Authors: Emma K Stanmore, Senior Lecturer1, Wytske Meekes1, Research Assistant, Vicky Bell1, Research Associate, Kelly Hagan2, Physiotherapist, Debra Maloney2, Operations Manager, Angela Easdon2, Senior Physiotherapist, Jay Chillala3, Consultant in Elderly Health, Bibhas Roy3, Orthopaedic Consultant, Chris Todd1, Professor of Primary Care and Community Health.
Affiliation: ¹School of Nursing, Midwifery and Social Work and MAHSC (Manchester Academic Health Science Centre), Jean McFarlane Building, University Place, U.K. M13 9LP.
2Trafford Community Services, Pennine Care NHS Foundation Trust, Meadway Health Centre, Meadway, Sale, U.K. M33 4PS.
3Central Manchester University Hospitals NHS Foundation Trust, Trafford General Hospital, Manchester, M41 5SL
Background: Fall related injuries are the greatest cause of accidental death in older people across Europe and with the growing proportion of older people, this problem is increasing. Fall consequences include serious injuries such as hip fracture, hospital admission, reduced quality of life, premature care home admission, fear of falling, anxiety and social isolation. There is a wealth of evidence about fall risk factors and effective interventions which can reduce falls. One of the most effective interventions to reduce falls and improve function in older people is specific strength and balance exercise programmes. However, there is generally low uptake, fidelity and adherence to these programmes. A solution may be the use of purposely designed Microsoft Kinect Exergames (videogames which combine gameplay with physical exercise). The Exergames in this study have been co-designed with users (older people), clinicians, academics and developed by industry (MIRA Rehab Ltd) to target strength and balance and thus reduce falls and related injuries.
Aims: The aims of this study were to investigate the feasibility and acceptability of using Exergames to improve function, and prevent falls in community dwelling older people.
This mixed methods study involved three inter-related phases:
Phase one: Patients and therapists at two fall prevention clinics in the Northwest were asked about their views before and after the introduction of the Exergame therapy to investigate acceptability and usability. Observation of usual practice in the fall prevention clinics was undertaken to identify best methods for introducing the Exergame therapy.
Phase two: A feasibility pilot study was conducted to test important parameters to inform a possible larger trial such as recruitment rates, adherence rates and proposed outcome measures. Participants were allocated to usual care or home based Exergame therapy plus usual care. Exergame therapy involved 12 weeks supported use with the frequency, duration and levels of difficulty set according to
individual needs and adjustments made as required to enable progression. Assessments were completed at baseline, 6 and 12 weeks. Participants undertook physical checks and
completed questionnaires to identify demographics, history of falls, levels of function, usability of the Exergames, physical activity levels, lower limb strength and balance assessment, fear of falling questionnaire, and falls risk. Data on medication, vision, and history of surgery and fractures was also recorded. Adherence (frequency, duration and time of use of the Exergames) to the Exergame programme was tracked in real time by the Mira-Exergame system.
Phase three: Staff and patients were interviewed to give their views of the Exergame therapy, how it fitted within the falls prevention service, whether they enjoyed the Exergames and if they felt any benefits or otherwise.
Twenty four older people completed the feasibility pilot study. Four focus groups were undertaken to capture qualitative data from users and therapists. Usability and acceptability data was obtained from 16 therapists and 24 older people. Usability responses were largely positive with all of the frequent users finding the Mira Exergame system easy to use but requiring technical support to set up the Exergames, nearly half felt very confident to use the Exergames and were willing to use the Exergames frequently. A history of falls in the previous year affected the majority of the participants and the majority of users reported positive physical and psychological outcomes after 12 weeks of Exergame use. The practicalities of setting up and using the Exergames with older people and the level of support required was also useful for informing a larger clinical trial regarding recruitment rates, adherence rates, necessary support and proposed outcome measures.
Conclusion and anticipated benefits to healthcare
The Mira-Exergames can be used safely with older people in the community setting under the supervision of therapists. The Exergames may enable more effective rehabilitation in older patients due to increased accessibility and adherence, which could improve patients’ satisfaction, physical function, prevent falls and reduce the cost of on-going health/social care.
Dr. Emma Stanmore Senior Lecturer in Nursing at the University of Manchester is a speaker at the 6th Annual Games For Health Europe Oct 31-Nov 1st 2016 in Utretcht, NL. The focus of the presentation will be on the above abstract demonstrating the use of MIRA Exergames to improve function and prevent falls.