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Background Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. Objective This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. Methods This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. Results The protocol (2019-11-22) has been approved by the Comité de Protection des Personnes Nord-Ouest I–Université de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. Conclusions The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. Trial Registration ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988 International Registered Report Identifier (IRRID) DERR1-10.2196/24665

Introduction. Exergaming is increasingly employed in rehabilitation for older adults. However, their effects on fall rate and fall risk remain unclear. Methods. We conducted a systematic review and meta-analysis that included randomized controlled trials (RCTs) comparing exergame-assisted rehabilitation with control groups, published in French or English, from Web of Science, CINHAL, Embase, Medline and CENTRAL (last search in June 2021). Two reviewers independently assessed studies. Risk of bias was assessed using RoB2, PEDRO scale and the GRADE system. The outcomes of interest were: a) Fall rate, b) Risk of falling, measured by the Short Physical Performance Battery (SPPB), Timed up and Go (TUG), One-Leg Stance or Berg Balance Scale (BBS), c) Fear of falling, measured with the Fall Efficacy Scale (FES-I) or the Activities-specific Balance Confidence (ABC) score. Data was pooled and mean differences (MD) between exergame and control groups calculated using a random-effects model. Results. Twenty-seven RCTs were included (1415 participants, including 63.9% of women, mean age ranged from 65 to 85.2 years old). Exergame-assisted interventions were associated with a reduction in the incidence of falls (4 studies, 316 participants, MD=-0.91 falls per person per year; 95% CI: -1.65 to -0.17, p =0.02, moderate quality). Regarding fall risk (20 studies included, low-quality evidence), SPPB did not change (MD=0.74; 95% CI: -0.12; 1.60, p= 0.09), but all other scores were improved: BBS (MD= 2.85; 95% CI: 1.27 to -4.43, p=0.0004), TUG (MD=-1.46; 95%: CI -2.21 to -0.71, p=0.0001) and One-leg stance (MD=7.09; 95% CI: 4.21 to 9.98, p<0.00001). Fear of falling scores (FES-I and ABC) showed no difference. Conclusion. There is moderate quality evidence of a reduction in the fall rate with exergame-assisted rehabilitation and low-quality evidence suggesting a mild reduction of the risk of falling. Statistically significant benefits from exergame-assisted rehabilitation did not achieve clinically meaningful changes in risk of falling assessments.

Background Frailty assessment is a major issue in geriatric medicine. The Vulnerable Elders Survey-13 (VES-13) is a simple and practical tool that identifies frailty through a 13-item questionnaire completed by older adults or their family caregivers by self-administration (pencil and paper) or by telephone interview. The VES-13 provides a 10-point score that is also a recognized mortality predictor. Objective This study aims to design an electronic version of the Echelle de Vulnérabilité des Ainés-13, the French version of the VES-13 (eEVA-13) for use on a digital tablet and validate it. Methods The scale was implemented as a web App in 3 different screens and used on an Android tablet (14.0× 25.6 cm). Participants were patients attending the outpatient clinic of a French geriatric hospital or hospitalized in a rehabilitation ward and family caregivers of geriatric patients. They completed the scale twice, once by a reference method (self-administered questionnaire or telephone interview) and once by eEVA-13 using the digital tablet. Agreement for diagnosis of frailty was assessed with the κ coefficient, and scores were compared by Bland and Altman plots and interclass correlation coefficients. User experience was assessed by a self-administered questionnaire. Results In total, 86 participants, including 40 patients and 46 family caregivers, participated in the study. All family caregivers had previously used digital devices, while 13 (32.5%) and 10 (25%) patients had no or infrequent use of them previously. We observed no failure to complete the eEVA-13, and 70% of patients (28/40) and no family caregivers needed support to complete the eEVA-13. The agreement between the eEVA-13 and the reference method for the diagnosis of frailty was excellent (κ=0.92) with agreement in 83 cases and disagreement in 3 cases. The mean difference between the scores provided by the 2 scales was 0.081 (95% CI–1.263 to 1.426). Bland and Altman plots showed a high level of agreement between the eEVA-13 and the reference methods and interclass correlation coefficient value was 0.997 (95% CI 0.994-0.998) for the paper and tablet group and 0.977 (95% CI 0.957-0.988) for the phone and tablet groups. The tablet assessment was found to be easy to use by 77.5% (31/40) of patients and by 96% (44/46) of caregivers. Finally, 85% (39/46) of family caregivers and 50% (20/40) of patients preferred the eEVA-13 to the original version. Conclusions The eEVA-13 is an appropriate digital tool for diagnosing frailty and can be used by older adults and their family caregivers. The scores obtained with eEVA-13 are highly correlated with those obtained with the original version. The use of health questionnaires on digital tablets is feasible in frail and very old patients, although some patients may need help to use them.

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