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Reducing falls risk with Kinect based falls prevention Exergames: A 12 week two centre, cluster RCT of community-dwelling older adults living in sheltered housing

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Emma Stanmore at The University of Manchester
Emma Stanmore
Alexandra Mavroeidi at Glasgow Caledonian University
Alexandra Mavroeidi
Vicky Bell
Vicky Bell
Vicky Bell
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Wytske Meekes at Tilburg University
Wytske Meekes
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Abstract

Reducing falls risk with Kinect based falls prevention Exergames: A 12 week two centre, cluster RCT of community-dwelling older adults living in sheltered housing. Stanmore E.1, Mavroeidi A.2, Bell V.1, Meekes W.1, de Jong L.D.3, Skelton D.A.2, Sutton C.J.4, Benedetto V.4 and Todd C.1 1University of Manchester, School of Health Sciences, Division of Nursing, Midwifery and Social Work, UK, 2School of Health and Life Sciences, Institute of Allied Health Research, Glasgow Caledonian University, UK, 3School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia, 4Lancashire Clinical Trials Unit, Faculty of Health and Wellbeing, University of Central Lancashire, UK Introduction: Falls are the leading cause of fatal and non-fatal unintentional injuries in older people. Despite overwhelming evidence for strength/balance training, adherence to both group and home-exercise programmes is often poor1. A novel approach is the use of home-based, strength and balance video-games (EXERGAMES) but data from randomized controlled trials are limited2. The aim of this study was to test whether a 12 week EXERGAMES home-based intervention, co-developed with older adults and therapists, can improve the risk of falling [by Berg Balance Scale (BBS)] in older adults living in sheltered housing. Methods: We conducted a two-site (Manchester/Glasgow) cluster RCT. Twelve sheltered housing facilities were randomised (1:1) to either a 12wk standard care plus 3 times/ week EXERGAMES physiotherapist one-to-one intervention (n=56) or standard care (control group n=50). Standard care involved the provision of a home exercise booklet (standard approach for those unable/unwilling to attend group exercise programmes in the community). results: A total of 106 older adults (83F, 23M) with a mean age of 77.8y (SD 10.2; range 55-101y), were recruited for the study. A total of 91 (86%) participants completed all study visits. Over 12 weeks the EXERGAMES intervention had a significant positive impact on BBS [p=0.003; mean (SD), 44.6 (10.7) (EXERGAMES) vs. 37.6 (14.9) (Control)]. The mean change of BBS from baseline was 2.9 (8.5) for the EXERGAMES and -2.8 (6.5) for the control group. The estimated increase in BBS score due to EXERGAMES was 6.2 (95% CI 2.4 to 9.9) which is greater than the minimal detectable change for the scale of 4.93. conclusions: Balance, and thus risk of falling, can be improved through a 12wk physiotherapy led EXERGAMES programme. This type of home based intervention could be considered as an effective alternative to traditional falls prevention exercise regimes to support outcomes for patients. References 1. Nyman, S.R. and C.R. Victor, Older people’s participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review. Age Ageing 2012;41(1):16-23. 2. Skjaeret N, et al. Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy. Int J Med Inform 2016;85(1):1-16. 3. Donoghue, D., et al., How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. J Rehabil Med 2009;41(5):343-6.
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Reducing falls risk with Kinect based falls prevention EXERGAMES: a 12 week two-
centre, cluster RCT of community-dwelling older adults living in sheltered housing
Emma Stanmore1, Alexandra Mavroeidi2, Vicky Bell1, Wytske Meekes1, Lex D. de Jong3,
Dawn A Skelton2 , Chris J Sutton4, Valerio Benedetto4, Chris Todd1
1University of Manchester, School of Health Sciences, Division of Nursing, Midwifery and
Social Work, UK, 2School of Health and Life Sciences, Institute of Allied Health Research,
Glasgow Caledonian University, UK, 3School of Physiotherapy and Exercise Science,
Faculty of Health Sciences, Curtin University, Perth, Australia, 4 Lancashire Clinical
Trials Unit, Faculty of Health and Wellbeing, University of Central Lancashire, UK.
