Effectiveness of virtual reality technology on functional mobility of older adults: systematic review and meta-analysis

Corregidor-Sánchez, Ana-Isabel; Segura‐Fragoso, Antonio; Rodríguez–Hernández, Marta; Jiménez-Rojas, Concepción; Polonio-López, Begoña; Criado‐Álvarez, Juan José

doi:10.1093/ageing/afaa197

Cited by 27 publications

(22 citation statements)

References 22 publications

(37 reference statements)

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“…Multiple meta-analyses in HOA have synthesized evidence for significant improvements in executive functions ( Howes et al, 2017 ; Chen et al, 2020 ; Mansor et al, 2020 ) and working memory ( Mansor et al, 2020 ) in response to sequential or simultaneous motor-cognitive training while the evidence for global cognition [i.e., improvement ( Stanmore et al, 2017 ; Northey et al, 2018 ; Chen et al, 2020 ; Zhu et al, 2020 ; Gavelin et al, 2021 ) vs. no effect ( Wu et al, 2019 )] and learning and memory {i.e., mixed findings [improvement in updating memory but no effect on delayed memory ( Mansor et al, 2020 )]} remains conflicting, and no significant effects were synthesized for complex attention ( Vaportzis et al, 2019 ; Mansor et al, 2020 ), and verbal fluency ( Stanmore et al, 2017 ). Additionally, improvements in balance ( Howes et al, 2017 ; Pacheco et al, 2020 ) and functional exercise capacity ( Howes et al, 2017 ) have been synthesized while the evidence for mobility remains conflicting [i.e., improvement ( Pacheco et al, 2020 ; Gavelin et al, 2021 ) vs. no effect ( Howes et al, 2017 )] and no significant effects have been synthesized for activities of daily living ( Corregidor-Sánchez et al, 2020 ). When considering meta-analytic results for exergaming specifically, significantly larger improvements in complex attention ( Stanmore et al, 2017 ), executive functions ( Howes et al, 2017 ; Stanmore et al, 2017 ), global cognition ( Stanmore et al, 2017 ), visuospatial processing ( Stanmore et al, 2017 ), and also functional physical outcomes (i.e., balance, mobility) ( Howes et al, 2017 ), and fear of falling ( Howes et al, 2017 ), but not activities of daily living ( Corregidor-Sánchez et al, 2020 ) or functional exercise capacity ( Howes et al, 2017 ) have been synthesized compared to physically or cognitively active control interventions.…”

Section: Case Studymentioning

confidence: 99%

“…Additionally, improvements in balance ( Howes et al, 2017 ; Pacheco et al, 2020 ) and functional exercise capacity ( Howes et al, 2017 ) have been synthesized while the evidence for mobility remains conflicting [i.e., improvement ( Pacheco et al, 2020 ; Gavelin et al, 2021 ) vs. no effect ( Howes et al, 2017 )] and no significant effects have been synthesized for activities of daily living ( Corregidor-Sánchez et al, 2020 ). When considering meta-analytic results for exergaming specifically, significantly larger improvements in complex attention ( Stanmore et al, 2017 ), executive functions ( Howes et al, 2017 ; Stanmore et al, 2017 ), global cognition ( Stanmore et al, 2017 ), visuospatial processing ( Stanmore et al, 2017 ), and also functional physical outcomes (i.e., balance, mobility) ( Howes et al, 2017 ), and fear of falling ( Howes et al, 2017 ), but not activities of daily living ( Corregidor-Sánchez et al, 2020 ) or functional exercise capacity ( Howes et al, 2017 ) have been synthesized compared to physically or cognitively active control interventions.…”

Section: Case Studymentioning

confidence: 99%

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Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder – A Methodological Paper

Manser

Bruin

2021

Front. Aging Neurosci.

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Background: Utilizing information technology (IT) systems, for example in form of computerized cognitive screening or exergame-based (also called active videogames) training, has gained growing interest for supporting healthy aging and to detect, prevent and treat neurocognitive disorders (NCD). To ameliorate the effectiveness of exergaming, the neurobiological mechanisms as well as the most effective components for exergame-based training remain to be established. At the same time, it is important to account for the end-users’ capabilities, preferences, and therapeutic needs during the design and development process to foster the usability and acceptance of the resulting program in clinical practice. This will positively influence adherence to the resulting exergame-based training program, which, in turn, favors more distinct training-related neurobiological effects.Objectives and Methods: This methodological paper describes the design and development process of novel exergame-based training concepts guided by a recently proposed methodological framework: The ‘Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health’ (Li et al., 2020).Case Study: A step-by-step application of the MIDE-framework as a specific guidance in an ongoing project aiming to design, develop, and evaluate an exergame-based training concept with the aim to halt and/or reduce cognitive decline and improve quality of life in older adults with mild neurocognitive disorder (mNCD) is illustrated.Discussion and Conclusion: The development of novel exergame-based training concepts is greatly facilitated when it is based on a theoretical framework (e.g., the MIDE-framework). Applying this framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This is expected to foster the usability and acceptance of the resulting exergame intervention in “real life” settings. Therefore, it is strongly recommended to implement a theoretical framework (e.g., the MIDE-framework) for future research projects in line with well-known checklists to improve completeness of reporting and replicability when serious games for motor-cognitive rehabilitation purposes are to be developed.

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Section: Case Studymentioning

confidence: 99%

Section: Case Studymentioning

confidence: 99%

Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder – A Methodological Paper

Manser

Bruin

2021

Front. Aging Neurosci.

