Implementing ward-based Exergames with older adults.
Research type
Research Study
Full title
A mixed methods study to evaluate the implementation of ward-based exergames to support the rehabilitation of older adults and help prevent falls.
IRAS ID
270237
Contact name
Emma Stanmore
Contact email
Sponsor organisation
The University of Manchester
Duration of Study in the UK
0 years, 11 months, 31 days
Research summary
Research Summary
Frailty is a long-term condition related to the ageing process. Features of frailty include reduced strength, stamina and physical function. Individuals with frailty are at increased risk of dependency on others during everyday activities and/or death.
In the UK, 10 per cent of people aged over 65 years have frailty, and improving care and support for this population is a government priority. Despite local and government policies however, shortages in social care support mean that hospital discharge is delayed for many frail older patients. This delay can result in patients being inactive in hospital wards for long periods, negatively affecting physical and psychological health.Evidence suggests that Exergames have potential to support older adults’ physical rehabilitation whilst in hospital. Exergames are exercise and computer games that use body movements as controls. They have been developed to improve balance, function, prevent falls and increase exercise adherence for older adults but their use in a ward setting has not been investigated.
This study will evaluate implementation of the Exergames strength and balance exercises in NHS wards. The cost of adopting and supporting ongoing use of ward-based Exergames will also be estimated.
Thirty-six frail older adults will be recruited from wards within Manchester University NHS Foundation Trust. Participants will use the Exergames for 15-30 minutes, 3 times per week for 4 weeks. Questionnaires and strength and balance assessments will be conducted at baseline and on study completion. Interviews will also be carried out regarding user's experience of the Exergames.Twenty-one ward staff will attend pre and post study focus groups to explore the best way to use the Exergames in a hospital setting and evaluate its impact on staff and patients. Near the end of the study, staff will complete a questionnaire that explores their attitude towards ward-based Exergames.
Summary of Results
Exergames (EGs), (that combine telerehabilitation gameplay with physical exercise using body movements as controls), may help frail older adults enhance their physical ability [4, 5]. A recently completed Cluster Randomised Controlled Trial of strength and balance EGs compared to standard care revealed that after twelve weeks, EGs significantly reduced falls and fear of falling, and improved balance and pain in older users residing in sheltered housing [6]. Although community based EGs has been investigated, to date, the feasibility of using this intervention in inpatient wards has not been explored [4, 5].
This study was designed to find out the best way to carry out ward-based Exergames in NHS hospitals to help mild to moderately frail older adults maintain and/or improve their strength and balance. To guide this process, the Quality Implementation Framework (QIF) - a meta-framework delineating factors affecting incorporation of new technology into routine practice - was used [7].This framework includes four phases that collectively encompass fourteen steps to help evaluate the implementation process. Due to COVID-19, the quantitative components of this research study with participants was not possible. Pre-implementation focus groups were able to be carried out at ward level to explore how to carry out i) the EGs intervention with patients and ii) the EGs staff training sessions. The potential impact of the EGs on staff and patients was also covered. Nineteen staff contributed to the pre-implementation consultation.
Sixteen participants took part in focus groups held during March 2020: one Activity Coordinator (AC), one nurse (N), three Rehabilitation Assistants (RA), three Occupational Therapists (OT) and eight Physiotherapists (PT). Four participants attended the first focus group, seven the second, three the third and two the fourth. The age range was 25 to 47 years, and banding levels spanned 3 to 7. Focus groups lasted between 25 and 60 minutes. Two wards (FG1 and FG4) were in the early stages of implementation and had started to trial the EGs with patients. Face to face interviews were conducted with two Consultant Nurses (CN) and one Consultant in Elderly Care (CEC). Interviews took place during November 2020 and lasted between 25 and 45 minutes.
Our findings indicate overwhelming support for ability of the EGs to engage patients. Staff noted that patients found the system the enjoyable to use, novel and entertaining. It also encouraged social interaction and lifted mood. EGs were found to be more engaging than paper based material. Potential issues were raised regarding whether EGs would be viewed as rehab by patients and staff and can preconceptions about games be overridden as they can be perceived more of an entertainment. Staff need to consider how the EGs is presented to patients as they can challenge traditional methods of delivery and may not associate EGs with exercise. This view may need to be challenged in material promoting this type of therapy delivery.
Context was also found to be important; a stable setting is more supportive and engenders enthusiasm. For instance, when there are changes in ward structure, this may not the best time to introduce anew technology. When considering delivery frameworks, a process of balancing risk against maximising patient access to the EGs intervention should be planned. The person actively delivering EGs needs to have the relevant knowledge and experience of the target patient group to monitor wellbeing and effectively deliver a programme set by the therapists. The ward environment can limits how and where the EGs can be used safety and effectively. Large systems may preclude some patients from participating if unable to leave the bed space. Time wise, less mobile patients may need to use it near bed therefore need an accessible system. System may need adapting to fit ward environment.
REC name
North West - Preston Research Ethics Committee
REC reference
19/NW/0724
Date of REC Opinion
17 Jan 2020
REC opinion
Further Information Favourable Opinion