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Mao Q, Zhang J, Yu L, Zhao Y, Luximon Y, Wang H. Effectiveness of sensor-based interventions in improving gait and balance performance in older adults: systematic review and meta-analysis of randomized controlled trials. J Neuroeng Rehabil 2024; 21:85. [PMID: 38807117 PMCID: PMC11131332 DOI: 10.1186/s12984-024-01375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/10/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Sensor-based interventions (SI) have been suggested as an alternative rehabilitation treatment to improve older adults' functional performance. However, the effectiveness of different sensor technologies in improving gait and balance remains unclear and requires further investigation. METHODS Ten databases (Academic Search Premier; Cumulative Index to Nursing and Allied Health Literature, Complete; Cochrane Central Register of Controlled Trials; MEDLINE; PubMed; Web of Science; OpenDissertations; Open grey; ProQuest; and Grey literature report) were searched for relevant articles published up to December 20, 2022. Conventional functional assessments, including the Timed Up and Go (TUG) test, normal gait speed, Berg Balance Scale (BBS), 6-Minute Walk Test (6MWT), and Falling Efficacy Scale-International (FES-I), were used as the evaluation outcomes reflecting gait and balance performance. We first meta-analyzed the effectiveness of SI, which included optical sensors (OPTS), perception sensors (PCPS), and wearable sensors (WS), compared with control groups, which included non-treatment intervention (NTI) and traditional physical exercise intervention (TPEI). We further conducted sub-group analysis to compare the effectiveness of SI (OPTS, PCPS, and WS) with TPEI groups and compared each SI subtype with control (NTI and TPEI) and TPEI groups. RESULTS We scanned 6255 articles and performed meta-analyses of 58 selected trials (sample size = 2713). The results showed that SI groups were significantly more effective than control or TPEI groups (p < 0.000) in improving gait and balance performance. The subgroup meta-analyses between OPTS groups and TPEI groups revealed clear statistically significant differences in effectiveness for TUG test (mean difference (MD) = - 0.681 s; p < 0.000), normal gait speed (MD = 4.244 cm/s; p < 0.000), BBS (MD = 2.325; p = 0.001), 6MWT (MD = 25.166 m; p < 0.000), and FES-I scores (MD = - 2.036; p = 0.036). PCPS groups also presented statistically significant differences with TPEI groups in gait and balance assessments for normal gait speed (MD = 4.382 cm/s; p = 0.034), BBS (MD = 1.874; p < 0.000), 6MWT (MD = 21.904 m; p < 0.000), and FES-I scores (MD = - 1.161; p < 0.000), except for the TUG test (MD = - 0.226 s; p = 0.106). There were no statistically significant differences in TUG test (MD = - 1.255 s; p = 0.101) or normal gait speed (MD = 6.682 cm/s; p = 0.109) between WS groups and control groups. CONCLUSIONS SI with biofeedback has a positive effect on gait and balance improvement among a mixed population of older adults. Specifically, OPTS and PCPS groups were statistically better than TPEI groups at improving gait and balance performance, whereas only the group comparison in BBS and 6MWT can reach the minimal clinically important difference. Moreover, WS groups showed no statistically or clinically significant positive effect on gait and balance improvement compared with control groups. More studies are recommended to verify the effectiveness of specific SI. Research registration PROSPERO platform: CRD42022362817. Registered on 7/10/2022.
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Affiliation(s)
- Qian Mao
- School of Design, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jiaxin Zhang
- School of System Design and Intelligent Manufacturing, Southern University of Science and Technology, Shenzhen, China
| | - Lisha Yu
- School of Data Science, Lingnan University, Hong Kong, China
| | - Yang Zhao
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Yan Luximon
- School of Design, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hailiang Wang
- School of Design, The Hong Kong Polytechnic University, Hong Kong, China.
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Lee K, Yi J, Lee SH. Effects of community-based fall prevention interventions for older adults using information and communication technology: A systematic review and meta-analysis. Health Informatics J 2024; 30:14604582241259324. [PMID: 38825745 DOI: 10.1177/14604582241259324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Objectives: This systematic review and meta-analysis aimed to investigate the effect of fall prevention interventions using information and communication technology (ICT). Methods: A comprehensive search across four databases was performed. The inclusion criteria were fall prevention interventions including telehealth, computerized balance training, exergaming, mobile application education, virtual reality exercise, and cognitive-behavioral training for community-dwelling adults aged ≥60 years. Results: Thirty-four studies were selected. Telehealth, smart home systems, and exergames reduced the risk of falls (RR = 0.63, 95% CI [0.54, 0.75]). Telehealth and exergame improved balance (MD = 3.30, 95% CI [1.91, 4.68]; MD = 4.40, 95% CI [3.09, 5.71]). Telehealth improved physical function (SMD = 0.69, 95% CI [0.23, 1.16]). Overall, ICT fall interventions improved fall efficacy but not cognitive function. For quality of life (QOL), mixed results were found depending on the assessment tools. Conclusion: Future investigations on telehealth, smart home systems, or exergames are needed to motivate older adults to exercise and prevent falls.
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Affiliation(s)
- Kayoung Lee
- College of Nursing, Gachon University, Incheon, Korea
| | - Jungeun Yi
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Seon-Heui Lee
- College of Nursing, Gachon University, Incheon, Korea
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Cieślik B, Mazurek J, Wrzeciono A, Maistrello L, Szczepańska-Gieracha J, Conte P, Kiper P. Examining technology-assisted rehabilitation for older adults' functional mobility: a network meta-analysis on efficacy and acceptability. NPJ Digit Med 2023; 6:159. [PMID: 37620411 PMCID: PMC10449892 DOI: 10.1038/s41746-023-00907-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Technological advancements facilitate feedback adaptation in rehabilitation through virtual reality (VR) exergaming, serious gaming, wearables, and telerehabilitation for older adults fall prevention. Although studies have evaluated these technologies, no comparisons of their effectiveness have been conducted to date. Thus, this study aims to assess the differences in effectiveness of these interventions on balance and functional mobility in the older adults. A systematic review and network meta-analysis (NMA) were conducted to identify the most effective interventions for improving balance and functional mobility in adults aged 60 and over. The search was conducted in five databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science) up to June 10, 2023. The eligibility criteria were: (1) older adults, (2) functional mobility, balance, or gait as the primary outcome, (3) new technology intervention, and (4) randomized study design. New technology interventions were classified into five categories: exergaming with balance platforms or motion capture technologies, other serious gaming, interventions with wearables, and telerehabilitation. Additionally, two categories of control interventions (conventional exercises and no treatment) were extracted. The NMA was performed for the aggregated results of all outcomes, and separately for clinical functional scales, functional mobility, and gait speed results. Fifty-two RCTs with 3081 participants were included. Exergaming with motion capture was found to be statistically significant in producing a better effect than no treatment in the analysis of the functional mobility with an SMD of -0.70 (P < 0.01). The network meta-analysis revealed that exergaming with motion capture offers greater therapeutic benefits for functional mobility and balance compared to no treatment control. The effectiveness of this approach is similar to that of conventional exercises. Further RCTs are needed to provide a more definitive conclusion, particularly with respect to the effectiveness of serious games, telerehabilitation, and interventions with wearables.
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Affiliation(s)
- Błażej Cieślik
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, Venezia, 30126, Italy.
| | - Justyna Mazurek
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw, 50-367, Poland
| | - Adam Wrzeciono
- Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, Wroclaw, 51-612, Poland
| | - Lorenza Maistrello
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, Venezia, 30126, Italy
| | | | | | - Pawel Kiper
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, Venezia, 30126, Italy
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Ge L, Su TT, An Y, Mejía ST. The effectiveness of exergames on fear of falling in community-dwelling older adults: a systematic review. Aging Ment Health 2022; 26:1306-1317. [PMID: 34291684 DOI: 10.1080/13607863.2021.1950615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ObjectivesFear of falling is common among older adults and can increase fall-risk through premature activity restriction. Exergames, an emerging tool in fall prevention, combine exercise with interactive and adaptive game elements. This review examines the extent to which exergame interventions reduce fear of falling among community-dwelling older adults. Method: Guided by the PRISMA methodology, we reviewed peer-reviewed studies that were published in English between 2006 and 2019 and employed a comparative design to test the effect of exergames on fear of falling in community-dwelling older adults. Two reviewers screened the literature and extracted data on the exergame platform, participants, study design, and results. A modified PEDro scale was used to assess study quality. Disagreements were resolved through discussion with the third reviewer. Results: Our literature search resulted in 23 eligible studies on exergame interventions where fear of falling was the primary or secondary outcome. Most interventions (35%) occurred within hospitals and were delivered via a Wii-based system (61%). Fear of falling was most commonly measured using the Falls Efficacy Scale, the Activities-specific Balance Scale and their modified versions. A total of 15 of the 23 studies reported statistically significant changes in fear of falling. Quality assessment showed 10 studies to be rated as 'good.' Conclusion: This review showed that exergame may have a positive effect in reducing fear of falling in community-dwelling older adults. The finding provides a direction for clinical practice in the research area of intervention on fear of falling in older adults.
