Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit Plus™ for frail elderly: study protocol for a feasibility trial

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

BACKGROUND

The accessibility, versatility and motivation provided by virtual reality technology (VRT) have fostered its rapid expansion as a rehabilitation technique to improve functional mobility. The aim of this study was to investigate the effectiveness of rehabilitation programmes using VRT, specific virtual reality technology (VRT-S) and non-specific virtual reality technology (VRT-NS), to improve functional mobility in individuals aged >60 years versus conventional treatment (CT) or no intervention.

METHODS

Nine databases (Cochrane Library, Scopus, PEDro, Medline, CSIC, Web of Science, OT Seeker, NGCH and CINAHL) were searched to identify randomised trials up to December 2019. Results of clinical trials that used VRT-S and VRT-NS in rehabilitation were combined, using a random effects model with inverse variance weighting of the studies. GRADE was used to assess the quality of evidence. The protocol was registered in PROSPERO: CRD42019131630. Overall, there was moderate quality of evidence for the functional mobility results, which means that the estimate of effect is likely to change.

RESULTS

Sixteen of the 18 studies selected (n = 568) provided data for the subgroup meta-analysis. VRT-NS was more effective in improving functional mobility than no intervention [standardised mean difference (SMD) = -1.02; 95% confidence interval (CI) -1,91 to -0,14). VRT-NS was also more effective than CT in improving resistance in ambulation (SMD = -1.20; 95% CI -1.93 to 0.46). No significant differences were found between VRT-S and CT or no intervention. Programmes in which >18 sessions were applied were more beneficial (SMD = -0.89; 95% CI -1.71 to -0.08; <0.001) than programmes with ≤18 sessions (SMD = 0.04; 95% CI -0.51 to 0.59) versus no intervention.

CONCLUSIONS

Our results suggest that VRT is an effective intervention for improving functional mobility in older persons compared with CT. VRT-NS proved to be more effective than VRT-S. However, these results are still not conclusive due to the low methodological quality of the studies. Thus, new studies and analyses are required.

Effectiveness of Virtual Reality Systems to Improve the Activities of Daily Life in Older People

(1) This review aims to evaluate the effectiveness of treatments with virtual reality systems (VRSs) on the functional autonomy of older adults versus conventional treatment. (3) Methods: Systematic review and meta-analysis. An electronic data search was carried out, following the PRISMA statement, up to February 2020. We combined results from clinical trials using VRSs for the improvement of basic and instrumental activities of daily living. The guidelines of the Cochrane Handbook for Systematic Reviews of Interventions were followed for calculations and risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence. (4) Results: The final analysis included 23 studies with a population of 1595 participants. A moderate, but clinically significant, effect was found for basic activities of daily living (BADLs), (Standard Medium Deviation, SMD 0.61; 95% CI: -0.15-1.37; P < 0.001). A small effect was found for instrumental ADLs (Instrumental Activities of daily living, IADLs) (SMD -0.34; 95% CI: -0.82-0.15; P < 0.001). Functional ambulation was the BADL which improved the most (SMD -0.63; 95% CI: -0.86, -0.40; P < 0.001). (5) Conclusion: The use of VRSs is an innovative and feasible technique to support and improve the functional autonomy of community-dwelling older adults. Due to the very low quality of the evidence for our main outcomes, the effects of a VRS on the BADLs and IADLs are uncertain. Clinical trials of a higher methodological quality are necessary to increase the level of knowledge of its actual effectiveness.

A single-arm feasibility study of community-delivered Baduanjin (Qigong practice of the eight Brocades) training for frail older adults

BACKGROUND

Frailty is a common geriatric syndrome, characterized by reduced physiologic reserve and increased vulnerability to stressors, due to cumulative decline in multiple physiological systems. We studied the feasibility of a community-delivered Baduanjin (BDJ) training program among pre-frail/frail community-dwelling older people. We examined (1) safety (adverse events) and physical and psychological effects; and (2) feasibility of recruitment, retention, adherence; recruitment efforts, and any program challenges, so as to inform future studies.

METHODS

Our study was a single arm pre-post study in a community setting. Sixteen-week group BDJ training (2×/week in the first 4 weeks and 3×/week thereafter) was co-designed and implemented by community-based providers in Singapore. Recruitment, attendance, and adverse events were recorded throughout the training. A participants' survey was also administered after the training program. Effects of the intervention on physical and functional outcomes (hand grip strength, knee extension strength, Time Up and Go (TUG), Physiological Profile Assessment (PPA), 30-s Sit-to-Stand test, 6-m fast gait speed test), frailty outcomes (frailty score and status), and other outcomes (Maastricht Questionnaire (MQ), Fall Efficacy Scale (FES), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), and EQ-5D-5L) were examined before and after the program.

RESULTS

Of 31 older adults screened to be frail, 15 met inclusion criteria and 3 refused participation, resulting in 12 older adults (9 women) enrolled into the program. During the program, one participant was hospitalized (unrelated to BDJ training) and the other 11 (aged 77 ± 6 years; 2 frail, 9 prefrail at baseline) completed the program with average overall attendance of 89%. Most (89%) of the 44 training sessions had attendance > 80%. The program received positive feedback with no training-related adverse events. Participants either reversed (n = 2) or maintained (n = 9) their frailty statuses. There post-training outcomes in hand grip strength, knee extension strength, TUG, MQ, FES, MoCA, GDS, and EQ-5D-5L index score appeared to be better. The reduction of frailty and PPA fall risk scores was of moderate-to-large effect size.

