Impact of Serious Games on Health and Well-being of Elderly: A Systematic Review

Besides their entertainment value, serious games can have beneficial therapeutic effects for elderly people that improve their health and well-being. Games are likely to be accepted by elderly persons who have enjoyed games their lives, and because there are more and more of such elderly, it is important to investigate games as a therapeutic device. This research reviewed the literature focusing on the effects of games on elderly persons in three main types of effects: physical, cognitive, and social effects. The majority of reviewed papers focused on physical and cognitive effects, and were published in recent years, which emphasizes the relative novelty of this topic and suggests that future research will need to address social impact as well. In addition, while many papers claimed positive impacts as a result of using games, our review found that more attention should be given to research designs

Effectiveness of Gamification in Knee Replacement Rehabilitation: Protocol for a Randomized Controlled Trial With a Qualitative Approach

Background: Exergames can provide encouraging exercise options. Currently, there is limited evidence regarding home-based exergaming in the postoperative phase of total knee replacement (TKR).Objective: This study aimed to investigate the effects of a 4-month postoperative home-based exergame intervention with an 8-month follow-up on physical function and symptoms among older persons undergoing TKR compared with home exercise using a standard protocol. In addition, a concurrent embedded design of a mixed methods study was used by including a qualitative component within a quantitative study of exergame effects.Methods: This was a dual-center, nonblinded, two-arm, parallel group randomized controlled trial with an embedded qualitative approach. This study aimed to recruit 100 patients who underwent their first unilateral TKR (aged 60-75 years). Participants were randomized to the exergame or standard home exercise arms. Participants followed a custom-made exergame program independently at their homes daily for 4 months. The primary outcomes at 4 months were function and pain related to the knee using the Oxford Knee Score questionnaire and mobility using the Timed Up and Go test. Other outcomes, in addition to physical function, symptoms, and disability, were game user experience, exercise adherence, physical activity, and satisfaction with the operated knee. Assessments were performed at the preoperative baseline and at 2, 4, and 12 months postoperatively. Exergame adherence was followed from game computers and using a structured diary. Self-reported standard exercise was followed for 4 months of intervention and physical activity was followed for 12 months using a structured diary. Qualitative data on patients' perspectives on rehabilitation and exergames were collected through laddering interviews at 4 and 12 months.Results: This study was funded in 2018. Data collection began in 2019 and was completed in January 2022. The COVID-19 pandemic caused an unavoidable situation in the study for recruitment, data collection, and statistical analysis. As of November 2020, a total of 52 participants had been enrolled in the study. Primary results are expected to be published by the end of 2022.Conclusions: Our study provides new knowledge on the effects of postoperative exergame intervention among older patients with TKR. In addition, this study provides a new understanding of gamified postoperative rehabilitation, home exercise adherence, physical function, and physical activity among older adults undergoing TKR.</p

Gender-related differences in psychometric properties of WHO Disability Assessment Schedule 2.0

Objective of this study was to investigate the gender-related differential item function of 12-item WHODAS 2.0 amongst patients with chronic musculoskeletal pain. This was a cross-sectional survey study among 1,988 patients at a university Physical and Rehabilitation Medicine outpatient clinic. To assess DIF, WHODAS 2.0 items were dichotomized as `none’ rated by respondents as `0’ versus `any limitation’ rated as `1,2,3 or 4’. The item response theory analysis was used to define discrimination and difficulty parameters of a questionnaire. The probit logistic regression was used to test uniformity of DIF between gender groups. The results of DIF analysis were presented and evaluated graphically as item characteristic curves based on 2-parameter IRT analysis of dichotomized responses. High to perfect discrimination ability was observed for all the items except one. Difficulty levels of eight items were shifted towards the elevated disability level, four items demonstrated a perfect difficulty property. Significant DIF between genders was observed in seven of 12 items. The detected DIFs were uniform. For item `household’, `emotional affection’ and `work’, men had to experience slightly worse disability than women to achieve the same score. A reverse effect was observed for items `concentration’, `washing’, `dressing’ and dealing with strangers. In this study, significant DIF between genders was found in seven of twelve items of 12-item WHODAS 2.0. amongst 1988 patients with chronic musculoskeletal pain. All the detected DIFs were uniform. Regardless gender-related DIF shown in seven out of 12 items, we recommend using and studying 12-item WHODAS 2.0 in different populations.</p

Floor and ceiling effects of the World Health Organization Disability Assessment Schedule 2.0 among patients with chronic musculoskeletal pain