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Affiliation(s)
- Lanying Ge
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
| | - Tai-Te Su
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Yu An
- College of P.E and Sports, Beijing Normal University, Beijing, China
| | - Shannon T Mejía
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Ambrens M, Alley S, Oliveira JS, To Q, Delbaere K, Vandelanotte C, Tiedemann A. Effect of eHealth-delivered exercise programmes on balance in people aged 65 years and over living in the community: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2022; 12:e051377. [PMID: 35688586 PMCID: PMC9189851 DOI: 10.1136/bmjopen-2021-051377] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Exercise that challenges balance is proven to prevent falls in community-dwelling older people, yet widespread implementation and uptake of effective programmes is low. This systematic review and meta-analysis synthesised the evidence and evaluated the effect of eHealth-delivered exercise programmes compared with control on balance in community-dwelling people aged ≥65 years. METHODS Nine databases including MEDLINE, CINAHL and Embase, were searched from inception to January 2022 to identify randomised controlled trials evaluating eHealth-delivered exercise programmes for community-dwelling people aged ≥65 years, published in English that included a balance outcome. Primary outcomes were static and dynamic balance. Secondary outcomes included fall risk and fear of falling. We calculated standardised mean differences (SMDs, Hedges' g) with 95% CIs from random effects meta-analyses. RESULTS We identified 14 eligible studies that included 1180 participants. Methodological quality ranged from 3 to 8 (mean, 5). The pooled effect indicated that eHealth-delivered exercise programmes have a medium significant effect on static balance (11 studies; SMD=0.62, 95% CI 0.27 to 0.72) with very low-quality evidence. There was small statistically significant effect on dynamic balance (14 studies; SMD=0.42, 95% CI 0.11 to 0.73) with very low-quality evidence, and fall risk (5 studies; SMD=0.32, 95% CI 0.00 to 0.64) with moderate-quality evidence. No significant effect of eHealth programmes on fear of falling was found (four studies; SMD=0.10, 95% CI -0.05 to 0.24; high-quality evidence). CONCLUSION This review provides preliminary evidence that eHealth-delivered exercise programmes improved balance and reduced fall risk in people aged ≥65 years. There is still uncertainty regarding the effect of eHealth delivered exercise programmes on fear of falling. PROSPERO REGISTRATION NUMBER CRD42018115098.
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Affiliation(s)
- Meghan Ambrens
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Queensland, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Stephanie Alley
- Physical Activity Research Group, Appleton Institute, CQUniversity, Rockhampton, Queensland, Australia
| | - Juliana S Oliveira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
- School of Public Health, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Quyen To
- Physical Activity Research Group, Appleton Institute, CQUniversity, Rockhampton, Queensland, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, CQUniversity, Rockhampton, Queensland, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
- School of Public Health, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
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Craig CM, Stafford J, Egorova A, McCabe C, Matthews M. Can We Use the Oculus Quest VR Headset and Controllers to Reliably Assess Balance Stability? Diagnostics (Basel) 2022; 12:diagnostics12061409. [PMID: 35741219 PMCID: PMC9221913 DOI: 10.3390/diagnostics12061409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Balance is the foundation upon which all other motor skills are built. Indeed, many neurological diseases and injuries often present clinically with deficits in balance control. With recent advances in virtual reality (VR) hardware bringing low-cost headsets into the mainstream market, the question remains as to whether this technology could be used in a clinical context to assess balance. We compared the head tracking performance of a low-cost VR headset (Oculus Quest) with a gold standard motion tracking system (Qualisys). We then compared the recorded head sway with the center of pressure (COP) measures collected from a force platform in different stances and different visual field manipulations. Firstly, our analysis showed that there was an excellent correspondence between the two different head movement signals (ICCs > 0.99) with minimal differences in terms of accuracy (<5 mm error). Secondly, we found that head sway mapped onto COP measures more strongly when the participant adopted a Tandem stance during balance assessment. Finally, using the power of virtual reality to manipulate the visual input to the brain, we showed how the Oculus Quest can reliably detect changes in postural control as a result of different types of visual field manipulations. Given the high levels of accuracy of the motion tracking of the Oculus Quest headset, along with the strong relationship with the COP and ability to manipulate the visual field, the Oculus Quest makes an exciting alternative to traditional lab-based balance assessments.
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Affiliation(s)
- Cathy M. Craig
- School of Psychology, Ulster University, Coleraine BT52 1SL, UK
- Correspondence:
| | - James Stafford
- School of Psychology, Queen’s University Belfast, Belfast BT7 1NN, UK;
| | - Anastasiia Egorova
- School of Maths & Physics, Queen’s University Belfast, Belfast BT7 1NN, UK;
| | - Carla McCabe
- School of Sport, Ulster University, Belfast BT15 1ED, UK; (C.M.); (M.M.)
| | - Mark Matthews
- School of Sport, Ulster University, Belfast BT15 1ED, UK; (C.M.); (M.M.)
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Liu H, Xing Y, Wu Y. Effect of Wii Fit Exercise With Balance and Lower Limb Muscle Strength in Older Adults: A Meta-Analysis. Front Med (Lausanne) 2022; 9:812570. [PMID: 35602499 PMCID: PMC9120538 DOI: 10.3389/fmed.2022.812570] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Falls and fall-related injuries are not uncommon among older adults and may lead to serious health deterioration and decreased quality of life. Numerous types of physical activity have been proposed to improve balance and strength in older adults with varying degrees of success. Nintendo's Wii Fit video exergame uses body movement as a game controller and provides real-time feedback for games designed to enhance balance and muscle strength. However, whether Wii Fit exercise improves the balance and lower limb muscle strength of older adults remains uncertain. Objective To evaluate the current literature by using meta-analyses to assess whether Wii Fit exercise is associated with improved balance and lower limb muscle strength in older adults. Methods We searched PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, and Wanfang Data from inception to February 16, 2022, for relevant studies and conducted a manual search of the literature. Data extraction of the included studies were independently performed by two authors. The methodologic quality of each included study was assessed using the Physical Therapy Evidence Database (PEDro) scale. Meta-analyses were conducted using Review Manager 5.3. Results Of 991 articles initially identified, 10 articles (379 participants; aged ≥65 years, range 65–92 years; 188 participants in Wii Fit exercise groups, and 191 participants in control groups), including 8 randomized controlled trials, were assessed in this meta-analysis. The methodologic quality of the included studies evaluated with the PEDro average score was 6.4 and ranged from 5 to 8 points, indicating moderate quality. Compared with no exercise, Wii Fit exercise was associated with significant improved scores on the Berg Balance Scale, which evaluates functional balance (mean difference, 1.38; 95% CI, 0.61–2.16; I2 = 31%; P = 0.0005) and on the Timed Up and Go test, which evaluates static and dynamic balance (standardized mean difference, −0.51; 95% CI,−0.88 to −0.14; I2 = 52%; P = 0.007). However, for the three studies assessed, Wii Fit exercise did not significantly improve scores on the 30-s chair stand test, which evaluates the functional strength and endurance of the lower limb muscles (mean difference, 0.82; 95% CI, −0.14 to 1.77; z = 1.68; P = 0.09). Conclusions Our findings indicated that Wii Fit exercise is an effective approach to improve functional, static, and dynamic balance among older adults. Additional meta-analyzes with higher numbers of randomized controlled trials are suggested to confirm the benefits of Wii Fit exercise on balance in older adults, to establish whether functional strength and endurance of lower limb muscles are improved, and to explore the relationship between improved balance and fall prevention in this population.
