Physiotherapy Programmes Aided by VR Solutions Applied to the Seniors Affected by Functional Capacity Impairment: Randomised Controlled Trial

[Effect of training with immersive virtual reality on the risk of falling in the elderly: a systematic review]

Aging entails changes in the human body, generating a decrease in physical capabilities, including the risk of falls. New therapies are currently emerging for the risk of falls and immersive virtual reality is one of them, giving the user a realistic feeling of a virtual environment. This systematic review aims to investigate the effects of immersive virtual reality on the risk of falling in older people. Randomized controlled clinical trials were included, with at least one intervention group that used immersive virtual reality, age >60 years and without multiple serious pathologies. Articles published until November 2023 were included, in accordance with the PRISMA guideline and including the PICO strategy, in the electronic databases PubMed, Scielo, Scopus, Semantic Scholar and Science Direct. From a total of 413 articles, 7 studies were selected, which met the pre-established inclusion and exclusion criteria. Of the studies reviewed, the majority found significant improvements in tests that measure risk of falls, only one study did not find improvements in this variable but did find improvements for walking speed and functional reach test. Despite the limited literature, it seems that these interventions can have a positive effect, becoming a good tool to reduce the risk of falling in older people.

Telerehabilitation in Physiotherapy Science: A Scoping Review

The advancement of computer science technologies and telemedical devices has led to an increase in the use of telerehabilitation (TR) as a therapeutic intervention. In our days, TR interventions can be considered as alternative solutions to face-to-face therapy. The primary aim of this study is to evaluate whether TR can be effective in physiotherapy. This can be adjudicated by investigating the use of the TR applications, their cost effect, and the level of effectiveness each one of them can provide. Randomized controlled trials that were published between 2003 and 2023 in the English language and used TR as the intervention were collected from online databases (MEDLINE, Physiotherapy Evidence Database (PEDro), and Cochrane) to be reviewed. Twenty of them met the criteria and were included in the study. Studies meeting the inclusion criteria were categorized by the body system investigated. Out of the 20 studies that met the inclusive criteria, five are related to the musculoskeletal system, six are related to the nervous system, two are related to proprioception and balance, one is related to the respiratory system, one is related to the cardiovascular system, two are related to pelvic floor control, and three are related to autoimmune disorders. Studies have shown that implementing TR has resulted in significant improvements in terms of functionality, muscle strength, endurance, and self-improvement. Proprioception, autoimmune diseases, and cardiovascular health have shown the most improvement. The most commonly used tools for implementing TR are gamified virtual reality (VR) and digital apps. However, there are some disadvantages, such as the lack of personal contact and the cost involved. We found that TR has the potential to positively impact various health disorders, making it a suitable form of therapy for people who can't receive in-person treatment. Nonetheless, it cannot replace traditional physiotherapy, nor does it hold the same value as it.

The Effects of ICT-Based Interventions on Physical Mobility of Older Adults: A Systematic Literature Review and Meta-Analysis

Systematic literature review and meta-analysis were conducted to integrate and analyze intervention studies dealing with the effects of information and communications technology- (ICT-) based interventions on the physical mobility of older adults in the community. The PubMed/MEDLINE, Embase, CINAHL, and Cochrane CENTRAL databases were searched for studies published from January 2000 to December 2022. We used the Risk of Bias 2 (RoB 2) tool to evaluate the quality of the randomized controlled studies in the systematic review. The meta-analysis was performed using a random-effects model. The model was used to calculate the standardized mean difference (SMD) and 95% confidence interval (CI) for both effect measures. I2 tests were used to measure the presence of heterogeneity. Thirty-seven randomized controlled trials were included (2,419 intervention participants), of which 23 were included in the meta-analysis. ICT interventions significantly improved Timed Up and Go (TUG) as a marker of physical mobility variable in older adults (SMD = -0.33, 95% CI: -0.57 to -0.10, p=0.005, I2 = 74.7%). A sensitivity analysis was performed on subgroups, and interventions were found to be effective in improving TUG in the exergame group (SMD = -0.40, 95% CI: -0.72 to -0.08, p < 0.001, I2 = 75.0%) and in the exergame with virtual reality (VR) group (SMD = -0.33, 95% CI: -1.01 to 0.35, p < 0.001, I2 = 91.0%) but both groups showed high heterogeneity. A meta-analysis was also performed on Short Physical Performance Battery (SPPB) but statistically significant results were not found (SMD = -0.19, 95% CI: -0.61 to 0.23, p=0.375, I2 = 87.7%). For the Berg Balance Scale (BBS), the post-intervention scores were significantly better than baseline (SMD = 1.52, 95% CI: 0.48 to 2.57, p=0.004, I2 = 93.5%). However, the number of studies included in the meta-analysis was small and heterogeneity was high, so follow-up studies are needed. This study confirmed that exergames, telecommunication, e-health, information applications, and robots were used as effective ICT-based interventions for improving the physical mobility of older adults. It is necessary to develop and apply more diverse ICT-based interventions that will prevent impairments of mobility and encourage older adults to live more independently, with a higher quality of life, based on extensive research on ICT-based interventions.

