JMIR Publications

ABSTRACT

Background:

Hospitalized older adults often spend prolonged periods of time bedridden leading to decreased muscle strength and function. To tackle this, rehabilitation aims to keep patients active and train affected muscles. Exergames have proven to be effective in rehabilitation of different patient populations and offer a motivating solution to combat inactivity associated with hospitalization. Furthermore, blood flow restriction (BFR) is effective in therapy of weakened patients so combining BFR and exergames might be promising.

Objective:

As part of an iterative process of user-centered development, this mixed method study investigates the acceptability and feasibility of the Ghostly game as a stand-alone added therapy or combined with BFR in strength training of hospitalized older adults.

Methods:

A mixed methods study was conducted in 15 hospitalized older adults. Participants were randomized in three groups and received daily interventions from the moment they were included in the geriatric ward, until discharge from the hospital. The Ghostly group received daily conventional therapy with the Ghostly game as added therapy, the Ghostly + BFR group received daily conventional therapy with Ghostly in combination with BFR as added therapy, and lastly, the control group received daily conventional therapy with dose-matched isometric exercises as added therapy. The primary outcome, user experience, was assessed before discharge from the hospital using the Usefulness, Satisfaction and Ease of use (USE) questionnaire and through expert observations. Clinical outcomes such as muscle strength, muscle architecture and segmental body composition were assessed at baseline and before discharge from the hospital to test the feasibility of the research protocol in preparation of future randomized controlled trials.

Results:

15 hospitalized older adults (73.33% female) were included in this study with an average age of 84.53 years (range: 78 – 94 years). Participants received an average of 3.47 intervention sessions (range: 3 – 5 sessions) after transferring to the geriatric ward of the hospital. Results on user experience revealed high scores on all subcategories of the USE questionnaire (Usefulness: 78.93%, Ease of use: 82.99%, Ease of learning: 85.36% and Satisfaction: 87.55%). Furthermore, expert observations identified issues with color contrast, reaction time speed and the need to tailor the game to accommodate the diverse requirements of different patient populations.. All outcomes and procedures were found feasible for a future randomized controlled trial.

Conclusions:

This mixed methods study is the first study to combine an EMG-based exergame with strength training principles of BFR and revealed acceptability and feasibility of the Ghostly game as a stand-alone added therapy modality for strength training in hospitalized older adults, and in combination with BFR. Future improvements of the exergame could focus on addressing expert-identified issues, including optimizing color contrast, adjusting reaction time speeds, and tailoring the game to meet the needs of different patient populations. Clinical Trial: registration number: NCT05258500 (https://clinicaltrials.gov/)