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Jiang J, Guo W, Wang B. Effects of exergaming on executive function of older adults: a systematic review and meta-analysis. PeerJ 2022; 10:e13194. [PMID: 35433124 PMCID: PMC9009327 DOI: 10.7717/peerj.13194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/09/2022] [Indexed: 01/12/2023] Open
Abstract
Background Executive function (EF) involves a series of high-level processes, such as inhibition, switching, and updating. Aging-related cognitive decline has been shown to be strongly associated with EF worsening. The aims of this study were to perform a meta-analysis to evaluate the effects of exergaming, an emerging intervention, on EF performance in older adults and to conduct a moderator analysis of exergaming effects on EF. Methods Randomized controlled trials examining exergaming influences on EF in older adults were collated by searching the Web of Science, Elsevier Science, PubMed, and Google Scholar databases. Statistical data were quantified in Comprehensive Meta-analysis software. Overall EF and EF domains (inhibition, switching, and updating) were analyzed separately. Results A total of 15 studies were included. The meta-analysis results indicated that exergaming had a significant influence on overall EF in the older adult (standardized mean difference (SMD) = 0.349, 95% confidence interval (CI) [0.191-0.506], p < 0.001). The same effects were also found in EF domains of inhibition (SMD = 0.415, 95% CI [0.102-0.729], p = 0.009), switching (SMD = 0.243, 95% CI [0.071-0.415], p = 0.005), and updating (SMD = 0.366, 95% CI [0.140-0.592], p = 0.002). The effects of exergaming on overall EF were found to be moderated by the frequency of the intervention (Q(1) = 3.537, p = 0.06). Conclusion Exergaming was confirmed to improve overall EF, as well as in older adults, and the effect of exergaming on EF was shown to be moderated by intervention frequency.
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Affiliation(s)
- Jiahui Jiang
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Wei Guo
- College of Physical Education, Yangzhou University, Yangzhou, China,Institute of Sports, Exercise and Brain, Yangzhou University, Yangzhou, China
| | - Biye Wang
- College of Physical Education, Yangzhou University, Yangzhou, China,Institute of Sports, Exercise and Brain, Yangzhou University, Yangzhou, China
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Liu M, Zhou K, Chen Y, Zhou L, Bao D, Zhou J. Is Virtual Reality Training More Effective Than Traditional Physical Training on Balance and Functional Mobility in Healthy Older Adults? A Systematic Review and Meta-Analysis. Front Hum Neurosci 2022; 16:843481. [PMID: 35399351 PMCID: PMC8984187 DOI: 10.3389/fnhum.2022.843481] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/23/2022] [Indexed: 12/04/2022] Open
Abstract
Objective The studies showed the benefits of virtual reality training (VRT) for functional mobility and balance in older adults. However, a large variance in the study design and results is presented. We, thus, completed a systematic review and meta-analysis to quantitatively examine the effects of VRT on functional mobility and balance in healthy older adults. Methods We systematically reviewed the publications in five databases. Studies that examine the effects of VRT on the measures of functional mobility and balance in healthy older adults were screened and included if eligible. Subgroup analyses were completed to explore the effects of different metrics of the intervention design (e.g., session time) on those outcomes related to functional mobility and balance. Results Fifteen studies of 704 participants were included. The quality of these studies was good. Compared to traditional physical therapy (TPT), VRT induced greater improvement in TUG (MD = −0.31 s, 95% CI = −0.57 to −0.05, p = 0.02, I2 = 6.34%) and one-leg stance with open eyes (OLS-O) (MD = 7.28 s, 95% CI = 4.36 to 10.20, p = 0.00, I2 = 36.22%). Subgroup analyses revealed that immersive VRT with more than 800 min of total intervention time over 8 weeks and at least 120 min per week and/or designed by the two motor-learning principles was optimal for functional mobility and balance. Conclusion Virtual reality training can significantly improve functional mobility and balance in healthy older adults compared to TPT, and the findings provided critical knowledge of the optimized design of VRT that can inform future studies with more rigorous designs. Systematic Review Registration [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021297085].
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Affiliation(s)
- Meng Liu
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Kaixiang Zhou
- Sports Coaching College, Beijing Sport University, Beijing, China
- College of Sports, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yan Chen
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Limingfei Zhou
- School of Strength and Conditioning Training, Beijing Sport University, Beijing, China
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
- *Correspondence: Dapeng Bao,
| | - Junhong Zhou
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
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Yang C, Han X, Jin M, Xu J, Wang Y, Zhang Y, Xu C, Zhang Y, Jin E, Piao C. The Effect of Video Game-Based Interventions on Performance and Cognitive Function in Older Adults: Bayesian Network Meta-analysis. JMIR Serious Games 2021; 9:e27058. [PMID: 34967759 PMCID: PMC8759017 DOI: 10.2196/27058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/22/2021] [Accepted: 10/12/2021] [Indexed: 01/29/2023] Open
Abstract
Background The decline in performance of older people includes balance function, physical function, and fear of falling and depression. General cognitive function decline is described in terms of processing speed, working memory, attention, and executive functioning, and video game interventions may be effective. Objective This study evaluates the effect of video game interventions on performance and cognitive function in older participants in terms of 6 indicators: balance function, executive function, general cognitive function, physical function, processing speed, and fear of falling and depression. Methods Electronic databases were searched for studies from inception to June 30, 2020. Randomized controlled trials and case-controlled trials comparing video game interventions versus nonvideo game control in terms of performance and cognitive function outcomes were incorporated into a Bayesian network meta-analysis. All data were continuous variables. Results In total, 47 studies (3244 participants) were included. In pairwise meta-analysis, compared with nonvideo game control, video game interventions improved processing speed, general cognitive function, and depression scores. In the Bayesian network meta-analysis, interventions with video games improved balance function time (standardized mean difference [SMD] –3.34, 95% credible interval [CrI] –5.54 to –2.56), the cognitive function score (SMD 1.23, 95% CrI 0.82-1.86), processing speed time (SMD –0.29, 95% CrI –0.49 to –0.08), and processing speed number (SMD 0.72, 95% CrI 0.36-1.09), similar to the pairwise meta-analysis. Interventions with video games with strong visual senses and good interactivity ranked first, and these might be more beneficial for the elderly. Conclusions Our comprehensive Bayesian network meta-analysis provides evidence that video game interventions could be considered for the elderly for improving performance and cognitive function, especially general cognitive scores and processing speed. Games with better interactivity and visual stimulation have better curative effects. Based on the available evidence, we recommend video game interventions for the elderly. Trial Registration PROSPERO CRD42020197158; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197158
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Affiliation(s)
- Chao Yang
- Department of Ethnic Culture and Vocational Education, Liaoning National Normal College, Shenyang, China
| | - Xiaolei Han
- Department of Ethnic Culture and Vocational Education, Liaoning National Normal College, Shenyang, China
| | - Mingxue Jin
- Department of Ethnic Culture and Vocational Education, Liaoning National Normal College, Shenyang, China
| | - Jianhui Xu
- Department of Ethnic Culture and Vocational Education, Liaoning National Normal College, Shenyang, China
| | - Yiren Wang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Yajun Zhang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | | | - Yingshi Zhang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Enshi Jin
- Department of Ethnic Culture and Vocational Education, Liaoning National Normal College, Shenyang, China.,Information Construction Department, Liaoning National Normal College, Shenyang, China
| | - Chengzhe Piao
- Department of Ethnic Culture and Vocational Education, Liaoning National Normal College, Shenyang, China.,Information Construction Department, Liaoning National Normal College, Shenyang, China
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Suleiman-Martos N, García-Lara R, Albendín-García L, Romero-Béjar JL, Cañadas-De La Fuente GA, Monsalve-Reyes C, Gomez-Urquiza JL. Effects of active video games on physical function in independent community-dwelling older adults: A systematic review and meta-analysis. J Adv Nurs 2021; 78:1228-1244. [PMID: 34935178 DOI: 10.1111/jan.15138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/25/2021] [Accepted: 12/09/2021] [Indexed: 02/02/2023]
Abstract
AIM To analyse the effects of active video games on physical function in independent community-dwelling older adults. DESIGN Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES The CINAHL, LILACS, Medline, Proquest and Scopus databases were consulted, with no restriction by year of publication. REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The meta-analysis was performed using RevMan software. RESULTS The analysis included 22 randomized controlled trials with a total of 1208 participants (all ≥55 years old). In our meta-analyses, the effects produced by playing the active video games (mean differences) were statistically significant for the variables Gait speed and Timed up-and-go. The differences between the control and experimental groups were not significant in the following tests: 6-minute walk, 30-second chair stand, balance (measured with the Berg Balance Scale), cadence, grip strength, knee extension strength, 8-Foot Up-and-Go or velocity. CONCLUSIONS Physical exercise from participation in active video games has beneficial effects on two clinical parameters (Gait speed and Timed up-and-go) in independent community-dwelling older adults. However, the effects on other parameters do not differ from those obtained with conventional exercise training. Therefore, the clinical significance of these benefits is limited. IMPACT Older adults usually perform little physical activity. In consequence, researchers have increasingly considered alternatives to traditional forms of exercise. One such is that provided by active video games, which can be a source of stimulation, encouraging adherence and motivation in exercise programmes. Our review shows that active video games can improve gait speed and mobility, but in other respects obtain no differences from conventional exercises. Further tailored randomized clinical trials should be undertaken with diverse populations of older adults to evaluate different physical function variables to determine the most appropriate training approach and its optimal design and duration.