Telerehabilitation in Low-Resource Settings to Improve Postural Balance in Older Adults: A Non-Inferiority Randomised Controlled Clinical Trial Protocol

Background: Several exercise methods with virtual reality devices have been used in treatments for older adults and patients with neurodegenerative diseases, although the mechanisms continue to be elucidated. The aim of this study is to establish the feasibility and effectiveness of a rehabilitation programme using low-cost virtual reality aimed at improving postural balance in older adults. It also seeks to compare low-cost virtual reality under two delivery modalities, telerehabilitation (TR) in elderly centres and face-to-face (FtF) in rehabilitation centres. Methods: The study is set up as a non-inferiority two-arm parallel triple-blind randomised controlled clinical trial. Sixteen persons aged 65 to 75-years-old will be included. Eighteen Wii therapy sessions (25-30 min) will be provided through both FtF (control group, n = 8) and TR (exposure group, n = 8), both with a Nintendo Wii balance board. Data will be collected at baseline (week 0), during the Wii therapy sessions (weeks 2, 4, and 6), and during the follow-up (weeks 8 and 10). The primary outcome will be the area of centre-of-pressure (CoP) sway; secondary outcomes will be medial-lateral and anterior-posterior velocity and standard deviation of CoP; and tertiary outcomes will be clinical measures: single-leg stand, timed up-and-go tests, Barthel Index, and Tinetti's scale. Statistical analyses will be performed using SPSS 20.00 for Windows. The trial adheres to the Declaration of Helsinki and the Chilean laws of rights and duties of the patient and research in humans. Ethical approval was obtained from the Ethics Committee of the University of Talca. Written informed consent will be obtained from participants. Discussion: In this trial, older adults from a Chilean city with a large rural and underserved population share will be included to test the feasibility and effectiveness of a rehabilitation programme using low-cost VR aimed at improving postural balance to generate evidence to support decision makers generating public health policy. Trial registration: Australian New Zeeland Clinical Trials Registration (ACTRN12621001380886).

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.

Research on the Factors Affecting the Adoption of Smart Aged-Care Products by the Aged in China: Extension Based on UTAUT Model

With the rapid development of network technology and smart technology, smart aged-care products are becoming increasingly valued for their ability to help the aged actively cope with the challenges of aging. However, seniors face challenges in using smart aged-care products for many reasons, which reduces their willingness to adopt them. As a result, the sustainable development of smart aged-care products is constrained. This study combined the unified theory of technology acceptance and use, perceived risk theory and perceived cost theory, and reconstructed a research model that investigated the adoption of smart aged-care products by the elderly in China. Questionnaires were given to older Chinese adults in this study, and 386 valuable responses were received. The findings of the structural equation model (SEM) analysis are as follows: (1) performance expectancy, effort expectancy, and social influence were positively related to the behavioral intention of seniors to use smart aged-care products; (2) perceived cost and perceived risk were negatively related to the behavioral intention of seniors to use smart aged-care products; (3) perceived risk indirectly affected use behavior through behavioral intentions; (4) facilitating conditions did not have a significant impact on the use behavior of seniors in adopting smart aged-care products. Based on the empirical results, this study sought to improve the use behavior of the aged in relation to the adoption of smart aged-care products, and provided suggestions to improve the overall service quality and sustainability of those products.

Acceptability, Feasibility, and Effectiveness of Immersive Virtual Technologies to Promote Exercise in Older Adults: A Systematic Review and Meta-Analysis

CONTEXT

This review aimed to synthesize the literature on the acceptability, feasibility, and effectiveness of immersive virtual technologies to promote physical exercise in older people.

METHOD

We performed a literature review, based on four databases (PubMed, CINAHL, Embase, and Scopus; last search: 30 January 2023). Eligible studies had to use immersive technology with participants aged 60 years and over. The results regarding acceptability, feasibility, and effectiveness of immersive technology-based interventions in older people were extracted. The standardized mean differences were then computed using a random model effect.

RESULTS

In total, 54 relevant studies (1853 participants) were identified through search strategies. Concerning the acceptability, most participants reported a pleasant experience and a desire to use the technology again. The average increase in the pre/post Simulator Sickness Questionnaire score was 0.43 in healthy subjects and 3.23 in subjects with neurological disorders, demonstrating this technology's feasibility. Regarding the effectiveness, our meta-analysis showed a positive effect of the use of virtual reality technology on balance (SMD = 1.05; 95% CI: 0.75-1.36; p < 0.001) and gait outcomes (SMD = 0.7; 95% CI: 0.14-0.80; p < 0.001). However, these results suffered from inconsistency and the number of trials dealing with these outcomes remains low, calling for further studies.

CONCLUSIONS

Virtual reality seems to be well accepted by older people and its use with this population is feasible. However, more studies are needed to conclude its effectiveness in promoting exercise in older people.

Validation of FES-I and Short FES-I Scales in the Polish Setting as the Research Tools of Choice to Identify the Fear of Falling in Older Adults

Fear of falling is associated with a clear hazard to individual self-reliance, reduced physical activity, as well as a sense of shame and loss of self-confidence. The present study aimed to complete the applicable translation and validation protocol for the Falls Efficacy Scale-International (FES-I) tool, following its prior adaptation to ensure full compatibility with the Polish setting. The FES-I questionnaire, along with its abridged version, was translated in line with the recommended standards of the MAPI Institute, taking into account both the cultural fabric and pertinent language specifics of the country. The survey was attended by 740 individuals (N = 740; 463 women, 277 men), over 60 years old. All respondents were required to complete both the FES-I and FES-I (Short) questionnaires twice, following an intervening period, and subsequently had their responses statistically assessed. The FES-I questionnaire, along with its abridged version, may be recommended as an effective assessment tool for addressing the fear of falling issue among the older adults, consequently allowing the teams of attending physicians, physiotherapists, psychologists, or psychiatrists to complete an unambiguous diagnosis, with a view to helping the patients overcome this particular type of anxiety.