1
|
van Santen J, Dröes RM, Blanson Henkemans O, Schoone M, Valk R, Straten AV, Meiland F. Implementation of exergaming for people with dementia: facilitators, barriers, and recommendations. Aging Ment Health 2024; 28:244-253. [PMID: 37493266 DOI: 10.1080/13607863.2023.2238259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES To identify facilitators, barriers, and formulate recommendations for the implementation of exergames for people with dementia (PWD) in day-care centers (DCCs). METHODS Within a randomized controlled trial into the effectiveness of exergaming, 73 PWD with their informal caregivers (IC) from 11 DCCs in the Netherlands and two exergame providers participated in a process evaluation. This was a mixed-methods study using focus groups, semi-structured interviews, the Measurement Instrument for Determinants of Innovations, forms for DCC staff, and a short satisfaction questionnaire. We used descriptive statistics for the quantitative outcomes, and thematic analysis for qualitative data. The Medical Research Council guidance for process evaluation was used to identify facilitators and barriers to the implementation, mechanisms of impact, and context. RESULTS Implementation-related facilitators and barriers were the availability of budget, staff, equipment, instructions, location, and supervision. Mechanisms of impact-related facilitators were experienced positive effects on physical functioning and mobility, cognitive, emotional, and social functioning, and quality of life. Barriers were mainly linked to the need to customize the intervention for each participant. Contextual facilitators were support and enthusiasm from others; barriers were costs and planning. Recommendations by DCC staff involved technical support, instructions, responsibility, location, supervision, planning, and exergaming as a group or individually. CONCLUSION Users, IC, and staff positively valued exergaming. We found various facilitators and barriers leading to recommendations for successful implementation. We recommend further research into tailoring exergaming to specific users and contexts, and into usability and cost-effectiveness. This may contribute to further dissemination and implementation of exergaming for PWD.
Collapse
Affiliation(s)
- Joeke van Santen
- Department of Psychiatry, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | | | - Ronald Valk
- HilverZorg-Day-Care Center Zonnehoeve, Hilversum, Netherlands
| | - Annemieke van Straten
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Clinical- Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - Franka Meiland
- Department of Psychiatry, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Medicine for Older People, Gerion, Amsterdam, Netherlands
| |
Collapse
|
2
|
van Santen J, Meiland FJM, Dröes R, van Straten A, Bosmans JE. Cost-effectiveness of exergaming compared to regular day-care activities in dementia: Results of a randomised controlled trial in The Netherlands. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1794-e1804. [PMID: 34657346 PMCID: PMC9544668 DOI: 10.1111/hsc.13608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/04/2021] [Indexed: 06/02/2023]
Abstract
The growing number of people living with dementia will result in increased costs of dementia worldwide. The e-Health intervention 'Exergaming' may improve health and quality of life of people with dementia, but the cost-effectiveness is unknown. We assessed the cost-effectiveness of exergaming compared to regular activities from a societal perspective in day-care centres (DCC) for people with dementia and their informal caregivers (IC) alongside a cluster randomised controlled trial. We included 112 dyads (person with dementia and IC) from 20 psychogeriatric DCCs (11 exergaming, 9 control) across the Netherlands. Exergaming consisted of interactive cycling at least twice a week for 6 months. Measurements were conducted at baseline (T0), after 3 (T1) and 6 (T2) months. Primary outcomes were minutes of physical activity, mobility of the participants with dementia (Short Physical Performances Battery, SPPB), and Quality-Adjusted Life-Years (QALYs) of participants with dementia and ICs. ICs filled out cost diaries to measure healthcare and informal care utilisation during the study. There were no statistically significant differences in outcomes or costs between the groups at the level of participants with dementia, the ICs or the dyad. With regard to QALYs and SPPB, the probability that exergaming is cost-effective compared to control was low for all possible willingness-to-pay (WTP) thresholds. However, for physical activity at WTP thresholds of 0, 50 and 250 Euros per additional minute of physical activity, the probability of cost-effectiveness is 0.46, 0.84 and 0.87, respectively. Exergaming in DCC was not cost-effective compared to usual activities. However, considering the small sample size and the large number of missing observations, findings should be interpreted with caution. Future studies with larger samples are recommended to obtain definitive answers on the cost-effectiveness of exergaming. This trial was registered in the Netherlands Trial Register (NTR5537/NL5420).