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Affiliation(s)
| | - Rubén García-Lara
- Granada-Northeast Health Management Area, Andalusian Health Service, Granada, Spain
| | - Luis Albendín-García
- Granada-Metropolitano Health District, Andalusian Health Service, Granada, Spain
| | - José L Romero-Béjar
- Statistics and Operational Research Department, University of Granada, Granada, Spain
| | | | - Carolina Monsalve-Reyes
- Social Sciences Department, Catholic University of La Santísima Concepción, Concepción, Chile
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12
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Henrique PPB, Perez FMP, Becker OHC, Bellei EA, Biduski D, Korb A, Pochmann D, Dani C, Elsner VR, De Marchi ACB. Kinesiotherapy With Exergaming as a Potential Modulator of Epigenetic Marks and Clinical Functional Variables of Older Women: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e32729. [PMID: 34643543 PMCID: PMC8552101 DOI: 10.2196/32729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 12/20/2022] Open
Abstract
Background Kinesiotherapy is an option to mitigate worsening neuropsychomotor function due to human aging. Moreover, exergames are beneficial for the practice of physical therapy by older patients. Physical exercise interventions are known to alter the epigenome, but little is known about their association with exergames. Objective We aim to evaluate the effects of kinesiotherapy with exergaming on older women’s epigenetic marks and cognitive ability, as well as on their clinical functional variables. Our hypothesis states that this kind of therapy can elicit equal or even better outcomes than conventional therapy. Methods We will develop a virtual clinic exergame with 8 types of kinesiotherapy exercises. Afterward, we will conduct a 1:1 randomized clinical trial to compare the practice of kinesiotherapy with exergames (intervention group) against conventional kinesiotherapy (control group). A total of 24 older women will be enrolled for 1-hour sessions performed twice a week, for 6 weeks, totaling 12 sessions. We will assess outcomes using epigenetic blood tests, the Montreal Cognitive Assessment test, the Timed Up and Go test, muscle strength grading in a hydraulic dynamometer, and the Game Experience Questionnaire at various stages. Results The project was funded in October 2019. Game development took place in 2020. Patient recruitment and a clinical trial are planned for 2021. Conclusions Research on this topic is likely to significantly expand the understanding of kinesiotherapy and the impact of exergames. To the best of our knowledge, this may be one of the first studies exploring epigenetic outcomes of exergaming interventions. Trial Registration Brazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-9tdrmw; https://ensaiosclinicos.gov.br/rg/RBR-9tdrmw. International Registered Report Identifier (IRRID) DERR1-10.2196/32729
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Affiliation(s)
- Patrícia Paula Bazzanello Henrique
- Faculty of Physical Education and Physiotherapy, University of Passo Fundo, Passo Fundo, Brazil.,Department of Physiotherapy, Regional Integrated University of High Uruguay and Missions, Erechim, Brazil
| | - Fabrízzio Martin Pelle Perez
- Faculty of Physical Education and Physiotherapy, University of Passo Fundo, Passo Fundo, Brazil.,Department of Physiotherapy, Regional Integrated University of High Uruguay and Missions, Erechim, Brazil
| | | | - Ericles Andrei Bellei
- Institute of Exact Sciences and Geosciences, University of Passo Fundo, Passo Fundo, Brazil
| | - Daiana Biduski
- Institute of Exact Sciences and Geosciences, University of Passo Fundo, Passo Fundo, Brazil
| | - Arthiese Korb
- Department of Physiotherapy, Regional Integrated University of High Uruguay and Missions, Erechim, Brazil
| | - Daniela Pochmann
- Graduate Program in Biosciences and Rehabilitation, Porto Alegre Institute of the Methodist Church, Porto Alegre, Brazil
| | - Caroline Dani
- Graduate Program in Biosciences and Rehabilitation, Porto Alegre Institute of the Methodist Church, Porto Alegre, Brazil
| | - Viviane Rostirola Elsner
- Graduate Program in Biological Sciences: Physiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Carolina Bertoletti De Marchi
- Faculty of Physical Education and Physiotherapy, University of Passo Fundo, Passo Fundo, Brazil.,Institute of Exact Sciences and Geosciences, University of Passo Fundo, Passo Fundo, Brazil
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13
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Virtual Reality Rehabilitation and Exergames—Physical and Psychological Impact on Fall Prevention among the Elderly—A Literature Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11094098] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The present review is aimed at the effectiveness of virtual reality (VR) and exergames in the prevention of falls among the elderly. Falls become a significant problem in the aging population and lead to psychological, social, and physical impairment. Prevention of falls is crucial to the well-being of the elderly population and is one of the challenges of contemporary rehabilitation. Recently, in view of the threat of the SARS-CoV-2 pandemic, contactless methods of rehabilitation, including telerehabilitation, appear as valuable rehabilitation tools. This review is based on the PRISMA guidelines and was carried out in five databases: PubMed, Medline, Web of Science, Scopus, and PEDro. Twenty-one randomized controlled trials, focused on the application of VR and exergames in the prevention of falls, were included. This review suggests that VR training in rehabilitation appears to be a promising complement to traditional techniques of physiotherapy to improve specific physical outcomes. VR and exergames could be considered as a complement of standard physiotherapy and its possible continuation at home for elderly. However, further high-quality studies, with carefully designed protocols and proper blinding, are needed.
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14
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Immediate Effects of Aquatic Therapy on Balance in Older Adults with Upper Limb Dysfunction: An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249434. [PMID: 33339299 PMCID: PMC7766887 DOI: 10.3390/ijerph17249434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 01/12/2023]
Abstract
Background: Aquatic physiotherapy has been shown to be effective in developing balance, strength, and functional reach over time. When dealing with immediate effects, the literature has concentrated more on the body’s physiological response to the physical and mechanical properties of water during passive immersion. The purpose of this study was to evaluate the effects of a single 45-min active aquatic physiotherapy session on standing balance and strength, and its relationship with functional reach in persons 55 years and older with upper limb dysfunction. Methods: The intervention group (n = 12) was assessed before and after a single aquatic physiotherapy session, while the control group (n = 10) was evaluated before and after 45 min of sitting rest. Functional assessment was made using the visual analogue pain scale (points), step test (repetitions), functional reach test (cm), and global balance-standing test on a force platform (% time). A two-way repeated-measures ANOVA was applied (p < 0.05). Results: The intervention group showed non-significant improvements between measurement before and after the intervention: Pain: 6.2 ± 1.9 vs. 5.2 ± 2.3 cm, steps: 7.0 ± 2.0 vs. 7.4 ± 1.8 repetitions, reach: 9.1 ± 2.8 vs. 10.4 ± 3.8 cm, and balance: 61.7 ± 5.9 vs. 71.3 ± 18.2% time in balance on the platform. The control group showed fewer changes but had better baseline values. A comparison between groups with time showed no significant differences in these changes. Conclusions: No significant immediate effects were found for one session of aquatic physiotherapy applied to patients older than 55 years with upper limb dysfunction.
