Feasibility of the Glenrose Grocery Game for Cognitive and Functional Outcomes in Older Inpatients

Overview

Older adults could benefit from computer serious games as a strategy for improving not only their cognitive functions but also their functioning and performance in daily activities, which are often compromised with age. A computer serious game is one designed for a primary purpose other than pure entertainment. Few computer games had been developed to emulate instrumental activities of daily living (IADLs), such as money management (e.g., shopping or paying bills). To fill this gap, occupational therapists at the Glenrose Rehabilitation Hospital (GRH) developed the Glenrose Grocery Game (GGG). At the time, the game had not yet been tested. Thus, the purpose of this feasibility study was to explore whether playing the GGG as part of the rehabilitation program at the GRH had an effect on specific mental functions (memory and attention), occupational performance in money management tasks, and satisfaction with occupational performance in older adults. In this study, we compared the outcomes of 7 participants who played the GGG (intervention group) with those of 8 different participants who received the GRH standard of care (control group). Data analysis is being conducted. The results of the study: Provided clinicians with evidence for implementing the GGG in interventions, which in turn may benefit inpatient clients at the GRH; Informed stakeholders' decisions about clients' safe discharge and transition to home and community; and Supported researchers in designing a larger and more robust study.

Occupational therapists at the Glenrose Rehabilitation Hospital (GRH) developed the Glenrose Grocery Game (GGG)-a serious game designed to simulate shopping, meal planning, and budgeting in a virtual environment. However, the GGG had not yet been tested for its impact on cognitive and occupational outcomes. The purpose of this feasibility study was to explore the implementation and effects of the GGG as part of the rehabilitation program at GRH, assessing its impact on specific mental functions, occupational performance, and satisfaction with performance in older adults. The study also aimed to estimate the parameters needed to design a future randomized controlled trial (RCT). Research Questions Was the designed protocol feasible for conducting a future definitive RCT? Did playing the GGG as part of the rehabilitation program at GRH affect mental functions, occupational performance, and satisfaction in older adults, compared to standard care? How engaged were older adults while playing the GGG? Methods Design A pretest-posttest control group design was used. The experimental group received sessions with the GGG, while the control group received standard care (i.e., compensatory strategies). The study followed the CONSORT guidelines for randomized pilot studies (Eldridge et al., 2016). Participants Inclusion Criteria: Adults aged 50 or older With or without cognitive impairment (MOCA ≥19) Functional vision and hearing (with or without aids) Functional upper extremity use Required no more than one-person assist for mobility Exclusion Criteria: Diagnosed with influenza or a virus affecting cognitive performance Unable to count, speak, or follow simple English instructions Sample Size Based on power analysis (α = 0.05, power = 0.8, effect size = 1.2), a minimum of 32 participants was required. We aimed to recruit 16 participants per group to account for a 25% dropout rate. Sampling and Allocation Stratified permuted block randomization was used, with stratification based on MOCA scores. Participants with MOCA scores between 19-24 were categorized as having moderate cognitive impairment; those with scores of 25-30 were considered to have mild/no impairment. Allocation was blinded to research staff administering and evaluating the intervention. Recruitment Protocol OTs at GRH inpatient units identified eligible participants. Informed consent (or assent via substitute decision-makers) was obtained. Allocation and coding were conducted by the PI (AMRR), and group assignment remained blinded to those delivering and evaluating the intervention. Independent Variable GGG Intervention: Participants played the GGG, completing meal planning and grocery shopping tasks in a gamified format. Sessions (8 × 30 minutes over 4 weeks) were delivered by trained RAs using tablets or computers. Standard Care: Included cognitive assessment, education, and compensatory strategies (e.g., journaling, memory logs). Interventions were tailored to comprehension level and included caregiver involvement when needed. Dependent Variables Specific Mental Functions: Trail Making Test (TMT) Parts A and B Walking and Remembering Test (WART) Montreal Cognitive Assessment (MOCA) Occupational Performance: Objective: PASS Task H8 (Money Management: Shopping) Subjective: Canadian Occupational Performance Measure (COPM) Engagement: 8-point Likert engagement scale developed in a prior study (Ríos Rincón et al., 2017) All tools have strong metric properties and are suitable for use with older adults. Data Collection The experimental group received GGG sessions in a dedicated room at GRH. Engagement was assessed post-session. All participants completed pretest and posttest assessments, taking \~80 minutes total. Blinded evaluators (RA 2) conducted assessments; a second rater (RA 3) scored at least 25% of measures to ensure reliability. Data Analysis Data are currently being analyzed using SPSS under intention-to-treat principles. Descriptive statistics are being used to characterize the groups at pretest. Due to the small sample size, non-parametric tests (Wilcoxon signed-rank and Mann-Whitney U) are being used for within- and between-group comparisons for MOCA, TMT, WART, PASS, and COPM scores. Clinical significance in COPM scores is being evaluated using the two-point threshold (Law et al., 1998). Engagement data are being analyzed descriptively. Potential Impact Findings from this study will provide clinicians with preliminary evidence regarding the GGG's impact on cognition, occupational performance, and engagement in older adults. If results are favorable, they will support the implementation of the GGG as a rehabilitation tool at GRH, benefiting inpatient clients. Insights will also help guide discharge planning and caregiver support and inform the design of a future, larger-scale RCT.