In order to design effective interventions to prevent age-related mobility loss, it is important to identify influencing factors. The concept of “motility” by Kaufmann et al. subdivides such factors into three categories: “access”, “skills”, and “appropriation”. The aim of this study was to assemble appropriate quantitative assessment tools for the assessment of these factors in frail older adults and to get first insights into their relative contribution for life-space and physical activity-related mobility. This is an exploratory cross-sectional study conducted with twenty-eight at least prefrail, retired participants aged 61–94. Life-space mobility was assessed using the “University of Alabama at Birmingham Life-space Assessment” (LSA) and physical activity using the “German Physical Activity Questionnaire” (PAQ50+). Factors from the category “appropriation”, followed by factors from the category “skills” showed the strongest associations with the LSA. Factors from the category “access” best explained the variance for PAQ50+. This study’s findings indicate the importance of accounting for and examining comprehensive models of mobility. The proposed assessment tools need to be explored in more depth in longitudinal studies with larger sample sizes in order to yield more conclusive results about the appropriateness of the motility concept for such purposes.
IntroductionTelerehabilitation in older adults using information and communication technologies (ICTs) provides therapy, which is potentially equally effective as traditional rehabilitation, yet more accessible. This study aimed to analyze the needs and requirements of older adults (OA) and healthcare-professionals (HP) toward ICTs and telerehabilitation in general as well as toward a specific novel exergame-based telerehabilitation system (COCARE system, Dividat).Materials and methodsThe COCARE telerehabilitation system enables individual training based on exergames, as well as an assessment system and a digital centralized case management. Six focus groups with in total 34 participants were conducted. A mixed-methods approach was used comprising questionnaires and semi-structured interviews.ResultsBoth OA and HP would engage to an exergame-based telerehabilitation program. Major motivating factors are the relevance of such a training for health and the entertainment component of exergames. Main requirements are simplification of the system, variety, a personalized training, a constantly available contact person, and comprehensive instructions for use. Besides, HP praised the system's motivational effect, but remained concerned about risk of falls and social isolation.ConclusionICTs for telerehabilitation are accepted by OA and HP but should be adapted hardware- and software-wise to address OA' age-stemming vulnerabilities (e.g., risk of falls) and low ICT literacy.
Background Life-space mobility (LSM) is an important aspect of older adults’ real-life mobility. Studies have shown that restricted LSM is a risk factor for many adverse outcomes such as low quality of life and mortality. Therefore, an increasing number of interventions aim to enhance LSM. However, the intervention approaches differ in terms of their type/content, duration, targeted populations, but also in terms of their outcome measures and assessment tools. Especially the latter impairs the comparability of studies with otherwise similar interventional approaches and thus also the interpretation of their results. Therefore, this systematic scoping review aims to provide an overview of the intervention components, assessment tools, and effectiveness of studies aiming to improve LSM in older adults. Methods A systematic literature search was carried out in PubMed and Web of Science. We considered studies in older adults of any design that included an intervention approach and at least one outcome of LSM. Results 27 studies were included in the review. These studies analyzed healthy community-dwelling as well as frail older adults in need of care or rehabilitation and nursing home residents with a mean age between 64 and 89. The percentage of female participants ranged from 3 to 100%. The types of interventions were of the following: physical, counseling, multidimensional, miscellaneous. Multidimensional interventions consisting of physical interventions plus any of the following or a combination of counseling/education/motivation/information appear to be most effective in increasing LSM. Older adults with mobility impairments were more responsive to these multidimensional interventions compared to healthy older adults. Most of the studies used the questionnaire-based Life-Space Assessment to quantify LSM. Conclusions This systematic scoping review provides a comprehensive overview of a heterogenous stock of literature investigating LSM-related interventions in older adults. Future meta-analyses are needed to provide a quantitative evaluation of the effectiveness of LSM interventions and recommendations.
Background Analyzing and adjusting training programs to increase exercise enjoyment is crucial to achieve long-term adherence and thus also maximize health benefits. The Exergame Enjoyment Questionnaire (EEQ) is the first questionnaire specifically developed to monitor exergame enjoyment. To be used in German speaking countries, the EEQ must be translated, cross-culturally adapted, and tested on its psychometric properties. Objectives The aim of this study was to develop (i.e., translate and cross-culturally adapt) the German Version of the EEQ (EEQ-G) and investigate its psychometric properties. Methods Psychometric properties of the EEQ-G were tested using a cross-sectional study design. Each participant performed two consecutive exergame sessions (i.e., ‘preferred’ and ‘unpreferred’ condition) in randomized order and rated the EEQ-G as well as reference questionnaires. Internal consistency of the EEQ-G was assessed by calculating Cronbach’s α. Construct validity was assessed by calculating Spearman’s rank correlation coefficients (rs) between the scores of the EEQ-G and reference questionnaires. Responsiveness was analyzed by performing a Wilcoxon signed-rank test between the median EEQ-G scores of the two conditions. Results Fourty-three healthy older adults (HOA; mean age = 69.4 ± 4.9 years; 53.5% females) were included. Cronbach’s α of the EEQ-G was 0.80. The rs values between the EEQ-G and reference questionnaire scores for intrinsic motivation, game enjoyment, physical activity enjoyment, and external motivation were 0.198 (p = 0.101), 0.684 (p < 0.001), 0.277 (p = 0.036), and 0.186 (p = 0.233), respectively. The EEQ-G was rated higher in the ‘preferred’ than the ‘unpreferred’ condition (p < 0.001, r = 0.756). Conclusion The EEQ-G has high internal consistency and is responsive to changes in exergame enjoyment. The highly skewed data with ceiling effects in some of the reference questionnaires deem the construct validity of the EEQ-G to be inconclusive and thus in need of further evaluation.
BACKGROUND Telerehabilitation is gaining in relevance as a tool to provide and supervise a therapy/ training, which can be equally effective as traditional rehabilitation methods, yet more accessible and affordable. An exergame-based telerehabilitation system was recently developed within the scope of the international COCARE-project. The system comprises training devices for the use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation-cockpit and its focus lays on a home-based, combined cognitive and physical training, which is remotely managed by healthcare-professionals (HPs). OBJECTIVE The present study aimed at analyzing the usability, acceptability, and enjoyment of the whole COCARE-system for use in older adults (OAs). METHODS In total, 45 OAs and 15 HPs (15 OAs and 5 HPs in each of the three trial sites (Switzerland, Italy, and Cyprus)) were invited to try out the system in a single session. Mixed methods (qualitative and quantitative questions and questionnaires) were applied to analyze OAs’ and HPs’ perceptions of the system and to figure out possible barriers to its implementation in a home setting. In addition, potential usability-influencing factors (i.e., performance during gameplay, demographics, and training-related contextual factors) were explored. RESULTS The COCARE-system received good acceptance ratings (83.2% (OAs) and 81% (HPs) of the maximum score) and OAs indicated high enjoyment (73.3±12.7 out of 100 points in the Exergame Enjoyment Questionnaire) while playing the exergames. The system´s usability, assessed with the System Usability Scale, was rated with a score of 68.1±18.8 (OAs), respectively 70.6±12.2 (HPs) out of 100 points, whereas significant differences between the trial sites were observed. A number of requirements and recommendations for improvement were revealed. Mostly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties understanding certain instructions of assessments and games. CONCLUSIONS The results of this study will serve as input to the further development of the COCARE-system towards a user-friendly and accepted version, aiming to stimulate older adult’s cognitive and physical functions. Feasibility and effectiveness of the system should further be evaluated in future randomized controlled trials.
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