Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 29, 2024
Date Accepted: Jul 14, 2024
Effects of Virtual Reality Motor-Cognitive Training for older people with cognitive frailty: A multi-centred, randomized controlled trial
ABSTRACT
Background:
Cognitive frailty refers to a clinical syndrome where physical frailty and mild cognitive impairment coexist that increases the risk of adverse health outcomes for older people, such as dementia. Motor-cognitive training and virtual reality have recently been used as a platform to launch various therapeutic modalities to promote health in older people. Literature advocates that motor-cognitive training and virtual reality are effective in promoting the cognitive and physical function of older people with various chronic conditions. However, the effects on older people with cognitive frailty are unclear.
Objective:
This study examined the effects of virtual reality motor-cognitive training (VRMCT) on global cognitive function, physical frailty, walking speed, visual short-term memory, inhibition of cognitive interference, and executive function in older people with cognitive frailty.
Methods:
This study employed a multi-centred, assessor-blinded, two-parallel-group, randomized controlled trial. Participants were recruited face-to-face in the elderly community centres. Eligible participants were those who were aged ≥ 60 years, were community-dwelling, lived with cognitive frailty, had no dementia, and were not mobility-restricted. Eligible participants were randomly allocated into two groups in a 1:1 intervention-to-control group ratio. In the intervention group, participants received VRMCT led by facilitators with 16 one-hour training sessions delivered twice per week for eight weeks. In the control group, participants received the usual care provided by the elderly community centres that were not interfered with by the investigators. The primary outcome was global cognitive function. The secondary outcomes included physical frailty, walking speed, verbal short-term memory, inhibition of cognitive interference, and executive function. Data were collected at baseline (T0) and the week post-intervention (T1). Generalized estimating equations were employed to examine the group, time, and interaction (time x group) effects on the outcomes.
Results:
293 eligible participants enrolled in the study. The mean age of the participants was 74.5 years. The majority of the participants were female (78.2%), completed primary education (52.1%), married (57.2%), lived with friends (43.0%), and had no virtual reality experience (79.5%). In the intervention group, 81.6% of participants attended > 80% of the total number of sessions. A negligible number of participants experienced virtual reality sickness symptoms. VRMCT is effective in promoting global cognitive function (interaction effect: P=.03), marginally promoting executive function (interaction effect: P=.007), and reducing frailty (interaction effect: P=.03). The effects were not statistically significant on other outcomes.
Conclusions:
VRMCT is effective in promoting cognitive functions and reducing physical frailty and is well tolerated and accepted by older people with cognitive frailty. Further studies should examine the efficacy of the intervention components (e.g., VR vs non-VR, dual-task vs single-task) on health outcomes, the effect of using technology on intervention adherence, and the long-term effects of the intervention on older people with cognitive frailty at the level of daily living. Clinical Trial: ClinicalTrials.gov ID: NCT04730817; https://clinicaltrials.gov/study/NCT04730817
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