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15
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Xu W, Liang HN, Baghaei N, Wu Berberich B, Yue Y. Health Benefits of Digital Videogames for the Aging Population: A Systematic Review. Games Health J 2020; 9:389-404. [DOI: 10.1089/g4h.2019.0130] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Wenge Xu
- Department of Computer Science and Software Engineering, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Hai-Ning Liang
- Department of Computer Science and Software Engineering, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Nilufar Baghaei
- Department of Information Technology, Otago Polytechnic Auckland International Campus, Auckland, New Zealand
- School of Natural and Computational Sciences, Massey University Auckland, Auckland, New Zealand
| | - Bing Wu Berberich
- International Business School Suzhou, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Yong Yue
- Department of Computer Science and Software Engineering, Xi'an Jiaotong-Liverpool University, Suzhou, China
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16
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Ditchburn JL, van Schaik P, Dixon J, MacSween A, Martin D. The effects of exergaming on pain, postural control, technology acceptance and flow experience in older people with chronic musculoskeletal pain: a randomised controlled trial. BMC Sports Sci Med Rehabil 2020; 12:63. [PMID: 33062284 PMCID: PMC7547415 DOI: 10.1186/s13102-020-00211-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 10/01/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Older people with chronic musculoskeletal pain are at risk of falls. This study aimed to investigate the effects of exergaming on pain and postural control in older people with chronic musculoskeletal pain. Secondary outcomes were technology acceptance, flow experience, perceived physical exertion, expended mental effort and heart rate. METHODS Fifty four older adults (age: 71 ± 5 years) with chronic musculoskeletal pain were randomised into 2 groups. Group 1 received exergaming training using the Interactive Rehabilitation and Exercise System (IREX®). Group 2 undertook traditional gym-based exercise (TGB). Both groups completed twice weekly 40-min exercise sessions for 6 weeks. Perceived pain was measured using a numeric pain rating scale and the Multidimensional Affect and Pain Survey questionnaire. Postural control was measured as sway using a Kistler™ force platform. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology questionnaire and flow experience with the Flow State Scale. Physiological measures of perceived physical exertion, expended mental effort and heart rate were recorded during all sessions. RESULTS The exergaming group demonstrated significant reductions in pain intensity and thermal pain including a near significant approach in physical engagement in comparison to TGB group. Although no intervention effects on postural control were found, the exergaming group showed significant improvements in three sway measures (AP SD, ML SD and AP range) over time whereas significant improvements in ML range were found in the TGB group. Relating to technology acceptance, significant intervention effects on social influence and behavioural intention were found in the TGB group instead, although both groups demonstrated increases of acceptance over time. Regarding flow experience, concentration at task was significantly influenced in the TGB group and significant increases in flow variables over time were observed in both groups. Significant increases over time in perceived physical exertion and expended mental effort were found in both groups. CONCLUSION Our findings support the potential of exergaming to alleviate pain and improve balance in older people with chronic musculoskeletal pain. Both forms of exercise are acceptable, intrinsically motivating and show evidence of benefit to older people with chronic musculoskeletal pain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04029285 (retrospectively registered, July 23, 2019).
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Affiliation(s)
- Jae-Llane Ditchburn
- Institute of Science, Natural Resources and Outdoor Studies, University of Cumbria, Fusehill Street, Carlisle, Cumbria, CA1 2HH UK
| | - Paul van Schaik
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - John Dixon
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX UK
| | - Alasdair MacSween
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX UK
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX UK
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17
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Chan JKY, Klainin-Yobas P, Chi Y, Gan JKE, Chow G, Wu XV. The effectiveness of e-interventions on fall, neuromuscular functions and quality of life in community-dwelling older adults: A systematic review and meta-analysis. Int J Nurs Stud 2020; 113:103784. [PMID: 33120138 DOI: 10.1016/j.ijnurstu.2020.103784] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/20/2020] [Accepted: 09/27/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Falls in older adults result in serious, life-limiting consequences. An increasing number of fall prevention interventions have used technology to reduce the number of falls in community-dwelling adults. Various types of e-interventions are being tested in clinical trials and in the community. These include telehealth, exergames, cognitive games, socialized training, smart home systems and non-conventional balance training. Currently, no systematic review and meta-analysis has assessed the overall effectiveness of e-interventions and compared the effectiveness of the different types. OBJECTIVES The aim of this review was to synthesize best available evidence concerning the effectiveness of e-interventions on fall, neuromuscular functions and quality of life in community-dwelling older adults. METHODS A rigorous three-step search was conducted in nine online databases for published and unpublished randomized controlled trials studying e-interventions. Studies were screened and assessed for individual and overall risk of bias by two independent reviewers. Six fall-related outcomes were evaluated in the meta-analysis: fall risk, balance, lower extremity strength, fall efficacy, cognitive function and health-related quality of life. Subgroup and sensitivity analysis were conducted during meta-analysis. RESULTS Thirty-one studies fit the eligibility criteria and had an overall 74.7% low risk of bias. A total of 4,877 older adults from 17 countries were included in narrative synthesis and meta-analysis. Telehealth combined with exercise programmes and smart home systems were able to reduce fall risk significantly (risk ratio=0.79, 95% CI [0.72, 0.86]). E-interventions also significantly improved balance and fall efficacy (standardized mean difference=0.28, 95% CI [0.04, 0.53]). However, lower extremity strength, cognitive function and health-related quality of life did not show significant improvements. CONCLUSION Telehealth combined with exercise and smart home systems demonstrated the best evidence of effectiveness in reduction of falls in community-dwelling older adults. Future research should focus on forecasting falls using smart home technology and Artificial Intelligence, and testing promising e-interventions on larger samples to improve the strength of evidence of fall prevention by e-interventions.
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Affiliation(s)
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore, 117597.
| | - Yuchen Chi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore, 117597.
| | | | - Gigi Chow
- Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828.
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore, 117597.
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18
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Yang CM, Chen Hsieh J(S, Chen YC, Yang SY, Lin HCK. Effects of Kinect exergames on balance training among community older adults: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e21228. [PMID: 32664177 PMCID: PMC7360267 DOI: 10.1097/md.0000000000021228] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recent years have witnessed wide applications of exergames to balance training among the older adults. However, research concerning balance training with the use of Kinect for Xbox has remained scarce. While previous studies have shown the positive effects of exergames on improving balance and preventing falling among the older adults, there has been a paucity of empirical evidence supporting the superiority of Kinect exercise to conventional exercise over balance training among the older adults. Therefore, this study aimed to compare the feasibility, safety, and effectiveness of Kinect exercise against conventional exercise over balance training among the community older adults. METHOD A total of 20 participants were randomly assigned to the Kinect Exercise Group (N = 10) or the Conventional Exercise Group (N = 10) for a 5-week balance training (45 minutes a time, 2 times a week). Assessor blinding was employed to assess the participants' performance before and after the treatment, including 30-Second Chair Stand Test (30-sec CST), Timed Up and Go (TUG), Functional Reach Test (FRT), and One-Leg Stance Test (OLST) respectively with eyes open and closed. Subjective feeling of the intensity of pain and side effects were recorded throughout the investigation period. Nonparametric statistics was used for data analysis. RESULTS Within-group comparison between the pre-test and post-test indicated that significant differences existed in all of the 5 tests (30-sec CST, TUG, FRT, OLST with eyes open, and OLST with eyes closed) in the Kinect exercise group. To the Conventional exercise group, however, significant differences were only observed in 30-sec CST, FRT and OLST with eyes open. With regard to between-group comparison, significant differences were only found in FRT. CONCLUSION Such results indicated that both treatments were helpful in improving the participants' balance performance, that Kinect exercise was more effective in terms of overall balance ability, and that Kinect exercise was particularly beneficial to functional reach enhancement in comparison with traditional exercise. Kinect exercise could be a feasible, safe, and effective alternative for dynamic balance training among older adults.
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Affiliation(s)
- Chi-Min Yang
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center
- Department of Information and Learning Technology, National University of Tainan, Tainan
| | | | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan, ROC
| | - Shu-Yu Yang
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center
| | - Hao-Chiang Koong Lin
- Department of Information and Learning Technology, National University of Tainan, Tainan
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20
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Fang Q, Ghanouni P, Anderson SE, Touchett H, Shirley R, Fang F, Fang C. Effects of Exergaming on Balance of Healthy Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Games Health J 2020; 9:11-23. [PMID: 31800322 DOI: 10.1089/g4h.2019.0016] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Balance is critical for older adults to perform daily activities. However, age-related declines in balance increase the risk of falls and severe injuries, such as bone fractures and head injuries. Exergames have been widely applied to improve health-related outcomes in older adults. This meta-analysis aims to quantify the effects of exergaming interventions on balance performance in healthy older adults. A literature search was performed using PubMed, ScienceDirect, SPORTDiscus, COCHRANE, EBSCO, and EMBASE. A total of 16 experimental studies met inclusion criteria for a full-text review. Data synthesis examined balance functions, including static, dynamic, proactive, and perceived balance abilities when performing daily activities. Intervention protocols of the reviewed studies included an average of two to three 40-minute exergaming sessions per week for 8 weeks. A random effects model identified significant effects in favor of the exergaming group, with moderate effect size in dynamic balance (Hedges' g = 0.36, 95% CI = 0.26-1.30, P < 0.001), and perceived balance (Hedges' g = 0.31, 95% CI = 0.04-0.58, P = 0.02); and considerable effect size in Chair Stand Test (Hedges' g = 0.78, 95% CI = 0.26-1.30, P = 0.003), and balance test batteries (Hedges' g = 0.72, 95% CI = 0.42-1.02, P < 0.001). No significant effect was found in the static balance (Hedges' g = 0.22, 95% CI = -0.31 to 0.76, P = 0.42), or proactive balance (Hedges' g = 0.54, 95% CI = -0.12 to 1.20, P = 0.11). Meta-analysis identified exergaming-associated benefits in older adults' balance function and confidence. This finding supports the feasibility of exergaming as a supplementary approach to improve balance for healthy older adults. Health professionals may optimize treatment effect by integrating exergaming sessions into a traditional balance exercise program.