Collapse
Affiliation(s)
- Joeke van Santen
- Department of PsychiatryAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Franka J. M. Meiland
- Department of PsychiatryAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Department of Medicine for Older People, Amsterdam UMCAmsterdamThe Netherlands
| | - Rose‐Marie Dröes
- Department of PsychiatryAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Annemieke van Straten
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Department of Clinical‐, Neuro‐ and Developmental PsychologyFaculty of Behavioural and Movement SciencesVU University AmsterdamAmsterdamThe Netherlands
| | - Judith E. Bosmans
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| |
Collapse
|
3
|
Swinnen N, Vandenbulcke M, de Bruin ED, Akkerman R, Stubbs B, Firth J, Vancampfort D. The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial. Alzheimers Res Ther 2021; 13:70. [PMID: 33785077 PMCID: PMC8008333 DOI: 10.1186/s13195-021-00806-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is currently unknown whether exergaming is efficacious in people with major neurocognitive disorder (MNCD) residing in long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality of life, and daily life functioning in people with MNCD residing in long-term care facilities. METHODS Participants were randomly assigned to 8 weeks, three times weekly, 15 min of exergaming versus watching preferred music videos. The exergame device consisted of a pressure-sensitive step training platform on which participants performed stepping movements to play the games. The device automatically adapted the training level to the participants' capabilities. The Short Physical Performance Battery (SPPB), step reaction time test (SRTT), Montréal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Dementia Quality of Life (DQoL), and Katz Activities of Daily Living (Katz ADL) were assessed at baseline and post-intervention. A Quade's non-parametric ANCOVA controlling for baseline values with post hoc Bonferroni correction (p < 0.00625) was used to analyze pre- and post-differences between the groups. Partial eta-squared (η2p) effect sizes were calculated. RESULTS Forty-five of 55 randomized inpatients with mild to moderate MNCD (Mini-Mental State Examination score = 17.2 ± 4.5; aged 70-91; 35 women) completed the study. The exergame group (n = 23) demonstrated improvements in gait speed (p < 0.001, η2p = 0.41), total SPPB (p < 0.001, η2p = 0.64), SRTT (p<0.001, η2p = 0.51), MoCA (p<0.001, η2p = 0.38), and reductions in CSDD (p<0.001, η2p = 0.43) compared to the control group (n = 22). There were no differences in NPI (p = 0.165, η2p = 0.05), DQoL (p = 0.012, η2p = 0.16), and ADL (p = 0.008, η2p = 0.16) post-intervention scores between the experimental and control group, albeit DQol and ADL measures showed large effect sizes in the exergame group. The mean attendance rate was 82.9% in the exergame group and 73.7% in the music control group. There were no study-related adverse events reported by the participants, nor observed by the research team. CONCLUSIONS The findings of this pilot RCT suggest that an individually adapted exergame training improves lower extremity functioning, cognitive functioning and step reaction time and symptoms of depression in inpatients with MNCD residing in long-term care facilities. TRIAL REGISTRATION ClinicalTrials.gov, NCT04436302.
Collapse
Affiliation(s)
- Nathalie Swinnen
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Leuven, Kortenberg, Belgium
| | - Mathieu Vandenbulcke
- University Psychiatric Centre KU Leuven, Leuven, Kortenberg, Belgium
- KU Leuven Department of Neurosciences, Leuven, Belgium
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zürich, Switzerland.
