Stacey George

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 …

Development of the Adelaide Driving Self-Efficacy Scale

Objective: To describe the development of the Adelaide Driving Self-Efficacy Scale (ADSES) and to report on its reliability and validity. Methods: A set of 12 driving behaviours, developed through literature review, clinical experience and expert review, were rated for self-efficacy using a Likert scale. Internal consistency was investigated using a Cronbachs alpha coefficient and construct validity by comparing ADSES scores of stroke and non-stroke drivers. Criterion-related validity was examined by comparing ADSES scores with the result on a standardized on-road assessment. Setting: A rehabilitation hospital in Adelaide, South Australia. Participants: Staff from the hospital and stroke patients from the rehabilitation unit. Data from a non-stroke sample (n -/ 79) and stroke patients (n -/ 81) were used to test internal consistency and construct validity. A separate group of 45 people recommended for a driving assessment, of whom 34 were stroke patients, were used to test criterion validity. Results: Cronbachs alpha coefficient was 0.98, indicating high internal consistency. The non-stroke and stroke groups showed significant differences in ADSES scores (t(158)-/ 5.5, P B < 0.05), demonstrating construct validity. Differences in ADSES scores for those participants who passed or failed the on-road assessment were significant for both the entire driving assessment group (t(43)-/ 3.2, P B < 0.05) and the stroke subgroup (t(43)-/ 3.2, P B < 0.05), indicating criterion validity. Conclusion: The ADSES has demonstrated internal consistency and construct validity with the stroke and non-stroke population. The scale demonstrated criterion validity in its relationship with outcome of an on-road driving assessment. It appears to be a reliable and valid measure of driving self-efficacy.

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.

Vision-Related Quality of Life in Patients with Complete Homonymous Hemianopia Post Stroke

Abstract Purpose: The aim is to determine the characteristics of vision-specific quality of life restriction using the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and Veterans Affairs Low Vision Visual Function Questionnaire (VA LV VFQ-48) in patients with complete homonymous hemianopia (HH) post stroke. Method: Prospective cohort study of patients with complete HH compared to age- and gender-matched subjects with normal visual fields. Results: In the NEI VFQ-25, scores on five subscales were significantly reduced after multiple logistic regression accounting for vision and comorbidities. The five subscales are vision-specific social functioning, vision-specific mental health, vision-specific dependency, driving, and peripheral vision. In the VA LV VFQ-48 postregression analysis, mobility is the only domain that is significantly affected in the people with HH. Conclusion: Identification of the significant areas of visual difficulties and their effects on quality of life is important as it can help better address the patients’ rehabilitation needs. The current study identifies the need for orientation and mobility training as well as independent living rehabilitation in patients with HH to help address the difficulties in their vision-specific quality of life and maximize their residual vision.

Retraining Visual Processing Skills to Improve Driving Ability after Stroke

UNLABELLED Crotty M, George S. Retraining visual processing skills to improve driving ability after stroke. OBJECTIVE To evaluate the effectiveness of retraining using the Dynavision on driving performance of people with stroke. DESIGN Randomized controlled trial. SETTING Outpatient rehabilitation clinic in Australia. PARTICIPANTS People with stroke (N=26) referred for driving assessment. INTERVENTIONS Eligible participants were randomized to either receive retraining with the Dynavision apparatus for 18 sessions or to receive no intervention and go onto a waitlist. MAIN OUTCOME MEASURES The primary outcome was an assessment of on-road ability. Secondary outcomes included measures of response speed, visual scanning, and self-efficacy. All assessments were conducted by assessors blinded to group assignment. RESULTS No significant difference (P=.223) was found between the intervention and control groups in results of on-road assessment in terms of pass or fail; the primary outcome measure; or the results on the secondary outcome measures of response speed, visual scanning, and self-efficacy. CONCLUSIONS In this small trial, training underlying skills (such as executing a continuous wide scan, combining motor and visual processing into a motor response) using the Dynavision apparatus did not improve the outcomes of an on-road assessment for people after strokes. Larger trials are needed to evaluate devices that claim to retrain underlying skills related to driving.

Comparison of iPad applications with traditional activities using person-centred care approach: Impact on well-being for persons with dementia:

Professionals working with people with dementia need to develop new activities that occupy patients and increase positive emotions. Dementia care mapping is a reliable method of measuring well-being during activities with people with dementia. The iPad has many applications that may be suitable as a group activity for persons with dementia. Six people with dementia took part in two traditional and two iPad activities over two days. Well-being was recorded using dementia care mapping. Subjects displayed similar or better levels of well-being during iPad activities than traditional activities. A larger variation of behaviors was seen during iPad activities than traditional activities. With detailed planning using a person-centred care approach, iPad group activity has the potential to be as effective and engaging as other conventional activities in achieving well-being.

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.

What factors influence older people in the decision to relinquish their driver's licence? A discrete choice experiment

PURPOSE To investigate the relative importance of a number of key factors that influence older people in the decision to relinquish their drivers licence. METHOD A discrete choice experiment (DCE) was administered as an online survey to Australian adults, 65 years plus (N=114) who drive, recruited from an online panel. The survey was composed of three main sections. (A) The Adelaide Driving Self Efficacy Scale to assess confidence in driving. The scale is generated from individuals responses about confidence in their driving ability in various situations. (B) The DCE in which respondents were presented with a series of hypothetical binary choice situations and asked to indicate in which situation they would be more likely to relinquish their driving licence