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Affiliation(s)
- Qun Fang
- Department of Kinesiology, Mississippi State University, Mississippi State, Mississippi
| | - Parisa Ghanouni
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia
| | - Sarah E Anderson
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Hilary Touchett
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas
| | - Rebekah Shirley
- Department of Kinesiology, Mississippi State University, Mississippi State, Mississippi
| | - Fang Fang
- Rehabilitation Center, Qing Dao Fu Wai Hospital, Qingdao, China
| | - Chao Fang
- Department of Pharmacology, the Fourth Military Medical University, Xi'an, China
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Litz E, Ball C, Jansen CP, Werner C, de Bruin E, Hauer K. Validation of a Motor-Cognitive Assessment for a Stepping Exergame in Older Adults: Use of Game-Specific, Internal Data Stream. Games Health J 2019; 9:95-107. [PMID: 31651191 DOI: 10.1089/g4h.2019.0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To comprehensively validate an assessment tailored to an exergaming training program with motor-cognitive challenges. Materials and Methods: Fifty-eight cognitively intact, multimorbid, independently living older adults (mean age [standard deviation]: 78.3 [6.5] years) with moderate functional limitations participated in the study. For construct validity, Spearman's rank correlations (rs) between game parameters and established cognitive (Number-Connection-Test [Zahlen-Verbindungs-Test], Simple Response Time Task, Simon Task) and motor (Short Physical Performance Battery, Physiomat® balance tests) measures were calculated. Test-retest reliability was documented by intraclass correlation coefficients (ICCs), sensitivity to change by effect sizes using partial eta squared (ηp2), and feasibility by mean completion time and completion rates. Results: Good construct validity of the assessment was observed, with on average moderate-to-high correlations between game parameters and cognitive tests, measures of lower extremity function and dynamic balance (range of rs including extreme outliers = 0.00-0.70, P < 0.001-0.998). Test-retest reliability was good, with ICCs mostly ranging from moderate to high (ICCs = 0.37-0.93, P < 0.001-0.130), and sensitivity to change was excellent (ηp2 = 0.16-0.81, P < 0.001-0.044). Completion rates for the initial challenge levels were 100%, mean completion time 36.3 minutes, and no clinical events or safety problems were observed. Conclusion: Study results documented on average good validity, test-retest reliability and feasibility, with an extraordinary high responsiveness of the presented game-based assessment in older adults with moderate functional limitations. The innovative, data-based assessment validated in this study may serve as a blueprint for future, tailored assessments for exergaming.
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Affiliation(s)
- Elena Litz
- Agaplesion Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany
| | - Caroline Ball
- Agaplesion Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany
| | | | - Christian Werner
- Agaplesion Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany.,Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Eling de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Klaus Hauer
- Agaplesion Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany
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Vázquez FL, Otero P, García-Casal JA, Blanco V, Torres ÁJ, Arrojo M. Efficacy of video game-based interventions for active aging. A systematic literature review and meta-analysis. PLoS One 2018; 13:e0208192. [PMID: 30533015 PMCID: PMC6289420 DOI: 10.1371/journal.pone.0208192] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/13/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Due to the appeal and recent technological advances of video games, the games have gained interest as an intervention tool for active aging. The aim of this systematic literature review and meta-analysis was to determine the efficacy of video games for active aging and to examine the influence of potential moderator variables. METHODS A systematic search was done using the following databases: Medline, PsycINFO, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. In addition, previous reviews and meta-analyses were used to identify randomized controlled trials (RCT) of video game-based interventions for active aging published through February 28, 2018. An evaluation of the methodological quality of the articles and a meta-analysis and moderator analysis was conducted. RESULTS A total of 22 articles depicting 21 RCT with 1125 participants were included. The results indicated that video game-based interventions produced positive effects on objectively measured physical health, negative affect and social health, with small effect sizes (d = 0.41, d = 0.26 and d = 0.40, respectively). The magnitude of this effect was moderated by the presence of subclinical conditions of participants, the type of game (exergames), the presence of physical activity, the type of prevention (indicated), non-blinded assignation, and older age of participants. The methodological quality of the studies was acceptable, the weakest area being external validity. CONCLUSION These finding indicate that video game-based interventions may assist adults in leading active aging processes and preventing secondary aging. Although more research is needed, video game-based interventions are a promising and accessible tool for active aging promotion.
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Affiliation(s)
- Fernando L. Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Patricia Otero
- Department of Psychology, University of A Coruña, A Coruña, Spain
| | - J. Antonio García-Casal
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Vanessa Blanco
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ángela J. Torres
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Instituto de Investigación Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela, Spain
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Spano G, O Caffò A, Bosco A. Cognitive functioning, subjective memory complaints and risky behaviour predict minor home injuries in elderly. Aging Clin Exp Res 2018; 30:985-991. [PMID: 29181769 DOI: 10.1007/s40520-017-0858-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/10/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Home accidents are one of the major causes of death, particularly in older people, young children and women. AIMS The first aim of this study was to explore the role of subjective memory complaints, cognitive functioning and risky behaviour as predictors of home injuries occurred in a year in a sample of healthy Italian older adults. The second aim was to investigate the role of risky behaviour as a mediator in the relationship between subjective and objective cognitive functioning and home injuries. METHODS One hundred thirty-three community-dwelling older people from southern Italy were administered a battery of tests to evaluate cognitive functioning, subjective memory complaints, and risky behaviour during home activities. Risky behaviour was evaluated using the Domestic Behaviour Questionnaire, created specifically for this purpose. The number of home injuries was recorded for a year throughout monthly telephone interviews. A path analysis was performed to test the following model: cognitive functioning and subjective memory complaints directly influence risky behaviour and number of accidents over a year; risky behaviour mediates the impact of cognitive functioning and subjective memory on number of accidents over a year. RESULTS Path analysis confirmed the model tested except the role of risky behaviour as a mediator between cognitive functioning and home accidents. DISCUSSION Risky behaviour could represent a further risk factor in cognitively intact older adults with subjective memory complaints. CONCLUSIONS The assessment of both cognition and behaviour in elderly can make a valuable contribution in preventing home accidents in elderly.
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Affiliation(s)
- Giuseppina Spano
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari "Aldo Moro", Via Crisanzio 42, 70122, Bari, Italy.
| | - Alessandro O Caffò
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari "Aldo Moro", Via Crisanzio 42, 70122, Bari, Italy
| | - Andrea Bosco
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari "Aldo Moro", Via Crisanzio 42, 70122, Bari, Italy
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Tahmosybayat R, Baker K, Godfrey A, Caplan N, Barry G. Movements of older adults during exergaming interventions that are associated with the Systems Framework for Postural Control: A systematic review. Maturitas 2018; 111:90-99. [PMID: 29673837 DOI: 10.1016/j.maturitas.2018.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 11/18/2022]
Abstract
One in three older adults fall annually, in part due to impairments in the physiological systems that make up the postural control (PC) system. Exercise, particularly balance training, helps to prevent deterioration and even to improve outcomes in the PC system. Exergaming (exercise-gaming) is interactive computer gaming whereby an individual moves the body in response to onscreen cues in a playful format. Exergaming is an alternative method to standard practice for improving PC outcomes, which has been shown to reduce the risk of falling. Exergaming has received research attention, yet the intervention is still in its infancy. There could be benefit in exploring the movements trained with respect to a framework known for identifying underlying deficits in the PC system, the Systems Framework for Postural Control (SFPC). This may help target areas for improvement in balance training using exergames and shed light on the impact for fall prevention. A literature search was therefore conducted across six databases (CINAHL, EMBASE, PubMed, ISI, SPORTdiscus and Science Direct) using a range of search terms and combinations relating to exergaming, balance, exercise, falls and elderly. Quality assessment was conducted using the PEDro Scale and a custom-made quality assessment tool. Movements were rated by two reviewers based on the 9 operational definitions of the SFPC. Eighteen publications were included in the analysis, with a mean PEDro score of 5.6 (1.5). Overall, 4.99 (1.27) of the 9 operational definitions of the SFPC are trained in exergaming interventions. Exergaming does encourage individuals to stand up (3), lean while standing (4), move upper limbs and turn heads (6) and dual-task while standing (9), to some extent move the body forwards, backwards and sideways (1), and coordinate movements (2) but hardly at all to kick, hop, jump or walk (7), or to force a postural reaction from a physical force to the individual (5) and it does not mimic actual changes in sensory context (8). This is the first review, to our knowledge, that synthesises the literature on movements trained in exergaming interventions with respect to an established theoretical framework for PC. This review could provide useful information for designing exergames with PC outcomes in mind, which could help target specific exergames for multi-factorial training to overcome balance deficits. Some elements of PC are too unsafe to be trained using exergames, such as restricting sensory inputs or applying physical perturbations to an individual to elicit postural responses.