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | | | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Leuven, Kortenberg, Belgium
| |
Collapse
|
4
|
Thomas TH, Sivakumar V, Babichenko D, Grieve VLB, Klem ML. Mapping Behavioral Health Serious Game Interventions for Adults With Chronic Illness: Scoping Review. JMIR Serious Games 2020; 8:e18687. [PMID: 32729836 PMCID: PMC7426803 DOI: 10.2196/18687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Serious games for health are increasingly being used to address health outcomes in patients with chronic illnesses. These studies vary in their study designs, patient populations, frameworks, outcome variables, and degree of specificity of the serious game intervention. OBJECTIVE This scoping review aims to clarify the conceptual features of the existing research related to serious games designed to improve cognitive and behavioral outcomes in adults with chronic illness. METHODS We applied the Preferred Reporting Items of Systematic Reviews and Meta-Analysis for scoping reviews (PRISMA-ScR) methodology, including an a priori research question. We searched 4 electronic databases to identify articles published through November 2019. Inclusion criteria encompassed (1) adults 18 years or older; (2) patients with a diagnosis of chronic illness; (3) a serious game intervention; and (4) defined patient outcomes that assess patients' behavioral, cognitive, or health outcomes. RESULTS Of the 3305 articles identified, 38 were included in the review. We charted and analyzed the theoretical frameworks, key concepts, and outcome variables of these studies with summaries of features across articles. The majority of studies used a randomized controlled trial design (23/38, 61%), included a custom serious game intervention (22/38, 58%), and lacked a theoretical framework (25/38, 66%). Common outcome variables included quality of life (16/38, 42%), mood (15/38, 39%), cognitive function (13/38, 34%), symptoms (12/38, 32%), and physical activity (9/38, 24%). Key differences between studies included whether or not serious games aimed to train versus teach patients, be widely accessible versus tailored interventions, or replace versus complement current treatments. CONCLUSIONS This scoping review defines the current landscape of research in serious games for health research targeting behavioral and cognitive outcomes in adults with chronic disease. Studies have addressed a variety of patient populations and diverse patient outcomes. Researchers wanting to build on the current research should integrate theoretical frameworks into the design of the intervention and trial to more clearly articulate the active ingredients and mechanisms of serious games.
Collapse
Affiliation(s)
| | - Varshini Sivakumar
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dmitriy Babichenko
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Victoria L B Grieve
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mary Lou Klem
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
5
|
van Santen J, Dröes RM, Twisk JWR, Blanson Henkemans OA, van Straten A, Meiland FJM. Effects of Exergaming on Cognitive and Social Functioning of People with Dementia: A Randomized Controlled Trial. J Am Med Dir Assoc 2020; 21:1958-1967.e5. [PMID: 32651132 DOI: 10.1016/j.jamda.2020.04.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Physical activity in people with dementia (PwD) may enhance physical and mental functioning. Exergaming, which combines physical exercise with cognitive stimulation in a gaming environment, was developed to overcome barriers in performing physical activities. We evaluated the effects of exergaming in day care centers (DCCs) for PwD and informal caregivers (ICs). DESIGN A randomized controlled trial among 23 DCCs across the Netherlands randomized to exergaming (interactive cycling during 6 months) or a care-as-usual control group. SETTING AND PARTICIPANTS A total of 112 (73 exergaming, 39 control) community-dwelling dyads (PwD, IC), with the PwD visiting a DCC at least twice per week. METHODS All outcomes were assessed using structured questionnaires during interviews with PwD and ICs at baseline (T0), 3 months (T1), and 6 months (T2). Primary outcomes: physical activity and mobility of the PwD. SECONDARY OUTCOMES physical, cognitive, emotional and social functioning, and quality of life for PwD. For ICs: experienced burden, quality of life, and positive care experiences. RESULTS Mixed-model analyses showed no statistically significant effects on primary outcomes. There were statistically significant positive effects on PwD's secondary outcomes at T2 on cognition [Mini-Mental State Examination (MMSE): r = 2.30, 95% confidence interval (CI): 0.65, 3.96, P = .007; and Trail Making Test part A (TMT-A): r = -28.98, 95% CI: -54.89, -3.08, P = .029], social functioning (Behavior Observation Scale for Intramural Psychogeriatrics subscale 1 (GIP): r = -1.86, 95% CI: -3.56, -0.17, P = .031), and positive post-test effects in ICs on distress caused by the PwD's neuropsychiatric symptoms (NPI-Q total distress: r = -3.30, 95% CI: -6.57, -0.03, P = .048) and on sense of competence (SSCQ: r = 2.78, 95% CI: 0.85, 4.71, P = .005). CONCLUSIONS AND IMPLICATIONS Exergaming appeared not effective on the primary outcomes. Despite the study being underpowered, we found positive effects on secondary outcomes for PwD and ICs, and no negative effects. We therefore recommend further study, dissemination, and implementation.
Collapse
Affiliation(s)
- Joeke van Santen
- Department of Psychiatry, Amsterdam UMC, VUmc, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam UMC, VUmc, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam UMC, VUmc, Amsterdam, the Netherlands
| | | | - Annemieke van Straten
- Department of Clinical- Neuro- and Developmental Psychology, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Franka J M Meiland
- Department of Psychiatry, Amsterdam UMC, VUmc, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| |
Collapse
|