Analysis of Feasibility, Adherence, and Appreciation of a Newly Developed Tele-Rehabilitation Program for People With MCI and VCI

Abstract

Background: Patients with Mild Cognitive Impairment (MCI) and Vascular Cognitive Impairment (VCI) are at a high risk of progressing to dementia. Recent guidelines indicate the importance of promoting multidimensional and multi-domain interventions to prevent further decline. Due to its growing effectiveness, comparable to conventional face-to-face interventions, the use of technology is gaining relevance. Tele-rehabilitation systems have the potential to engage patients in multi-dimensional activity programs and to guarantee a low-cost continuum of care through remote control. A possible limitation of such programs is represented by the lack of familiarization with technology and computers in elderly people. The purpose of this study is to describe the feasibility, adherence, and appreciation of the GOAL Tele-R system, administered by a web-application through remote control in patients with MCI/VCI.Methods: Feasibility of the Tele-R system was evaluated by means of distribution of patients' attrition along the study phases, controlling for potential systematic bias in drop-out rates due to the technological device. Adherence was evaluated analyzing drop-out rates and indexes of carried out activities. Patients' appreciation was analyzed through ad hoc satisfaction questionnaire items.Results: Out of 86 approached patients, 25 (29%) were not enrolled, 30 (35%) dropped-out after randomization, and 31 (36%) completed the study (standard care group n = 12, the tele-R group n = 19). Compared to the tele-R group, rates of drop-outs resulted significantly higher for the standard care group (34 vs. 62%, respectively, p = 0.029). Taking into account baseline characteristics, females resulted in a statistically significant higher rate of drop-outs compared to males (66 vs. 27%, respectively, p = 0.003). Overall adherence to the proposed activities was 84% (85% for cognitive module and 83% for physical activity module). Concerning satisfaction, participants provided a good mean level of appreciation (3.7 ± 0.8, range 1–5), a positive feedback for usability, and a subjective perception of cognitive, emotional, and physical benefits due to the training.Conclusion: The GOAL Tele-R system seems a feasible technological rehabilitation program, reaching an acceptable level of adherence and appreciation in patients with an MCI/VCI condition.Clinical Trial Registration:www.ClinicalTrials.gov, ID: NCT03383549 (registration date: 26/dec/2017).

Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations

“…A total of 9% (n=3) of studies used a mixed methods methodology [ 3 , 87 , 96 ], whereas the remaining studies (28/34, 82%) used a quantitative methodological approach. Of the 28 quantitative studies, 8 (n=8, 28%) used a randomized controlled trial design [ 89 , 90 , 97 , 101 , 106 , 107 , 109 , 110 ]. Other quantitative studies have used observational or nonrandomized trial designs.…”

“…The focus of digital health interventions varied. For example, some were related to medication reconciliation [ 79 , 81 , 97 , 104 ], whereas others aimed at providing education (eg, about rehabilitative exercises), internet-based care, and resources [ 83 , 86 , 89 , 92 , 94 , 96 , 100 , 104 - 106 , 111 ] and improved communication and care coordination with older adults’ care providers [ 3 , 82 , 91 , 104 , 108 ]. A total of 2 interventions aimed to improve communication processes among health care providers regarding discharge processes and care plans [ 93 , 109 ].…”

A Scoping Review for Usage of Telerehabilitation among Older Adults with Mild Cognitive Impairment or Cognitive Frailty

“…In this study, participants in the control group who received conventional behavioral change via face-to-face were reported giving burden to the caregivers [ 42 ]. Another study revealed that ICT platforms used to conduct telerehabilitation was suitable to be implemented among MCI patients as drop-out rate in the control group was higher when compared to telerehabilitation intervention group [ 68 ].…”

“…In addition, other protocol randomized controlled studies with multi-domain of telerehabilitation intervention were also outlined to conduct the same goal which is to counteract cognitive dysfunction and enhance quality of life such as Games for Older Adults Active Life (GOAL) Project and TV-AssistDem [ 65 , 91 ]. Telerehabilitation was found to be feasible among people with mild cognitive impairment or vascular cognitive impairment [ 68 ].…”

Pivoting an MCI Empowerment Program to Online Engagement

“…daily steps [57]), and improving self-efficacy in diabetic patients [23,59]. One telerehabilitation study for individuals with MCI, GOAL (Games for Older Adults' Active Live) Project [13] uses an 8-week app-based program to complete cognitive (computerized training), physical (guided videos of exercises), and caregiver training [37]. Although the program has demonstrated good attendance and low attrition rates, its efficacy has not yet been established with regard to allaying cognitive decline or improving mood or other outcomes.…”