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Interactive mobile phone

 

 

 

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RemindMe                            

 

 

 

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Exergaming

  

 

 

 

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Interactive website

 

 

 

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Co-design, Social
selectivity 
Cost-effectiveness

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Progress - Exergaming

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Contact - exergaming

Motivation for exercise and maintaining a stable level of activity is a vital component, but often it is the ‘Achilles heel’ of exercise and activity. Elements of competition, setting personal goals and social interaction are strong motivators to be active, both in the young and old, healthy or diseased. The connection between the older and the younger generations is not always easy due to lack of mutual interests, distances or busyness. Exercise is an important self-care behavior and is related to mortality in heart failure (HF). It is not always easy for patients to start exercising in the conventional ways (rehabilitation center, fitness club). Virtual reality might be a solution to increase exercise in the home environment. Virtual reality is a technology that allows the user to interact directly with a computer- simulated environment. The Wii, a video game console made by Nintendo, uses virtual reality where people of any age have the opportunity to exercise. It is conceivable that computer-based rehabilitation programs could be developed using current, widely available, affordable virtual reality platforms, such as the Nintendo Wii.

Aim: To determine the effectiveness of using a Wii game computer in older persons with HF to improve their exercise capacity, daily physical activity, decrease health care use and improve quality of life.

Method: This study contains two elements:

1. HF-Wii study

A multicenter RCT design with an intervention and a control group, in total, 300 persons with HF in Sweden and 300 patients from Italy, Israel and the Netherlands will be performed to test the effects of the Wii game computer to increase daily activity among older persons with HF. Persons with HF are randomized into attention control (control) or structured access to a Wii game computer (Wii). After 3 months we will analyze if the exercise capacity as determined by the six-minute walking test improved more in the Wii group compared to the control patient. We also will measure daily physical activity, health care use (hospitalizations, institutionalization in nursing homes) and quality of life.

2. The virtual national Swedish bowling competition

Using the format of the National Senior League, recreational competitions will be organized, starting on a local level. Teams consisting of four bowlers will be brought together and play one competition game a week in their own environment setting (e.g. sheltered living, retirement, community home). The setting will have access to a game computer and a virtual “coach” will be assigned to the setting to manage the play and post the scores on a gaming website. The website will contain all the participating teams, short descriptions of each player, competition schedule, the scores and standings. If the regional competition is a success, national and international bowling competitions will be organized.

Impact:  It is evident that our more traditional approaches to motivate people to stay active are not successful in all patients and therefore we have to look around and creatively use existing tools and interventions to apply in a ‘new’ population. This project will strengthened evidence base on the effects of using exergames in older cardiac patients. The intervention may improve physical function and independence in daily activities of patients with other long-term illnesses as well as the interaction between patients, their relatives and others, facilitating more inclusion in active society.

What is new:  Although gaming is extremely popular among the young, the potential has not been fully considered in older persons with long-term illness. A novel approach is to use a virtual medium to contact others and be active ‘together at distance’. 

 

RemindMe – an interactive reminder support for self-care in older people with cognitive impairment 

 

Progress - RemindMe

Publication - RemindMe

Contact - RemindMe

 

Cognitive impairments are common in older ages and might be the result of diseases such as stroke or dementia. For example each year about 25000 Swedish persons get a stroke and one third of these will have residual difficulties such as memory problems that will influence their participation in society. Assistive technology (AT) is used to enable persons to participate in society and live an active life. However, to date AT most often are designed for people with physical impairments and not for persons with cognitive impairments such as memory problems. One reason for this might be lack of knowledge on how to design AT for people with cognitive impairments, for whom learning to use a new device might be extra challenging. However, recent years advances in new technology have opened new possibilities for persons with cognitive impairments.

RemindMe is a non-stigmatising web-based mobile reminder system that has been developed by the research group in collaboration with Monkey dancers (IT cooperate business). Based on earlier research it is specifically developed for persons with memory problems who need support in planning, remembering and executing daily activities. The user plans weekly activities in a web-based diary and chooses which ones are to have reminders. The diary will then subsequently send reminders by text messages to the user's own mobile phone. If desired and needed the planning is done in collaboration with a support person, and if so the diary is accessible for both parts at the web. The user actively confirm whether or not he/she will perform the planned activity by answering the text message with a yes or no which is saved in the interactive feedback loop. The feedback loop provides the user and support person with a graphic summary of planned activities with reminders, frequency and intensity of reminders and results of the reminders in order to monitor success and failure and support future planning. A quality control of RemindMe has had good results in people without cognitive impairments. Currently a first evaluation of RemindMe is performed in a limited group of people with a variety of cognitive impairments and their family carers.

