Kate Laver

Is the Nintendo Wii Fit really acceptable to older people?: a discrete choice experiment

BackgroundInteractive video games such as the Nintendo Wii Fit are increasingly used as a therapeutic tool in health and aged care settings however, their acceptability to older people is unclear. The aim of this study was to determine the acceptability of the Nintendo Wii Fit as a therapy tool for hospitalised older people using a discrete choice experiment (DCE) before and after exposure to the intervention.MethodsA DCE was administered to 21 participants in an interview style format prior to, and following several sessions of using the Wii Fit in physiotherapy. The physiotherapist prescribed the Wii Fit activities, supervised and supported the patient during the therapy sessions. Attributes included in the DCE were: mode of therapy (traditional or using the Wii Fit), amount of therapy, cost of therapy program and percentage of recovery made. Data was analysed using conditional (fixed-effects) logistic regression.ResultsPrior to commencing the therapy program participants were most concerned about therapy time (avoiding programs that were too intensive), and the amount of recovery they would make. Following the therapy program, participants were more concerned with the mode of therapy and preferred traditional therapy programs over programs using the Wii Fit.ConclusionsThe usefulness of the Wii Fit as a therapy tool with hospitalised older people is limited not only by the small proportion of older people who are able to use it, but by older peoples preferences for traditional approaches to therapy. Mainstream media portrayals of the popularity of the Wii Fit with older people may not reflect the true acceptability in the older hospitalised population.

Virtual Reality for Stroke Rehabilitation

Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. These approaches may be advantageous because they provide the opportunity to practice activities that are not or cannot be practiced within the clinical environment. Furthermore, virtual reality programs are often designed to be more interesting and enjoyable than traditional therapy tasks, thereby encouraging higher numbers of repetitions. The use of specialized virtual reality programs designed for rehabilitation is not yet commonplace in clinical settings. However, gaming consoles are ubiquitous. The primary objective of this review was to evaluate the effects of virtual reality and interactive video gaming compared with an alternative intervention or no intervention on upper limb, lower limb, and global motor function after stroke. Secondary outcomes included activity limitation and adverse events. We also explored feasibility of the approach by examining recruitment rates. ### Search Strategy We searched the Cochrane Stroke Trials Register (March 2010), the …

Use of an interactive video gaming program compared with conventional physiotherapy for hospitalised older adults: a feasibility trial

Purpose: To assess the feasibility of a physiotherapy intervention using an interactive gaming program compared with conventional physiotherapy for hospitalised older people. Methods: Randomised controlled pilot study in a geriatric rehabilitation unit within an acute public hospital. Participants were randomly allocated to physiotherapy using an interactive gaming program (n = 22) or conventional physiotherapy in a ward-based gym (n = 22). Feasibility was assessed by comparing the effects of the intervention on clinical outcome measures (primary outcome: mobility as assessed by the Timed Up and Go test, secondary outcomes: safety, adherence levels, eligibility and consent rates). Results: Participants (n = 44) had a mean age of 85 years (SD 4.5) and the majority (80%) were women. Univariable analyses showed no significant difference between groups following intervention. However, multivariable analyses suggested that participants using the interactive gaming program improved more on the Timed Up and Go test (p = 0.048) than participants receiving conventional physiotherapy. There were no serious adverse events and high levels of adherence to therapy were evident in both groups. Only a small proportion of patients screened were recruited to the study. Conclusions: In this feasibility study, the use of a commercially available interactive gaming program by physiotherapists with older people in a hospital setting was safe and adherence levels were comparable with conventional therapy. Preliminary results suggest that further exploration of approaches using games as therapy for older people could include commonly used measures of balance and function. Implications for Rehabilitation The use of an interactive gaming program by physiotherapists with hospitalised older people appeared to be safe and resulted in improvements in balance and mobility. Use of these programs may be limited to a relatively small proportion of older people, only those able to use and interested in this technological approach to therapy.

Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews

Objective To summarise existing systematic reviews that assess the effects of non-pharmacological, pharmacological and alternative therapies on activities of daily living (ADL) function in people with dementia. Design Overview of systematic reviews. Methods A systematic search in the Cochrane Database of Systematic Reviews, DARE, Medline, EMBASE and PsycInfo in April 2015. Systematic reviews of randomised controlled trials conducted in people with Alzheimers disease or dementia measuring the impact on ADL function were included. Methodological quality of the systematic reviews was independently assessed by two authors using the AMSTAR tool. The quality of evidence of the primary studies for each intervention was assessed using GRADE. Results A total of 23 systematic reviews were included in the overview. The quality of the reviews varied; however most (65%) scored 8/11 or more on the AMSTAR tool, indicating high quality. Interventions that were reported to be effective in minimising decline in ADL function were: exercise (6 studies, 289 participants, standardised mean difference (SMD) 0.68, 95% CI 0.08 to 1.27; GRADE: low), dyadic interventions (8 studies, 988 participants, SMD 0.37, 95% CI 0.05 to 0.69; GRADE: low) acetylcholinesterase inhibitors and memantine (12 studies, 4661 participants, donepezil 10 mg SMD 0.18, 95% CI 0.03 to 0.32; GRADE: moderate), selegiline (7 studies, 810 participants, SMD 0.27, 95% CI 0.13 to 0.41; GRADE: low), huperzine A (2 studies, 70 participants, SMD 1.48, 95% CI 0.95 to 2.02; GRADE: very low) and Ginkgo biloba (7 studies, 2530 participants, SMD 0.36, 95% CI 0.28 to 0.44; GRADE: very low). Conclusions Healthcare professionals should ensure that people with dementia are encouraged to exercise and that primary carers are trained and supported to provide safe and effective care for the person with dementia. Acetylcholinesterase inhibitors or memantine should be trialled unless contraindicated. Trial registration number CRD42015020179.

Not just about costs: the role of health economics in facilitating decision making in aged care

This commentary discusses how health economic techniques can usefully be applied to inform clinical and policy decision making in the aged care sector from two perspectives: firstly, in relation to the measurement and valuation of the costs and benefits of new and existing health care technologies and modes of aged care service delivery and secondly, in relation to the facilitation of autonomy and patient choice.

Clinical practice guidelines for dementia in Australia

About 9% of Australians aged 65 years and over have a diagnosis of dementia. Clinical practice guidelines aim to enhance research translation by synthesising recent evidence for health and aged care professionals. New clinical practice guidelines and principles of care for people with dementia detail the optimal diagnosis and management in community, residential and hospital settings. The guidelines have been approved by the National Health and Medical Research Council. The guidelines emphasise timely diagnosis; living well with dementia and delaying functional decline; managing symptoms through training staff in how to provide person-centred care and using non-pharmacological approaches in the first instance; and training and supporting families and carers to provide care.

Early rehabilitation management after stroke: what do stroke patients prefer?

BACKGROUND Stroke rehabilitation is moving towards more intense therapy models that incorporate technologies such as robotics and computer games. It is unclear how acceptable these changes will be to stroke survivors, as little is known about which aspects of rehabilitation programmes are currently valued. Discrete choice experiments are a potential approach to assessing patient preferences, as they reveal the characteristics of programmes that are most important to consumers. METHODS A discrete choice experiment was presented as a face-to-face interview to assess the priorities and preferences of stroke survivors (n=50, mean age 72 years) for alternative rehabilitation service configurations. The discrete choice experiment was presented to the participants while they were on the stroke rehabilitation ward (approximately 3-4 weeks following stroke). RESULTS Participants were highly focused on recovery and expressed strong preferences for therapy delivered one-to-one, but they did not favour very high intensity programmes (6 hours per day). While the attitudinal statements indicated high levels of agreement for programmes to incorporate the latest technology, the results from the discrete choice experiment indicated that participants were averse to computer-delivered therapy. CONCLUSION Whilst rehabilitation therapy is highly valued, stroke survivors exhibited stronger preferences for low-intensity programmes and rest periods. High-intensity therapy protocols or approaches dependent on new technologies will require careful introduction to achieve uptake and acceptability.