Presenting author: Alexandra Mavroeidi Alexandra.mavroeidi@gcu.ac.uk, tel no: 0141
273 1144
Falls are the leading cause of fatal and non-fatal unintentional injuries in older people.
Despite overwhelming evidence for strength/balance training, adherence to both group
and home-exercise programmes is often poor [1]. A novel approach is the use of home-
based, strength and balance video-games (EXERGAMES) but data from randomized
controlled trials are limited [2]. The aim of this study was to test whether a 12 week
EXERGAMES home-based intervention, co-developed with older adults and therapists,
can improve the risk of falling [by Berg Balance Scale (BBS)] in older adults living in
sheltered housing.
We conducted a two-site (Manchester/Glasgow) cluster RCT. Twelve sheltered housing
facilities were randomised (1:1) to either a 12wk standard care plus 3 times/ week
EXERGAMES physiotherapist one-to-one intervention (n=56) or standard care (control
group n=50). Standard care involved the provision of a home exercise booklet (standard
approach for those unable/unwilling to attend group exercise programmes in the
community). A total of 106 older adults (83F, 23M) with a mean age of 77.8y (SD 10.2;
range 55-101y), were recruited for the study.
A total of 91 (86%) participants completed all study visits. Over 12 weeks the
EXERGAMES intervention had a significant positive impact on BBS [p=0.003; mean (SD),
44.6 (10.7) (EXERGAMES) vs. 37.6 (14.9) (Control)]. The mean change of BBS from
baseline was 2.9 (8.5) for the EXERGAMES and -2.8 (6.5) for the control group. The
estimated increase in BBS score due to EXERGAMES was 6.2 (95% CI 2.4 to 9.9) which is
greater than the minimal detectable change for the scale of 4.9 [3].
Balance, and thus risk of falling, can be improved through a 12wk physiotherapy led
EXERGAMES programme. This type of home based intervention could be considered as
an effective alternative to traditional falls prevention exercise regimes to support
outcomes for patients.
References
1. Nyman, S.R. and C.R. Victor, Older people's participation in and engagement with
falls prevention interventions in community settings: an augment to the Cochrane
systematic review. Age Ageing, 2012. 41(1): p. 16-23.
2. Skjaeret, N., et al., Exercise and rehabilitation delivered through exergames in
older adults: An integrative review of technologies, safety and efficacy. Int J Med
Inform, 2016. 85(1): p. 1-16.
3. Donoghue, D., et al., How much change is true change? The minimum detectable
change of the Berg Balance Scale in elderly people. J Rehabil Med, 2009. 41(5): p.
343-6.
Development and Evaluation of a Motion-Based Exercise Game for Balance Improvement
Chapter
  • Jul 2020
Over the past years many systems involving exercising through games (exergaming) have been developed by leveraging on new technologies to provide an alternative way for improving physical condition and balance control. Such systems are widely used for improving the physical condition of healthy persons and for rehabilitation. For seniors, exergames provide a new and enjoyable way for increasing physical activity and for improving balance condition and muscle strength to reduce fall risks. However, a matter arising is whether such systems are well designed to suit seniors. In this work the development and evaluation of a new exergame is presented. The development process followed a human centered design approach involving the relevant stakeholders to create an effective system for balance training. The implementation was based on the Microsoft Kinect sensor for motion recognition and the Unity graphics engine for creating a realistic three-dimensional open world. The influence of user diversity on gesture training and recognition is discussed and the proper sample size is determined in order to achieve a high confidence level in gestures recognition. Results of a user evaluation study are reported both on balance improvement and on system usability, by using proper measurement instruments. The results indicate a positive acceptance of the technology and the possibility for balance improvement leading to healthier seniors.
