The Feasibility of Exergaming to Improve Postural Control in Community-Dwelling Older Adults

Tahmosybayat, Robin (2019) The Feasibility of Exergaming to Improve Postural Control in Community-Dwelling Older Adults. Doctoral thesis, Northumbria University.

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Abstract

Objective: This thesis reports on the design, development and implementation of a feasibility study to investigate if a tailored exergame could be implemented to improve postural control outcomes for community-dwelling older adult fallers living in the North East of England, UK.

Design: This feasibility study was carried out in several phases according to the Medical Research Council (MRC) framework guidance for complex interventions. Phase 1 consisted of two systematic reviews to identify characteristics to aid in the design, development and implementation of the intervention and subsequent pilot study and also to identify potential outcome measures. This also included a qualitative study of participants’ perspectives using focus groups. Phase 2 consisted of a non-randomised controlled study where participants, recruited from 2 sites, Northumbria University and Gateshead Older Peoples Association (GOPA), were allocated to either one of two intervention groups (exergaming or traditional balance training) or a no exercise control group. The intervention lasted for 6 weeks and outcomes were assessed prior to the start of the intervention and following the final training session. Follow up interviews were conducted with participants and analysed using deductive thematic analysis.

Findings: After reviewing the existing evidence, the literature indicated that exergaming interventions were as beneficial as traditional balance interventions, although the evidence for each outcome was of low quality, assessed using the GRADE approach. No intervention had implemented an outcome measure that assessed reactive postural control, verticality or the cognitive influences on postural control, such as the Mini-Balance Evaluation Systems Test (Mini-BESTest) and not all components of postural control were trained. Thematically analysed data from 3 focus groups totalling 13 participants, deduced four main themes: 1) attitudes toward technology, 2) consideration of balance and movement, 3) ease of use, and 4) social influence and exergaming. Adults of all ages perceived exergames to be enjoyable, yet, there were perceived barriers in using commercial exergames for older adults and individuals with balance impairments. The nonrandomised pilot intervention took place in Newcastle and Gateshead, UK. Thirty-five participants (10 exergaming, 10 traditional balance training and 10 controls) were included in the study. All four of the progression criteria were met in that 69% of eligible participants were screened and allocated to the intervention with a retention rate of 95.7% for all assessments. Adherence was 100% successful and only 1 adverse event occurred (3%) and did not occur during any of the training or assessment visits. Analysis of interview data from 10 participants (5 exergaming, 5 traditional balance training) following the pilot intervention revealed that older adult fallers accept the use of a tailored exergame (Mira™) as a method to train postural control.

Conclusions: A tailored exergaming intervention was successfully implemented and received well by participants, although amendments to the protocol and barriers to future participation for older adult fallers should be considered prior to implementing a future definitive trial.

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