The aim of this study was to investigate the floor and ceiling effects of 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS). This was a cross-sectional survey study at a university’s physical and rehabilitation medicine outpatient clinic of 1988 patients with chronic musculoskeletal pain. Floor and ceiling effects were calculated as relative frequencies of the lowest or the highest possible scores for each item. The probit plotting method was used to detect the non-normality of distribution of the total score graphically. A significant floor effect of 15–79% was observed in all 12 WHODAS 2.0 items. A substantial floor effect for total score was also detected graphically. No ceiling effects were observed. In this study, a significant floor effect was found for all WHODAS 2.0 items among patients with chronic musculoskeletal pain associated with mild or no disability.</p

Proceedings of the 50th Annual Hawaii International Conference on System Sciences

Besides their entertainment value, serious games can have beneficial therapeutic effects for elderly people that improve their health and well-being. Games are likely to be accepted by those elderly persons who have enjoyed games their lives, and because there are more and more of such elderly, it is important to investigate games as a therapeutic device. This research reviewed the literature focusing on the effects of games on elderly persons in three main types of effects: physical, cognitive, and social effects. The majority of reviewed papers focused on physical and cognitive effects, and were published in recent years, which emphasizes the relative novelty of this topic and suggests that future research will need to address social impact as well. In addition, while many papers claimed positive impacts as a result of using games, our review found that more attention should be given to research designs.</p

Gaming for health across various areas of life

Abstract Lack of physical activity is mostly addressed by implementing programs to promote physical activity but seeing as the major cause for physical inactivity is that of technology. Few studies used the approach to use the very barrier as s mean to try and educate and breed good habits. This paper outlines the design and development of a project that will us various environments, home, gym and outdoors to promote physical activity by means of technology and more specifically games

Movement characteristics during customized exergames after total knee replacement in older adults

Abstract Introduction: There is limited understanding of how older adults can reach kinematic goals in rehabilitation while performing exergames and conventional exercises, and how similar or different the kinematics during exergaming are when compared with conventional therapeutic exercise with similar movement. The aim of this study was to describe the movement characteristics performed during exercise in custom-designed exergames and conventional therapeutic exercises among patients who have undergone unilateral total knee replacement (TKR). In addition, the secondary aim was to assess the relation of these exercise methods, and to assess participants’ perceived exertion and knee pain during exergaming and exercising. Materials and methods: Patients up to 4 months after the TKR surgery were invited in a single-visit exercise laboratory session. A 2D motion analysis and force plates were employed to evaluate movement characteristics as the volume, range, and intensity of movement performed during custom-designed knee extension-flexion and weight shifting exergames and conventional therapeutic exercises post TKR. The perceived exertion and knee pain were assessed using the Borg Rating of Perceived Exertion and Visual Analog Scale, respectively. Results: Evaluation of seven patients with TKR [age median (IQR), 65 (10) years] revealed that the volume and intensity of movement were mostly higher during exergames. Individual goniometer-measured knee range of motion were achieved either with exergames and conventional therapeutic exercises, especially in knee extension exercises. The perceived exertion and knee pain were similar after exergames and conventional therapeutic exercises. Conclusions: During custom-designed exergaming the patients with TKR achieve the movement characteristics appropriate for post-TKR rehabilitation without increasing the stress and pain experienced even though the movement characteristics might be partly different from conventional therapeutic exercises by the volume and intensity of movement. Physical therapists could consider implementing such exergames in rehabilitation practice for patients with TKR once effectiveness have been approved and they are widely available

Effects of a home-based, exergaming intervention on physical function and pain after total knee replacement in older adults:a randomised controlled trial

Abstract Objectives: To investigate the effects of 4 months of customised, home-based exergaming on physical function and pain after total knee replacement (TKR) compared with standard exercise protocol. Methods: In this non-blinded randomised controlled trial, 52 individuals aged 60–75 years undergoing TKR were randomised into an exergaming (intervention group, IG) or a standard exercising group (control group, CG). Primary outcomes were physical function and pain measured before and after (2 months and 4 months) surgery using the Oxford Knee Score (OKS) and Timed Up and Go (TUG) test. Secondary outcomes included measures of the Visual Analogue Scale, 10m walking, short physical performance battery, isometric knee extension and flexion force, knee range of movement and satisfaction with the operated knee. Results: Improvement in mobility measured by TUG was greater in the IG (n=21) at 2 (p=0.019) and 4 months (p=0.040) than in the CG (n=25). The TUG improved in the IG by −1.9 s (95% CI, −2.9 to −1.0), while it changed by −0.6 s (95% CI −1.4 to 0.3) in the CG. There were no differences between the groups in the OKS or secondary outcomes over 4 months. 100% of patients in the IG and 74% in the CG were satisfied with the operated knee. Conclusion: In patients who have undergone TKR, training at home with customised exergames was more effective in mobility and early satisfaction and as effective as standard exercise in pain and other physical functions. In both groups, knee-related function and pain improvement can be considered clinically meaningful. Trial registration number: NCT03717727