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The minimum detectable change of the Berg Balance Scale in elderly people
Article
Full-text available
  • May 2009
  • J REHABIL MED
To determine the minimum detectable change at 95% confidence for the Berg Balance Scale in a group of elderly people, undergoing physiotherapy rehabilitation. Multi-centre, test-retest design. Cross-sectional sample of convenience of people over 65 years (n = 118) without a previous history of stroke, Parkinson's disease or recent hip arthroplasty. RATERS: Physiotherapists working with elderly people, drawn from the Physiotherapy Research into Older People group, ranging in experience from newly qualified to 39 years qualified. Each participant was assessed using the Berg Balance Scale and again within 48 hours by the same physiotherapist. The minimum detectable change at 95% was established. A change of 4 points is needed to be 95% confident that true change has occurred if a patient scores within 45-56 initially, 5 points if they score within 35-44, 7 points if they score within 25-34 and, finally, 5 points if their initial score is within 0-24 on the Berg Balance Scale. A clinician with a working knowledge of these minimum detectable change values can be up to 95% confident that a true change or not a true change in a patients' functional balance has occurred and can therefore alter their interventions accordingly to ensure quality, focused rehabilitation.
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Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy
Article
  • Oct 2015
Background: There has been a rapid increase in research on the use of virtual reality (VR) and gaming technology as a complementary tool in exercise and rehabilitation in the elderly population. Although a few recent studies have evaluated their efficacy, there is currently no in-depth description and discussion of different game technologies, physical functions targeted, and safety issues related to older adults playing exergames. Objectives: This integrative review provides an overview of the technologies and games used, progression, safety measurements and associated adverse events, adherence to exergaming, outcome measures used, and their effect on physical function. Methods: We undertook systematic searches of SCOPUS and PubMed databases. Key search terms included "game", "exercise", and "aged", and were adapted to each database. To be included, studies had to involve older adults aged 65 years or above, have a pre-post training or intervention design, include ICT-implemented games with weight-bearing exercises, and have outcome measures that included physical activity variables and/or clinical tests of physical function. Results: Sixty studies fulfilled the inclusion criteria. The studies had a broad range of aims and intervention designs and mostly focused on community-dwelling healthy older adults. The majority of the studies used commercially available gaming technologies that targeted a number of different physical functions. Most studies reported that they had used some form of safety measure during intervention. None of the studies reported serious adverse events. However, only 21 studies (35%) reported on whether adverse events occurred. Twenty-four studies reported on adherence, but only seven studies (12%) compared adherence to exergaming with other forms of exercise. Clinical measures of balance were the most frequently used outcome measures. PEDro scores indicated that most studies had several methodological problems, with only 4 studies fulfilling 6 or more criteria out of 10. Several studies found positive effects of exergaming on balance and gait, while none reported negative effects. Conclusion: Exergames show promise as an intervention to improve physical function in older adults, with few reported adverse events. As there is large variability between studies in terms of intervention protocols and outcome measures, as well as several methodological limitations, recommendations for both practice and further research are provided in order to successfully establish exergames as an exercise and rehabilitation tool for older adults.
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Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane Systematic Review
Article
  • Aug 2011
  • AGE AGEING
Randomised controlled trials (RCTs) of fall prevention conducted in community settings have recently been systematically reviewed. To augment this review by analysing older people's participation in the trials and engagement with the interventions. Review of the 99 single and multifactorial RCTs included in the Cochrane systematic review of falls prevention interventions. Community. Adults aged 60+/mean age minus one standard deviation of 60+. Calculated aggregate data on recruitment (proportion who accepted the invitation to participate), attrition at 12 month follow-up (loss of participants), adherence (to intervention protocol) and whether adherence moderated the effect of interventions on trial outcomes. The median recruitment rate was 70.7% (64.2-81.7%, n = 78). At 12 months the median attrition rate including mortality was 10.9% (9.1-16.0%, n = 44). Adherence rates (n = 69) were ≥80% for vitamin D/calcium supplementation; ≥70% for walking and class-based exercise; 52% for individually targeted exercise; approximately 60-70% for fluid/nutrition therapy and interventions to increase knowledge; 58-59% for home modifications; but there was no improvement for medication review/withdrawal of certain drugs. Adherence to multifactorial interventions was generally ≥75% but ranged 28-95% for individual components. The 13 studies that tested for whether adherence moderated treatment effectiveness produced mixed results. Using median rates for recruitment (70%), attrition (10%) and adherence (80%), we estimate that, at 12 months, on average half of community-dwelling older people are likely to be adhering to falls prevention interventions in clinical trials.
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