Análise de viabilidade do uso domiciliar do exergame VirtualTer para reabilitação do equilíbrio postural da pessoa idosa

Abstract

Introduction: The use of exergames has been gaining prominence in rehabilitation to increase levels of physical activity, promoting health, improving physical function in older adults, and as a training tool in the home environment. VirtualTer is an exergame, validated and tested in a laboratory setting, and adapted for the home context of older adults, with the aim of enhancing levels of physical activity and reducing the risk of falls in this population. In this regard, it is important to investigate the feasibility and effects of using the VirtualTer exergame at home for older adults. Objective: The main objective of this thesis is to analyze the feasibility of using the VirtualTer exergame at home for postural balance rehabilitation in older adults. Methods: The study involved three integrated modalities: 1) Elaboration of a protocol and systematic review; 2) Pilot study with the application of the prototype of VirtualTer home version in a single 15-minutes session; 3) Feasibility analysis of the effects of using VirtualTer at home and qualitative assessment of barriers and facilitators during the application of the game. VirtualTer was executed three times a week for two weeks, with each session lasting 25 minutes. The game effects were analyzed using sociodemographic assessment, Short Physical Performance Battery (SPPB), International Physical Activity Questionnaire (IPAQ), World Health Organization Disability Assessment Schedule 2.0 (WHODAS), Functional Reach Test (FRT), System Usability Scale (SUS) and Intrinsic Motivation Inventory (IMI). During the intervention, an observational analysis of barriers and facilitators was carried out using a daily form, structured according to the domains of the International Classification of Functioning, Disability and Health (ICF). Results: Modality 1 resulted in two articles: Article 1 – The systematic review protocol defined the methodology that guided the execution of the review. Article 2 – In the systematic review, after screening 1107 records, 4 trials were eligible. The usability of exergames was classified as acceptable and good. The pooled effect indicated improvements in functional balance in the TUG test (MD = -5.90; 95%CI = -10.29 to -1.51) and Tinetti test (MD = 4.80; 95%CI = 3.36 to 6.24), in favor of the exergame group. A significant difference was observed in the experimental group for the immersive modalities (MD = -9.14; 95%CI = -15.51 to -2.77). The certainty of evidence was classified as low and very low. Modality 2 resulted in one article: Article 3 – 25 older adults with low physical performance, high level of physical inactivity, and impaired functionality participated in the pilot study. There was a significant relationship between the SUS scale and gender (P=0.04), marital status (P=0.03), and education level (P=0.01). A motivation score of 87 points was observed in the IMI, with a usability score of 72.50 points on the SUS scale and a satisfaction level of 80%. Technical elements subject to adaptation were identified, and functional solutions were incorporated for stationary gait and overtaking obstacles for the final consolidation of the home version. Modality 3 resulted in two articles: Article 4 – The sample consisted of 15 older adults. Better test scores were observed after the intervention. A significant correlation was found between pre- and post-intervention for FRT values (P = 0.001), walking speed on the SPPB (P = 0.023) and IPAQ score (P = 0.020). The older adults exhibited high intrinsic motivation (92 points on the IMI) after training, classified the usability of the game as excellent (score of 85 on the SUS), and a satisfaction level of 86.7% was observed. There was a significant difference (P = 0.001) in game scores across the intervention. Article 5 – Mild functional disability was observed in the WHODAS without significant differences between pre and post intervention. The facilitators elements were the motivation (b1301), fun (d920), innovation, usability, and competitiveness of the game; the benefits of physical activity (b455); the adaptations, structure, and comfort of the home environment (e298); and the encouragement and support of family members (e410). The barriers were related to technological elements of the game (e1301); fear and insecurity of climbing up and down the step (b152); limited mobility (d4106/d4108/d4452); external noise (e2501); attitudes of household members (e410); domestic animals (e350); unexpected phone calls (d3608) and visits (d9205). Conclusion: Exergames applied at home showed good usability and had significant effects on postural balance, especially the immersive modalities. The prototype of the home version of VirtualTer achieved good usability and highlighted the need for adjustments in the technical elements to promote greater specificity and robustness in the final version of the game. The VirtualTer exergame was considered a feasible and safe tool, presenting excellent usability and acceptance in the home environment, generated high motivation in the older adults and improved better scores in post-intervention clinical tests. The facilitators elements aggregate and can make the experience of playing the game at home positive, as well as the barriers, which, despite being modifiable, can make it difficult.