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Affiliation(s)
- Robin Tahmosybayat
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK
| | - Alan Godfrey
- Department of Computing and Information Science, Faculty of Engineering and Environment, University of Northumbria, Newcastle Upon Tyne, UK
| | - Nick Caplan
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK.
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Bao T, Carender WJ, Kinnaird C, Barone VJ, Peethambaran G, Whitney SL, Kabeto M, Seidler RD, Sienko KH. Effects of long-term balance training with vibrotactile sensory augmentation among community-dwelling healthy older adults: a randomized preliminary study. J Neuroeng Rehabil 2018; 15:5. [PMID: 29347946 PMCID: PMC5774163 DOI: 10.1186/s12984-017-0339-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022] Open
Abstract
Background Sensory augmentation has been shown to improve postural stability during real-time balance applications. Limited long-term controlled studies have examined retention of balance improvements in healthy older adults after training with sensory augmentation has ceased. This pilot study aimed to assess the efficacy of long-term balance training with and without sensory augmentation among community-dwelling healthy older adults. Methods Twelve participants (four males, eight females; 75.6 ± 4.9 yrs) were randomly assigned to the experimental group (n = 6) or control group (n = 6). Participants trained in their homes for eight weeks, completing three 45-min exercise sessions per week using smart phone balance trainers that provided written, graphic, and video guidance, and monitored trunk sway. During each session, participants performed six repetitions of six exercises selected from five categories (static standing, compliant surface standing, weight shifting, modified center of gravity, and gait). The experimental group received vibrotactile sensory augmentation for four of the six repetitions per exercise via the smart phone balance trainers, while the control group performed exercises without sensory augmentation. The smart phone balance trainers sent exercise performance data to a physical therapist, who recommended exercises on a weekly basis. Balance performance was assessed using a battery of clinical balance tests (Activity Balance Confidence Scale, Sensory Organization Test, Mini Balance Evaluation Systems Test, Five Times Sit to Stand Test, Four Square Step Test, Functional Reach Test, Gait Speed Test, Timed Up and Go, and Timed Up and Go with Cognitive Task) before training, after four weeks of training, and after eight weeks of training. Results Participants in the experimental group were able to use vibrotactile sensory augmentation independently in their homes. After training, the experimental group had significantly greater improvements in Sensory Organization Test and Mini Balance Evaluation Systems Test scores than the control group. Significant improvement was also observed for Five Times Sit to Stand Test duration within the experimental group, but not in the control group. No significant improvements between the two groups were observed in the remaining clinical outcome measures. Conclusion The findings of this study support the use of sensory augmentation devices by community-dwelling healthy older adults as balance rehabilitation tools, and indicate feasibility of telerehabilitation therapy with reduced input from clinicians.
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Affiliation(s)
- Tian Bao
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St., Ann Arbor, 48109, MI, USA
| | - Wendy J Carender
- Department of Otolaryngology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Catherine Kinnaird
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St., Ann Arbor, 48109, MI, USA
| | - Vincent J Barone
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St., Ann Arbor, 48109, MI, USA
| | - Geeta Peethambaran
- Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Susan L Whitney
- Department of Physical Therapy and Otolaryngology, School of Health and Rehabilitation Sciences, University of Pittsburgh, 4028 Forbes Tower, Pittsburgh, PA, 15260, USA
| | - Mohammed Kabeto
- Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, 48109, MI, USA
| | - Rachael D Seidler
- School of Kinesiology, University of Michigan, 1402 Washington Heights, Ann Arbor, MI, 48109, USA.,Department of Psychology, University of Michigan, 530 Church St, Ann Arbor, MI, 48109, USA.,Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, USA
| | - Kathleen H Sienko
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St., Ann Arbor, 48109, MI, USA. .,Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, MI, 48109, USA.
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O’Callaghan G, O’Dowd A, Stapleton J, Merriman NA, Roudaia E, Newell FN. Changes in Regional Brain Grey-Matter Volume Following Successful Completion of a Sensori-Motor Intervention Targeted at Healthy and Fall-Prone Older Adults. Multisens Res 2018; 31:317-344. [DOI: 10.1163/22134808-00002604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/08/2017] [Indexed: 02/03/2023]
Abstract
Previous studies have suggested that discrete cross-sensory events could be incorrectly combined in the brain of older adults with a history of falls, possibly undermining motor and balance control. Based on previous findings that multisensory integration is modifiable with practice, even in an ageing population, we designed a serious game, named CityQuest, to train typical, everyday multisensory processes including sensori-motor control, spatial navigation, obstacle avoidance and balance control. Played over several sessions, this game was shown to improve these functions in older adults with and without a history of falls, depending on the specific condition of the game on which they were trained. Here, using voxel-based morphometry analysis of anatomical magnetic resonance imaging (MRI) data, we investigated structural changes in the brain of a smaller group of older adults from those who successfully completed this five-week intervention. A grey-matter (GM) volume increase in the precentral gyrus, and GM volume reduction in the inferior temporal and orbitofrontal gyri, was found for all participants. Changes in GM volume within regions of the cerebellum were differentially associated with fall-prone and healthy older adults. Furthermore, a greater GM volume increase in the precentral gyrus was observed in participants who performed the full CityQuest intervention relative to those required to avoid obstacles only. Our results support previous evidence that multisensory training can affect structural changes in the older brain and have implications for programmes designed for the successful rehabilitation of perceptual and cognitive functions.
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Affiliation(s)
- Georgia O’Callaghan
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Alan O’Dowd
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - John Stapleton
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Niamh A. Merriman
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Eugenie Roudaia
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Fiona N. Newell
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
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Howes SC, Charles DK, Marley J, Pedlow K, McDonough SM. Gaming for Health: Systematic Review and Meta-analysis of the Physical and Cognitive Effects of Active Computer Gaming in Older Adults. Phys Ther 2017; 97:1122-1137. [PMID: 29077911 DOI: 10.1093/ptj/pzx088] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 08/29/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Active computer gaming (ACG) is a method of facilitating physical activity in older people to improve health outcomes. PURPOSE The purpose of this study was to update and extend a systematic review of the evidence for ACG to determine its effects on physical and cognitive health in older adults. DATA SOURCES MEDLINE, EMBASE, CENTRAL in the Cochrane Library, and PsycINFO databases were searched from the date of the previous review (2011) to May 2016. STUDY SELECTION Eligible articles were randomized controlled trials (RCTs) investigating the effect of ACG in adults aged 65 and older. DATA EXTRACTION Thirty-five studies were eligible for inclusion. Two review authors independently conducted data extraction, risk-of-bias assessment, and coding of behavior change techniques. Outcomes of interest were analyzed as continuous data and pooled as standardized mean differences (SMD) and 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to determine the quality of the evidence. DATA SYNTHESIS Behavior change techniques (N = 106) were coded in the included studies (mean = 3.02). Data were pooled for 5 main outcomes of interest. Significant moderate effects in favor of ACG were observed for balance (SMD = 0.52, 95% CI = 0.24 to 0.79; 17 studies; 743 participants), for functional exercise capacity when intervention delivery was >120 minutes per week (SMD = 0.53, 95% CI = 0.15 to 0.90; 5 studies; 116 participants), and for cognitive function (SMD = -0.48, 95% CI = -0.80 to 0.17; 8 studies; 459 participants). There was no significant effect observed for functional mobility or fear of falling. LIMITATIONS The quality of the evidence for all comparisons was graded low or very low. CONCLUSIONS At present there is very little confidence that ACG improves physical and cognitive outcomes in older adults.
