Peninsula Clinical School, Central Clinical School, Monash University, 2 Hastings Road, Frankston, Victoria, Australia; Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania, Australia.
Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania, Australia.
Exp Gerontol. 2021 Sep;152:111434. doi: 10.1016/j.exger.2021.111434. Epub 2021 Jun 8.
Evidence-based interventions to improve mobility in older people include balance, strength and cognitive training. Digital technologies provide the opportunity to deliver tailored and progressive programs at home. However, it is unknown if they are effective in older people, especially in those with cognitive impairment.
The aim of this study was to examine the efficacy of a novel tablet-delivered cognitive-motor program on mobility in older people with cognitive impairment.
This was a 6-month single-blind randomised controlled trial of older people living in the community with subjective and/or objective cognitive impairment. Participants randomised to the intervention were asked to follow a 120 min per week balance, strength and cognitive training program delivered via an app on an iPad. Both the intervention and control group received monthly phone calls and health fact sheets. The primary outcome measure was gait speed. Secondary measures included dual-task gait speed, balance (step test, FISCIT-4), 5 sit to stand test, cognition (executive function, memory, attention), mood and balance confidence. Adherence, safety, usability and feedback were also measured.
The planned sample size of 110 was not reached due to COVID-19 restrictions. A total of 93 (mean age 72.8 SD 7.0 years) participants were randomised to the two groups. Of these 77 participants returned to the follow-up clinic. In intention-to-treat analysis for gait speed, there was a non-significant improvement favouring the intervention group (β 0.04 m/s 95% CI -0.01, 0.08). There were no significant findings for secondary outcomes. Adherence was excellent (84.5%), usability of the app high (76.7% SD 15.3) and no serious adverse events were reported. Feedback on the app was positive and included suggestions for future updates.
Due to COVID-19 the trial was under powered to detect significant results. Despite this, there was a trend towards improvement in the primary outcome measure. The excellent adherence and positive feedback about the app suggest a fully powered trial is warranted.
改善老年人活动能力的循证干预措施包括平衡、力量和认知训练。数字技术提供了在家中提供量身定制和渐进式计划的机会。然而，目前尚不清楚它们是否对老年人有效，尤其是对认知障碍者。
本研究旨在检验一种新型平板电脑提供的认知运动程序对认知障碍老年人活动能力的疗效。
这是一项针对居住在社区中且存在主观和/或客观认知障碍的老年人的为期 6 个月的单盲随机对照试验。随机分配至干预组的参与者被要求按照每周 120 分钟的平衡、力量和认知训练计划进行训练，该计划通过 iPad 上的应用程序提供。干预组和对照组每月都会接到电话和健康知识单。主要观察指标为步态速度。次要观察指标包括双任务步态速度、平衡（台阶测试、FISCIT-4）、5 次坐站测试、认知（执行功能、记忆、注意力）、情绪和平衡信心。还测量了依从性、安全性、可用性和反馈。
由于 COVID-19 限制，未达到计划的 110 名样本量。共有 93 名（平均年龄 72.8 岁，标准差 7.0 岁）参与者被随机分配至两组。其中 77 名参与者返回了随访诊所。在意向治疗分析中，步态速度的改善有利于干预组（β 0.04 m/s，95%置信区间-0.01，0.08），但无显著差异。次要结果无显著发现。依从性极好（84.5%），应用程序的可用性很高（76.7%，标准差 15.3），未报告严重不良事件。对应用程序的反馈是积极的，包括对未来更新的建议。
由于 COVID-19，试验的效力不足以检测出显著结果。尽管如此，主要观察指标仍有改善的趋势。极好的依从性和对应用程序的积极反馈表明，进行一项完全有力的试验是合理的。