Measuring technology self efficacy: reliability and construct validity of a modified computer self efficacy scale in a clinical rehabilitation setting

Purpose: To describe a modification of the computer self efficacy scale for use in clinical settings and to report on the modified scale’s reliability and construct validity. Methods: The computer self efficacy scale was modified to make it applicable for clinical settings (for use with older people or people with disabilities using everyday technologies). The modified scale was piloted, then tested with patients in an Australian inpatient rehabilitation setting (n = 88) to determine the internal consistency using Cronbach’s alpha coefficient. Construct validity was assessed by correlation of the scale with age and technology use. Factor analysis using principal components analysis was undertaken to identify important constructs within the scale. Results: The modified computer self efficacy scale demonstrated high internal consistency with a standardised alpha coefficient of 0.94. Two constructs within the scale were apparent; using the technology alone, and using the technology with the support of others. Scores on the scale were correlated with age and frequency of use of some technologies thereby supporting construct validity. Conclusions: The modified computer self efficacy scale has demonstrated reliability and construct validity for measuring the self efficacy of older people or people with disabilities when using everyday technologies. This tool has the potential to assist clinicians in identifying older patients who may be more open to using new technologies to maintain independence. Implications for Rehabilitation Technology is playing an increasing role in supporting older people or people with disabilities to function safely and independently in their own home. Assessment tools that are able to predict those people that are more likely to successfully adopt new technologies will be useful to clinicians. A modified version of the computer self efficacy scale appears to be a promising way of measuring technology self efficacy in a clinical rehabilitation population.

Health Economics and Geriatrics: Challenges and Opportunities

The fundamental economic problem of limited resources coupled with unlimited claims upon those resources holds particular resonance for geriatrics given the projected huge future growth in demand for health and aged care services for older people as a consequence of demographic change. Population ageing is a world-wide phenomenon which poses major challenges and opportunities for health economics and geriatrics. Currently approximately 2 million Australians, almost 10% of the total population, are aged 70 years and over and this figure is set to double during the next two decades. It is estimated that by 2045, one in four Australians will be aged 65 years or more and nearly one in ten will be 80 years or over [Productivity Commission, 2005]. This situation is not unique to Australia, population ageing forecasts in many countries and regions throughout the world mirror these statistics. In addition, factors other than an ageing population are creating new pressures and challenges for geriatrics, particularly in relation to how health and aged care services are provided in the future. The so called post-war “baby boomer” generation is generally expected to have much higher expectations for choice and responsiveness in the provision of health and aged care services relative to previous generations. Therefore, techniques for systematically engaging older people to establish their preferences in relation to the provision and configuration of geriatric services are likely to become more important. This chapter discusses the challenges and opportunities for the application of health economics and geriatrics from two main perspectives. Firstly, in relation to economic evaluation and the methods for assessing the cost effectiveness of new health care technologies and models of aged care service delivery. Secondly, in relation to methods adopted by health economists for measuring and valuing patient or consumer preferences in health care.

Organising health care services for people with an acquired brain injury: an overview of systematic reviews and randomised controlled trials

BackgroundAcquired brain injury (ABI) is the leading cause of disability worldwide yet there is little information regarding the most effective way to organise ABI health care services. The aim of this review was to identify the most up-to-date high quality evidence to answer specific questions regarding the organisation of health care services for people with an ABI.MethodsWe conducted a systematic review of English papers using MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library. We included the most recently published high quality systematic reviews and any randomised controlled trials, non-randomised controlled trials, controlled before after studies or interrupted time series studies published subsequent to the systematic review. We searched for papers that evaluated pre-defined organisational interventions for adults with an ABI. Organisational interventions of interest included fee-for-service care, integrated care, integrated care pathways, continuity of care, consumer engagement in governance and quality monitoring interventions. Data extraction and appraisal of included reviews and studies was completed independently by two reviewers.ResultsA total of five systematic reviews and 21 studies were included in the review; eight of the papers (31%) included people with a traumatic brain injury (TBI) or ABI and the remaining papers (69%) included only participants with a diagnosis of stroke. We found evidence supporting the use of integrated care to improve functional outcome and reduce length of stay and evidence supporting early supported discharge teams for reducing morbidity and mortality and reducing length of stay for stroke survivors. There was little evidence to support case management or the use of integrated care pathways for people with ABI. We found evidence that a quality monitoring intervention can lead to improvements in process outcomes in acute and rehabilitation settings. We were unable to find any studies meeting our inclusion criteria regarding fee-for-service care or engaging consumers in the governance of the health care organisation.ConclusionsThe review found evidence to support integrated care, early supported discharge and quality monitoring interventions however, this evidence was based on studies conducted with people following stroke and may not be appropriate for all people with an ABI.