Residents living in long-term care (LTC) homes spend up to 75% of their day in sedentary, socially withdrawn situations which increases their risk for depression, dementia, decreased functional status and increased care costs. Physical activity is an accepted intervention to improve the physical health, cognition, and well-being of older adults. Moreover, systematic reviews have found that exergaming (i.e. physical activity gamified with technology) offers physical, cognitive, and social benefits by means of dual-task activities that engage both motor and cognitive abilities. The effect of exergaming for older adults in LTC is less clear, as this population has greater health needs related to physical health conditions, cognitive impairment, and functional dependence. Given the increased global demand for LTC, there is a need to develop and assess innovative exergaming technologies that can support the physical and cognitive health of LTC residents. MouvMat is an exergaming technology intervention with an interactive digital gaming surface designed for older adults (OA) in LTC settings. Participants can play familiar games, like Simon or Bingo, by stepping on or tapping the surface with an assistive pointing device. Games can be played individually or with multiple players. LED lights on the surface provide an adaptive digital display and embedded pressure sensors respond to players' input. The investigators collaboratively designed a preliminary prototype with OA aged 65 and older in a pilot project. The overall objective of this proposal is to conduct a pilot RCT of the Mouvmat to evaluate the feasibility, acceptability and efficacy of the exergaming technology to improve the primary outcome of mobility, and the secondary outcomes of cognitive function and social isolation compared to a usual care control group receiving standard recreational programming by recreational therapists.
The sample size calculation was completed based on an effect size of 0.65 (power = 0.80; 2-tailed; α= 0.05). Assuming a 5% attrition rate, a total of 56 residents (28 people in a control group and 28 people in the intervention group) will be recruited. A block randomization design using a number generator to conceal the randomization sequence will be used to assign participants' units to the intervention or control groups. Block randomization was conducted to comply with COVID-19 restrictions. The investigators will attempt to recruit equal numbers of men and women with a range of mobility requirements (i.e., ambulate independently, using gait aids such as canes or walkers). In addition, a mix of approximately 5-10 LTC staff and/or residents' family members will be recruited at the end of the trial to conduct semi-structured interviews to understand the acceptability of the technology, design, usability and enjoyment, potential facilitators and barriers to exergame technology.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
60
Sessions engaging with exergaming device.
Conducted by recreational therapists.
Chester Village
Toronto, Canada
COMPLETEDKensington Gardens
Toronto, Canada
RECRUITINGChange in mean mobility scores on the Timed-up-and-Go test
Completion time in seconds when participant sits in a standard armchair and is instructed to stand up and walk to a line 3 m away at their normal pace, turn around and sit back down in the chair.
Time frame: Baseline and mid-point of the intervention (3 weeks)
Change in mean mobility scores on the Timed-up-and-Go test
Completion time in seconds when participant sits in a standard armchair and is instructed to stand up and walk to a line 3 m away at their normal pace, turn around and sit back down in the chair.
Time frame: Baseline and following the completion of the intervention (6 weeks)
Change in mean mobility scores on the 2-Minute Walk Test
Distance walked in meters when a participant is instructed to walk at the fastest speed that they can for 2 minutes.
Time frame: Baseline and mid-point of the intervention (3 weeks)
Change in mean mobility scores on the 2-Minute Walk Test
Distance walked in meters when a participant is instructed to walk at the fastest speed that they can for 2 minutes.
Time frame: Baseline and following the completion of the intervention (6 weeks)
Adverse events (e.g. injury) related to exergame use
Number of adverse events related to use of the exergame in the intervention group
Time frame: Over the course of the intervention (baseline to 6 weeks)
Feasibility related to adherence rate
Mean percentage of sessions attended in the intervention group (i.e., number of sessions attended / total scheduled sessions)
Time frame: Over the course of the intervention (baseline to 6 weeks)
Change in mean working memory scores on digit span
Total scores for the WAIS-III forward and backward digit span, in which participants are asked to repeat a series of digits that are read by an experimenter in the same order (forward) or reverse order (backward).
Time frame: Baseline and mid-point of the intervention (3 weeks)
Change in mean working memory scores on digit span
Total scores for the WAIS-III forward and backward digit span, in which participants are asked to repeat a series of digits that are read by an experimenter in the same order (forward) or reverse order (backward).
Time frame: Baseline and following the completion of the intervention (6 weeks)
Change in mean basic attention/psychomotor speed on the Trail Making Test A
Time to completion in seconds on a task requiring connecting numbered dots on a page in order as quickly as possible.
Time frame: Baseline and mid-point of the intervention (3 weeks)
Change in mean basic attention/psychomotor speed on the Trail Making Test A
Time to completion in seconds on a task requiring connecting numbered dots on a page in order as quickly as possible.
Time frame: Baseline and following the completion of the intervention (6 weeks)
Change in mean alternating attention scores on the Trail Making Test B
Time to completion in seconds on a task requiring switching between connecting numbers and letters in dots on a page as quickly as possible.
Time frame: Baseline and mid-point of the intervention (3 weeks)
Change in mean alternating attention scores on the Trail Making Test B
Time to completion in seconds on a task requiring switching between connecting numbers and letters in dots on a page as quickly as possible.
Time frame: Baseline and following the completion of the intervention (6 weeks)
Change in errors made on an alternating sequences test
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Number of errors made on a task requiring alternating between drawing two designs. This test is sensitive to cognitive problems with executive functions including inhibition and perseveration.
Time frame: Baseline and mid-point of the intervention (3 weeks)
Change in errors made on an alternating sequences test
Number of errors made on a task requiring alternating between drawing two designs. This test is sensitive to cognitive problems with executive functions including inhibition and perseveration.
Time frame: Baseline and following the completion of the intervention (6 weeks)
Change in mean verbal fluency scores
Number of words generated in one minute given a letter cue
Time frame: Baseline and mid-point of the intervention (3 weeks)
Change in mean verbal fluency scores
Number of words generated in one minute given a letter cue
Time frame: Baseline and following the completion of the intervention (6 weeks)
Change in mean scores for social isolation assessed by UCLA Loneliness Scale 3
Total score on a 20-item questionnaire that assesses how often a person feels lonely and isolated from others.
Time frame: Baseline and mid-point of the intervention (3 weeks)
Change in mean scores for social isolation assessed by UCLA Loneliness Scale 3
Total score on a 20-item questionnaire that assesses how often a person feels lonely and isolated from others.
Time frame: Baseline and following the completion of the intervention (6 weeks)
Change in mean scores on the Cornell Scale for Depression in Dementia
Total scores on a measure based on interviews on 19 items related to depression.
Time frame: Baseline and mid-point of the intervention (3 weeks)
Change in mean scores on the Cornell Scale for Depression in Dementia
Total scores on a measure based on interviews on 19 items related to depression.
Time frame: Baseline and following the completion of the intervention (6 weeks)