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Affiliation(s)
- Sarah C Howes
- S.C. Howes, BSc, Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health, School of Health Sciences, Ulster University, Newtownabbey, Antrim, United Kingdom of Great Britain and Northern Ireland
| | - Darryl K Charles
- D.K. Charles, PhD, Computer Science Research Institute, School of Computing and Information Engineering, Ulster University
| | - Joanne Marley
- J. Marley, PhD, Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health, School of Health Sciences, Ulster University, and Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Katy Pedlow
- K. Pedlow, PhD, Brain Injury Matters (NI), Belfast, Northern Ireland
| | - Suzanne M McDonough
- S.M. McDonough, PhD, Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health, School of Health Sciences, Ulster University, Room 01F118, Jordanstown, United Kingdom; UKCRC Centre of Excellence for Public Health, Belfast, Northern Ireland; and School of Physiotherapy, University of Otago, Dunedin, New Zealand
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28
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Choi SD, Guo L, Kang D, Xiong S. Exergame technology and interactive interventions for elderly fall prevention: A systematic literature review. APPLIED ERGONOMICS 2017; 65:570-581. [PMID: 27825723 DOI: 10.1016/j.apergo.2016.10.013] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/21/2016] [Accepted: 10/26/2016] [Indexed: 05/17/2023]
Abstract
Training balance and promoting physical activities in the elderly can contribute to fall-prevention. Due to the low adherence of conventional physical therapy, fall interventions through exergame technologies are emerging. The purpose of this review study is to synthesize the available research reported on exergame technology and interactive interventions for fall prevention in the older population. Twenty-five relevant papers retrieved from five major databases were critically reviewed and analyzed. Results showed that the most common exergaming device for fall intervention was Nintendo Wii, followed by Xbox Kinect. Even though the exergame intervention protocols and outcome measures for assessing intervention effectiveness varied, the accumulated evidences revealed that exergame interventions improved physical or cognitive functions in the elderly. However, it remains inconclusive whether or not the exergame-based intervention for the elderly fall prevention is superior to conventional physical therapy and the effect mechanism of the exergaming on elderly's balance ability is still unclear.
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Affiliation(s)
- Sang D Choi
- Department of Occupational & Environmental Safety & Health, University of Wisconsin - Whitewater, Whitewater, WI, USA
| | - Liangjie Guo
- Human Factors and Ergonomics Laboratory, Department of Industrial & Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Yuseong, South Korea; Department of Safety Engineering, China University of Geosciences, Wuhan, China
| | - Donghun Kang
- Department of Human & Systems Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea
| | - Shuping Xiong
- Human Factors and Ergonomics Laboratory, Department of Industrial & Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Yuseong, South Korea.
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29
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Keune PM, Young WR, Paraskevopoulos IT, Hansen S, Muenssinger J, Oschmann P, Müller R. Measuring standing balance in multiple sclerosis: Further progress towards an automatic and reliable method in clinical practice. J Neurol Sci 2017; 379:157-162. [PMID: 28716231 DOI: 10.1016/j.jns.2017.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/11/2017] [Accepted: 06/08/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Balance deficits in multiple sclerosis (MS) are often monitored by means of observer-rated tests. These may provide reliable data, but may also be time-consuming, subject to inter-rater variability, and potentially insensitive to mild fluctuations throughout the clinical course. On the other hand, laboratory assessments are often not available. The Nintendo Wii Balance Board (WBB) may represent a low-cost solution. The purpose of the current study was to examine the methodological quality of WBB data in MS (internal consistency, test-retest reliability), convergent validity with observer-rated tests (Berg Balance Scale, BBS; Timed-Up and Go Test, TUG), and discriminative validity concerning clinical status (Expanded Disability Status Scale, EDSS). METHODS Standing balance was assessed with the WBB for 4min in 63 MS patients at two assessment points, four months apart. Additionally, patients were examined with the BBS, TUG and the EDSS. RESULTS A period of 4min on the WBB provided data characterized by excellent internal consistency and test-retest reliability. Significant correlations between WBB data and results of the BBS and TUG were obtained after merely 2min on the board. An EDSS median-split revealed that higher EDSS values (>3) were associated with significantly increased postural sway on the WBB. CONCLUSIONS WBB measures reflecting postural sway are methodologically robust in MS, involving excellent internal consistency and test-retest reliability. They are also characterized by convergent validity with other considerably lengthier observer-rated balance measures (BBS) and sensitive to broader clinical characteristics (EDSS). The WBB may hence represent an effective, easy-to-use monitoring tool for MS patients in clinical practice.
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Affiliation(s)
- Philipp M Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Germany; Department of Physiological Psychology, Otto-Friedrich-University Bamberg, Germany.
| | - William R Young
- Department of Clinical Sciences, Brunel University London, United Kingdom.
| | | | - Sascha Hansen
- Department of Neurology, Klinikum Bayreuth GmbH, Germany.
| | | | | | - Roy Müller
- Department of Neurology, Klinikum Bayreuth GmbH, Germany; Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, Germany; Department of Sports Science, Friedrich-Schiller-University, Jena, Germany.
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30
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Tahmosybayat R, Baker K, Godfrey A, Caplan N, Barry G. A systematic review and meta-analysis of outcome measures to assess postural control in older adults who undertake exergaming. Maturitas 2017; 98:35-45. [PMID: 28274326 DOI: 10.1016/j.maturitas.2017.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
Exergaming has been shown to be an effective tool to improve postural control (PC) in older community-dwelling individuals. The outcome measures (OMs) used to assess PC are varied and this could limit the estimation of the effectiveness of the intervention. This systematic review and meta-analysis aims to explore the OMs currently used to assess PC in exergaming interventions, for healthy elderly individuals aged over 60 years. The literature search was conducted across five databases (CINAHL, EMBASE, PubMed, ISI, SPORTdiscus and Science Direct) using a range of search terms and combinations relating to exergaming, balance, exercise, falls and elderly. Quality assessment was conducted using the PEDro Scale and a custom-made quality assessment tool. Eleven trials were included in the meta-analysis, with a mean (SD) PEDro score of 5.36 (1.57). Primary and secondary OMs showed small effects in favour of alternative training modes, although these effects were statistically insignificant for all primary OMs. Tertiary OMs could not be included in the meta-analysis due to varying output parameters from different instruments. Heterogeneity remained high across trials and no studies performed long-term follow-up. Exergaming is a potential alternative to PC training, although still in its infancy. Strong and well-designed RCTs are needed, targeting specific populations aged over 60 years. Variability in instrumented OMs prevents generalisation of results. Technological improvements may provide data not currently available from clinical and laboratory-based methods, and may allow PC to be assessed more realistically and specifically in relation to a population's activities of daily living, though this remains a new area of research.
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Affiliation(s)
- Robin Tahmosybayat
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK.
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK
| | - Alan Godfrey
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - Nick Caplan
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK; Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
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31
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Murray NG, Fernandez E, Salvatore AP, Reed-Jones RJ. Assessment of the Wii Basic Balance Test in measuring postural deficits post-concussion. J Clin Transl Res 2016; 2:123-128. [PMID: 30873470 PMCID: PMC6410636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/15/2016] [Accepted: 11/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background and Aim: To evaluate the Wii Basic Balance Test (WBBT), as a tool for detecting postural instability in athletes with concussions. Methods: Seventy-nine healthy physically active controls (NORM) (mean age 21.23 ± 1.78), and fifty-six athletes with concussions (CONC) (mean age 19.39 ± 2.145) participated in this study. All participants performed the Wii Basic Balance Test, which requires the participants to shift weight mediolaterally to maintain a red bar within a blue area denoted on the screen for three seconds during set levels of difficulty. CONC were included in the study within 24-48 hours of the initial concussion injury. Seven one-way ANOVAs assessed differences for each (1) Mean total number of WBBT Levels completed (TL), (2) Mean total seconds to complete all WBBT Level (TT), (3) Time to complete Level 1 (LI), (4) Time to complete Level 2 (L2), (5) Time to complete Level 3 (L3), (6) Time to complete Level 4 (L4), (7) Time to complete Level 5 (L5). Results: CONC completed significantly fewer Levels of the WBBT (p=0.032) when compared to NORM. Athletes with Concussions took a significantly longer time to complete LI (p=0.002) when compared to CONC. Post-hoc Chi-Square analysis determined a significantly greater (p=0.015) proportion (39%) of CONC successfully completed WBBT L5 when compared to the proportion (19%) of CONC. Follow up ROC curves revealed an Sn = 0.392 and an Sp = 0.821 for TL with a cutoff value of 4 levels, Sn=0.875 and an Sp = 0.253 for LI with a cutoff value of 4.4 seconds, and Sn = 0.804 and an Sp = 0.392 for those who successfully completed the WBBT L5. Conclusions: WBBT could be a low cost object method of assessing postural instability within 24-48 hours post-concussion. Relevance for patients: This data could provide health providers with an alternative method to measure the presence of postural instability post-concussion injury.
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Affiliation(s)
- Nicholas G. Murray
- School of Health and Kinesiology, College of Health Sciences, Georgia Southern University, Georgia, United States
| | - Eileen Fernandez
- Speech Language Pathology Program, College of Health Sciences, University of Texas at El Paso, Texas, United States
| | - Anthony P. Salvatore
- Speech Language Pathology Program, College of Health Sciences, University of Texas at El Paso, Texas, United States
| | - Rebecca J. Reed-Jones
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, Canada
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32
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Affiliation(s)
- Tom Baranowski
- Pediatrics (Behavioral Nutrition & Physical Activity), USDA/ARS Children's Nutrition Research Center , Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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