ICT-Based Individualized Training of Institutionalized Individuals With Dementia. Evaluation of Usability and Trends Toward the Effectiveness of the InCoPE-App

Abstract

Physical activity interventions can alleviate the course of disease for individuals with dementia (IWD) who have been extraordinarily affected by the COVID-19 pandemic. Information and Communication Technology (ICT) provides new opportunities not only to mitigate negative effects of the pandemic but also to sustainably improve everyday life of IWD in nursing homes. The aim of the present study was to evaluate the ICT-based InCoPE-App, which was used to assess physical and cognitive performance and deliver individualized exercise for IWD, with regard to 1) user experience of nursing assistants, and 2) trends toward the effectiveness of the intervention on physical and cognitive performance of IWD. An 18-week individualized multidomain intervention (2 × 60 min/session) was delivered to an intervention group (IG; n = 10, mean age 88.4 ± 5.6, 70% female) by nursing assistants (n = 10, mean age 56.1 ± 10.4, 90% female) using the InCoPE-App. A control group (CG; n = 3, mean age 87.3 ± 3.5, 100% female) received conventional treatment. User experience was assessed among nursing assistants by different questionnaires, i.e., PSSUQ and ISONORM 9241/110-S for usability, and AttrakDiff2 for pragmatic (PQ), hedonic quality-identity and stimulation (HQI and HQS), and attractiveness (ATT). Trends toward the effectiveness of the intervention were assessed using MMSE (global cognitive function), FICSIT-4 (balance), 6MWT and TUG (mobility), and m30CST (function of lower limbs). Usability of the InCoPE-App was rated as high by nursing assistants (mean ± SD; overall PSSUQ 2.11 ± 0.75; overall ISONORM 9241/110-S 1.90 ± 0.88; ATT 1.86 ± 1.01; PQ 1.79 ± 1.03; HQI 1.8 ± 0.79; and HQS 1.37 ± 0.69). Dropout was high in the total sample (36.7%). Trends toward the effectiveness were observed within IG in nine IWD who showed positive or neutral trends in at least two physical performance outcomes. Seven participants had positive or neutral trends in the FICSIT-4, seven participants in m30CST, and four and seven participants in 6MWT and TUG, respectively. In conclusion, the InCoPE-App has good nursing assistant-rated usability, whereas training effects and intervention adherence were rather low most likely due to COVID-19 restrictions. Single-subject research revealed more positive than negative trends in IG of IWD. Further research is needed to evaluate feasibility, suitability, and effectiveness of the InCoPE-App.

A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study

“…Overall, the inclusion of end users in the app’s development process continues to be critically relevant and highly important. Therefore, the InCoPE-App was further tested in an 18-week intervention study [ 68 ].…”

“…On the basis of the individual performance results, each individual with dementia is assigned to one of four exercise clusters, which are integrated in the app [45]: (1) individuals with below-average cognitive and physical performance, (2) individuals with average cognitive performance and above average physical performance, (3) individuals with above average cognitive performance and below average physical performance, and (4) individuals with above average cognitive and physical performance. The clustering into these 4 groups is based on previous studies by our group that have demonstrated the need for individualization of PA programs for individuals with dementia [8][9][10]46]. Depending on the cluster assignment, the InCoPE-App generates an exercise plan that fits the current performance level and needs of the individual with dementia.…”

A New Approach to Individualize Physical Activity Interventions for Individuals With Dementia: Cluster Analysis Based on Physical and Cognitive Performance

“…This implies that PA can be administered in the correct dose for IWD, if and when cognitive and physical baseline performance of IWD is considered, which is transferable by means of the presented training clusters. Furthermore, our approach can be used for future research on digital solutions using intelligent algorithms to increase treatment efficiency of PA interventions 36. However, it can also be useful to exercise instructors or staff in a nursing home setting to improve group composition in order to deliver PA interventions with a higher degree of individualization.…”

“…Furthermore, our approach can be used for future research on digital solutions using intelligent algorithms to increase treatment efficiency of PA interventions. 36 However, it can also be useful to exercise instructors or staff in a nursing home setting to improve group composition in order to deliver PA interventions with a higher degree of individualization.…”

Usability and Effectiveness of an Individualized, Tablet-Based, Multidomain Exercise Program for People With Dementia Delivered by Nursing Assistants: Protocol for an Evaluation of the InCoPE-App

“…The tests assessing motor and cognitive performance included in the InCoPE-App are based on published recommendations and were used with people with dementia before [ 21 , 22 ]. On the basis of cluster analysis in a large sample of people with dementia who participated in our group’s previous randomized controlled trial [ 19 ], we identified 4 homogeneous subgroups of people with dementia [ 23 ] who were also considered when we designed the InCoPE-App: participants with (1) below-average motor and cognitive performance, (2) average cognitive performance and above-average motor performance, (3) above-average cognitive and motor performance, and (4) above-average cognitive performance and below-average motor performance. The initial testing of physical and cognitive performance included in the InCoPE-App will be used to determine whether an individual belongs to cluster 1, 2, 3, or 4.…”