized cognitive screening or exergame-based (also called active videogames) training, has gained growing interest for supporting healthy aging and to detect, prevent and treat neurocognitive disorders (NCD). To ameliorate the effectiveness of exergaming, the neurobiological mechanisms as well as the most effective components for exergame-based training remain to be established. At the same time, it is important to account for the end-users' capabilities, preferences, and therapeutic needs during the design and development process to foster the usability and acceptance of the resulting program in clinical practice. This will positively influence adherence to the resulting exergame-based training program, which, in turn, favors more distinct training-related neurobiological effects. Objectives and Methods: This methodological paper describes the design and development process of novel exergame-based training concepts guided by a recently proposed methodological framework: The 'Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health' (Li et al., 2020). Case Study: A step-by-step application of the MIDE-framework as a specific guidance in an ongoing project aiming to design, develop, and evaluate an exergame-based training concept with the aim to halt and/or reduce cognitive decline and improve quality of life in older adults with mild neurocognitive disorder (mNCD) is illustrated. Discussion and Conclusion: The development of novel exergame-based training concepts is greatly facilitated when it is based on a theoretical framework (e.g., the MIDE-framework). Applying this framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This is expected to foster the usability and acceptance of the resulting exergame intervention in "real life" settings. Therefore, it is strongly recommended to implement a theoretical framework (e.g., the MIDE-framework) for future research projects in line with well-known checklists to improve completeness of reporting and replicability when serious games for motor-cognitive rehabilitation purposes are to be developed.

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

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.

Old-age diversity is underrepresented in digital health research: findings from the evaluation of a mobile phone system for post-operative progress monitoring in Sweden

Much research is conducted to evaluate digital-based solutions for health-care services, but little is known about how such evaluations acknowledge diversity in later life. This study helps fill this gap and analyses participation in the evaluation of a web-based mobile phone system for monitoring the post-operative progress of patients after day surgery. Participation is conceptualised as resulting from three processes: pre-screening, recruitment and self-selection. Based on field information and survey data, this study models (a) the (non-)participation in a sample of 498 individuals aged 60 and older that includes non-screened, non-recruited, decliners and participants in the evaluation, and (b) the individual decision to participate in a sample of 210 individuals aged 60 and older who were invited to take part in the evaluation. Increasing age enhances the likelihood of not being screened, not being recruited or declining the invitation. Those not recruited were most often ineligible because of technology-related barriers. Decliners and participants differed by age, gender, job, health status, digital skills, but not by social participation. Results suggest that highly specific groups of older people are more likely to be involved than others. Old-age diversity is not properly represented in digital health research, with implications for the inclusivity of new digital health technologies. This has implications for increased risks of old-age exclusion and exacerbation of social and digital inequalities in ageing societies.