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“…Exergaming interventions were shown to be a feasible and effective training approach in healthy older people; with high adherence to exergame interventions (>90%) and only rare and minor adverse events being reported ( Valenzuela et al, 2018 ). In addition to this, exergaming interventions have positive effects on physical and cognitive functioning such as balance, functional mobility, gait and executive functions in healthy older adults ( Stanmore et al, 2017 ; Corregidor-Sánchez et al, 2020a , b ; Fang et al, 2020 ; Pacheco et al, 2020 ; Wollesen et al, 2020 ), as well as people suffering from chronic diseases ( Bonnechère et al, 2016 ; Stanmore et al, 2017 ; Zeng et al, 2017 ). However, some current gaps in knowledge need to be addressed.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Cognitive-Motor Exergames in Geriatric Inpatient Rehabilitation: A Pilot Randomized Controlled Study

Altorfer

Adcock

Bruin

et al. 2021

Front. Aging Neurosci.

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Objective: The aim of this pilot randomized clinical trial was to test the feasibility and efficacy of an exergame-based cognitive-motor training program in geriatric inpatients.Methods: The study participants were randomly allocated to either the exergame intervention group or the control group. The control group received the standard rehabilitation treatment offered in the clinic. In addition to the standard rehabilitation program, the intervention group conducted supervised exergame training on 5 days per week using the Dividat Senso, an exergame system specifically designed for older adults. The primary outcome was feasibility, as measured by e.g., adherence rate, attrition rate, occurrence of adverse events, System Usability Scale (SUS) and NASA-TLX score. Secondary outcomes included measures of physical and cognitive functioning such as comfortable walking speed, maximal walking speed, dual task walking speed, Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), Color-Word Interference test (D-KEFS), Trail Making test A and B (TMT), Go/No-Go test and Step Reaction Time test (SRTT). All secondary outcome measures were assessed pre- and post-intervention.Results: Thirty-nine persons were included in the study. Average adherence rate was 99%, there were no intervention-related dropouts and no adverse events. The mean System Usability Scale (SUS) score was 83.6 and the mean NASA-TLX score 45.5. Significant time-group interaction effects were found for the dual task walking speed, the Go/No-Go test and Step Reaction Time test (SRTT).Conclusion: Exergaming is a feasible, safe and effective cognitive-motor training approach in inpatient rehabilitation of geriatric patients. Incorporating exergaming in the rehabilitation program of geriatric patients offers potential to reduce fall risk factors and to increase patients’ exercise motivation and rehabilitation success.

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“…Moreover, there is a lack of research on the use of serious games or VR for the treatment of neck pain in this population [ 14 ]. Previous research has suggested that VR technology could improve variables such as functional mobility through improving gait quality and resistance in older populations [ 20 ]. A recent systematic review also suggested that VR interventions have the potential to improve health outcomes in older adults.…”

Section: Introductionmentioning

confidence: 99%

A Serious Game for Performing Task-Oriented Cervical Exercises Among Older Adult Patients With Chronic Neck Pain: Development, Suitability, and Crossover Pilot Study

et al. 2022

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Background There is sparse research on the effectiveness of therapeutic exercise for the treatment of neck pain in older adult populations. Moreover, there is a lack of research on the use of serious games or virtual reality for the treatment of neck pain in this population. Objective The primary aim of this study was to develop and assess the suitability of a serious game for performing task-oriented cervical exercises in patients with neck pain. Methods A serious game was designed based on the key features identified by previous studies that designed serious video games for physical and cognitive rehabilitation or exercise. The game in this study was designed to provide an interactive scenario, with the main functionality of the software solution to control a virtual airplane to reach targets using head motions. At the end of the exercise, the application stores the targets reached and missed and the airplane’s trajectory. A crossover pilot study was carried out for preliminary evaluation of the suitability of the technology in the older adult population. Men and women over 65 years of age with chronic neck pain were included. Subjects were randomly assigned to two study arms; each arm consisted of a sequence of two 4-week treatments with an intermediate washout period of 4 weeks. The total study duration was 16 weeks due to a final follow-up measure 4 weeks after the end of all treatments. Treatment A consisted of the use of the serious game developed in this study, and treatment B consisted of conventional exercises. Subjects allocated to the A-B study arm received treatment A first, followed by treatment B, and vice versa in the B-A arm. The following variables were assessed: Suitability Evaluation Questionnaire (SEQ) scores, Visual Analog Scale scores, and the number of targets reached in the serious game. Results A total of 18 subjects were assessed for eligibility. A total of 13 subjects, aged between 71 and 92 years (mean 81.85, SD 6.82), were finally included and completed the study protocol. The global mean SEQ score was 50.38 (SD 5.35) out of 65 points, showing good suitability of the serious game. Most patients considered the experience very enjoyable and “real” in terms of the virtual environment and found the information provided to be clear. Also, they believed that the game could be very helpful for their rehabilitation. None of the patients felt any neck pain or discomfort when playing the game, and only 2 patients out of 13 (15%) reported some degree of dizziness, eye discomfort, or disorientation, which did not limit their capacity to finish the session. Conclusions The serious game developed in this study showed good suitability for use in adults over 70 years of age with chronic neck pain. The game was a safe method for performing task-oriented cervical exercises, and patients reported very high levels of satisfaction and acceptance after the use of this technology.

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Effectiveness of virtual reality technology on functional mobility of older adults: systematic review and meta-analysis

Cited by 27 publications

References 22 publications

Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder – A Methodological Paper

Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder – A Methodological Paper

Feasibility of Cognitive-Motor Exergames in Geriatric Inpatient Rehabilitation: A Pilot Randomized Controlled Study

A Serious Game for Performing Task-Oriented Cervical Exercises Among Older Adult Patients With Chronic Neck Pain: Development, Suitability, and Crossover Pilot Study

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