Aim: To examine the effectiveness and usability of a new non-stigmatising, user-friendly, web-based mobile reminder system (RemindMe) which supports older people with cognitive impairments in planning, remembering and executing activities in everyday life.

Methods: A wait-list control group design will be performed to examine effectiveness and usability of RemindMe in persons with cognitive impairments. Measures before, after and at follow-up will focus on performed activities, satisfaction with occupational performance, participation and autonomy, and perceived health. In addition, focus groups interviews are planned with both users and support persons concerning their experiences of RemindMe as support for remembering and executing everyday activities. Data generated by the RemindMe feedback loop will be used throughout the project to measure the amount of activities with reminders, frequency of reminders before response and executed planned activities over time. In a first step about 30 participants will be included. Thereafter a multicentre RCT study is planned.

Impact: This project will strengthen the evidence base on the effects of using a reminder AT in older persons with cognitive impairments. It is expected to facilitate independence and participation in daily activities of older persons with cognitive impairments and may improve security and safety. This increased knowledge on how new technology can support independence and participation in everyday activities for persons with cognitive impairments is valuable for societal institutions and clients organisations.

What is new: AT for persons with cognitive impairments is lacking. The interactive feedback loop provides the user with statistics of reminders and fulfilled activities and by that an accurate base for self-monitoring, evaluation and further planning. The feedback loop also makes it possible for a support person to follow whether or not a user performs planned activities in real-time on the web.

Progress - Interactive mobile phone

Publication - Interactive mobile phone

Contact - Interactive mobile phone 

Day surgery implies a short period of postoperative surveillance before discharge from the surgery unit. Patients and families have to manage the recovery mainly by themselves at home. Over the years there has been a shift in day surgery and older persons with multiple diagnoses are also included. The organization of day surgery, allowing the patient to recover in familiar surroundings, is considered beneficial for older people. However, many day surgical patients feel burdened by the responsibility to manage their own care following discharge. The postoperative period at home is a weak link in an otherwise efficient flow of day surgical care.

Aim: To develop and evaluate the feasibility and cost-effectiveness of an interactive mobile phone self-report system aimed at supporting older persons recovery at home after day surgery.

Method: In order to develop a truly valid system, the iterative process recommended by the US Food and Drug Administration (FDA) regarding the development of a PRO instrument in clinical trials will be followed. Items included in the self-report system will be based on interviews with day surgery patients and a cognitive debriefing will be achieved through focus group interviews with experienced day surgical physicians and nurses and individual day surgery patients.

A communication system for mobile phones Circadian Questions (CQ) for the patient’s own mobile phone available for multiple platforms developed by 21st Century Mobile AB (http://www.cqmobil.se) will be used. The data will be returned and stored in a database, with security levels comparable to those used within Internet banking systems. The answers are only visible for patients and family carers through a personal login to the database (Hallberg et al. 2014).

In the pilot study older patients from one data collection site will be included. As part of the intervention patients in the intervention group respond to short questions in the mobile phone on postoperative day 1-14, 21 and 28. Patients in the control group follow their usual care on day 1-27. For evaluation purpose identical self-reported data will be collected in both groups on day 28.

Study populations: A convenient sample of 6-10 experienced (≥ 3 years) day surgery physicians and nurses in two focus groups. Twenty patients (≥ 60 years, Swedish-speaking with no cognitive disorders and scheduled for a day surgical procedure) will be used for cognitive debriefing. The evaluation phases initially consist of a pilot of the system (10 patients), followed by a multicentre RCT with 300 consecutively included patients divided into the intervention and the control group from three-day surgical units.

Impact: To facilitate interactive communication between patients and the health care, use of different ICT solutions may result in increased safety and satisfaction among patients when discharged. The mobile phone system is expected to increase patients’ feeling of health care professionals closeness and enable identification and prevention of complications and thereby increase patients’ and families’ sense of security during the postoperative period as well as reduce the consumption of health care.

What is new: The older person’s use of his or her own mobile phone results in a method uncomplicated to implement in clinical practice. The system has very high security and the data traffic is cheap.