CONCLUSIONS

Community-delivered BDJ training program was safe and feasible for prefrail/frail older adults with the potential to improve physical and cognitive function, reduce fall risk, improve psychological well-being, and reverse frailty status.

Can exergames contribute to improving walking capacity in older adults? A systematic review and meta-analysis

BACKGROUND

The accessibility, low cost and motivation generated by exergames has fostered its rapid expansion as a rehabilitation technique.

OBJECTIVE

To estimate the effectiveness of rehabilitation programs using IVGT in improving walking capacity of people aged 60 years and over.

MATERIALS AND METHODS

The electronic data research following the PRISMA Statement (Scopus, Cochrane, Web of Science, OT Seeker, National Guideline Clearinghouse, Trip Database, CSIC Spanish National Research Council) was completed in September 2018. The results of randomized clinical trials using exergames for rehabilitation of walking capacity were combined. The calculations have followed the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The Grading of Recommendations Assessment, Development and Evaluation system was used to evaluate the quality of the evidence.

RESULTS

We obtained data from 14 trials, including 11 meta-analysis studies. The size of exergames effects on walking capacity is moderate, but significant (SMD -0.56; 95 % CI: -0.90, -0.21; p = 0.002). Effectiveness was greater to recover the ability to transfer from one position or place to another (SMD -1.02; CI 95 %: -1.70, -0.35; P = 0.003). The intervention protocols, their duration and intensity varied considerably. The lack of masking, the allocation concealment, the absence of assessor blinding were the main causes of bias so the final grade of evidence has been low for walking and very low for transfers.

CONCLUSIONS

Positive clinical effects of exergames have been found to improve walking capacity, but the quality of evidence to refute its effectiveness is weak with risk of bias. Further research is needed in order to know the actual magnitude of its effect.

The Effect of Frankel's Stabilization Exercises and Stabilometric Platform in the Balance in Elderly Patients: A Randomized Clinical Trial

Background and Objectives: Every year, older people are becoming a larger part of the population. In a couple of years medicine is going to struggle with specific disorders and their consequences, where one of them are falls. Fall prevention involves a use of strengthening exercises, equivalent exercises, stabilometric platforms, and special exercise programs. Almost the entire brain is involved in maintaining correct balance. Reduction of a volume of gray matter negatively affects balance. Single exercise sessions do not significantly improve balance. In order to achieve satisfactory results at least 10 training sessions are required. The aim of this study is to determine if there is a correlation between a risk of falls, gender, and a risk of falls and the age of the subjects. Another reason to conduct that research was to assess the effectiveness of Frankel's exercises and training of using the stabilometric platform in rehabilitation, which aims to reduce the risk of falls among elderly people. Materials and Methods: The study involved 40 elderly patients referred for physiotherapy to a rehabilitation center. The patients were divided into two groups of 20 people. In experimental group 1 (C) Frankel's stabilization exercises were used; in experimental group 2 (E) a stabilometric platform was used. The correlation between the risk of falls and age as well a risk of falling and the gender of the examined persons was taken into consideration. The effect of therapy that uses stabilization exercises and the stabilometric platform on the risk of falls in the examined persons was assessed using the Tinetti scale. Clinical control was performed using the Tinetti scale, before and after a two-week rehabilitation period. Results: The study showed no correlation between the degree of risk of falling and age, and between the risk of falling by the elderly and gender. There were also changes in the results obtained by patients after using the training, both with the use of Frankel's stabilization exercises as well as with the use of the stabilometric platform. Patients using the dynamometric platform obtained higher results in the Tinetti test after treatment. Conclusions: In the examined sample, no correlation was found between the risk of falls and age as well as the risk of falls and gender. Both Frankel's exercises and training with the use of the stabilometric platform were effective in a rehabilitation program aimed at reducing the risk of falls among the elderly.

Effects of a Nintendo Wii exercise program versus Tai Chi Chuan on standing balance in older adults: a preliminary study

[Purpose] This study compared the effect of the Nintendo Wii balance board (NWBB) and Tai Chi Chuan (TCC) on the standing balance (SB) of older adults. [Participants and Methods] Twelve older adults (NWBB=7 and TCC=5) completed the intervention and two testing sessions (pre-post). SB was assessed using posturographic measures with the center of pressure (CoP) in five modes: quiet eyes open (QSB-EO) and eyes closed (QSB-EC), on sponge (SBS-EO and SBS-EC), and with optokinetic field (SB-OF). [Results] Both interventions significantly decrease the area of CoP sway (CoP_Sway) in QSB-EO and SB-OF. The NWBB-group decreased CoP_Sway in SBS-EC and CoP velocity (V_mean) in QSB-EO, QSB-EC, and SBS-EC. The TCC-group decreased the V_mean in SBS-EO and conversely the V_mean in QSB-EC increased. [Conclusion] Sponge and optokinetic field were the most unstable assessments. These findings reveal the potential benefits for SB of both interventions, however the NWBB improved more variables in the postural control of older adults.