Feasibility of a tele-game-based exercise (Tele-exergame) program to prevent deconditioning in hospitalized COVID-19 patients

基于远程游戏的锻炼 (Tele-exergame) 计划预防住院 COVID-19 患者功能失调的可行性

• 批准号: 10251582
• 负责人: Sarvari Yellapragada
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10251582
• 关键词: Activities of Daily Living; Address; Adherence; Adverse event; Aging; Algorithms; Ankle; Anxiety; Beds; Blood Vessels; COVID-19; COVID-19 patient; Cessation of life; Cognitive; Communities; Complex; Dropout; Drops; Effectiveness; Elderly; Equilibrium; Equipment; Exercise; Feedback; Fright; Goals; Health; Home; Hospitalization; Hospitals; Image; Infection; Inpatients; Intervention; Investigation; Lead; Leg; Length of Stay; Life; Lower Extremity; Medical center; Mental Depression; Mental Health; Modeling; Monitor; Motion; Motivation; Motor; Movement; Online Systems; Outcome; Participant; Patient Self-Report; Patients; Perception; Persons; Physical activity; Pilot Projects; Play; Population; Protocols documentation; Questionnaires; Randomized; Recovery; Research; Research Support; Risk; Series; Severity of illness; Short-Term Memory; Supervision; Surveys; Tablet Computer; Tablets; Technology; Telemedicine; Telephone; Texas; Time; Translating; Veterans; Visual; Work; acceptability and feasibility; base; cognitive performance; comorbidity; deconditioning; design; digital; disability; eligible participant; evidence base; exercise intensity; exercise program; exergame; exhaustion; falls; feasibility testing; flexibility; foot; frailty; functional decline; improved; improved mobility; infection risk; innovation; instrumental activity of daily living; meter; motor learning; novel; patient population; prevent; primary outcome; programs; psychologic; recruit; secondary outcome; sensor; standard of care; venous thromboembolism; virtual; visual feedback; wearable sensor technology

Conventional face-to-face in-hospital mobility program (MP) is impractical for COVID-19 patients because of its associated risk of infection to hospital staff as well as other hospitalized patients. To address the gap, we propose a novel game-based virtually supervised (contactless) foot and ankle exercise, called Tele-Exergame, as an alternative and practical option. The primary goal of this SPiRE application is to test feasibility, acceptability, and proof of concept effectiveness of Exergame in COVID-19 patients as an alternative to conventional in-hospital MP to reduce the loss of mobility during hospitalization and decline in mental health. Exergames are digital or web-based games that use body movement to promote physical activity and generally involve strength, balance, and flexibility exercises. The tele-exergame MP, developed by our team, uses a remotely supervised and game-based approach, which helps to increase patient motivation and engagement in a cognitively demanding exercise program. For example, the Tele-Exergame MP includes foot and ankle exercise tasks with explicit augmented visual feedback (i.e., the patient's movement controls an object on the screen, thus providing real-time visual and audio feedback that is critical for motor learning). Monitoring and feedback are achieved by using wearable sensors worn on feet. Our game-based exercise includes a wide range of safe non-weight bearing exercise tasks, suitable for bedbound patients, and is inspired by an evidence-based exercise program. A popular game (flight shooter game) that could be played either while sitting or lying in bed by rapid, alternating ankle dorsiflexion and plantarflexion will be used. The motion of foot is translated into the movement of an avatar to play the game; for example, to “shoot” targets on a screen. The sensor on the foot can quantify motor and cognitive performance (e.g., slowness, weakness, exhaustion, and working memory), defined as cognitive frailty, using a validated algorithm developed by our team. Exercises are demonstrated remotely using a tele-medicine tablet, and the movement of subjects is monitored in real-time by research staff. To demonstrate the feasibility of Tele-Exergame MP, COVID-19 or PUI (persons under investigation) participants admitted to the MEDVAMC (n=60), with an anticipated length of stay at least 3 days will be recruited. Participants will be randomized (n=1:1) to either intervention (IG) or control (CG) groups. Both groups will receive standard of care. IG will additionally receive Tele-Exergame MP therapy. Tele-Exergame sessions will range from 3-10 minutes based on patient ability and completed twice daily. Primary outcomes include acceptability, deconditioning (cognitive-frailty), and mental health (e.g., depression and anxiety) assessed at baseline, at discharge, and at 1-month post-discharge. Secondary outcomes include adverse events (e.g., venous thromboembolism (VTE), falls, etc), instrumental activities of daily living, and community mobility, which will be assessed at baseline and at one-month post-hospital discharge. Our main hypotheses are H1) Tele-Exergame in hospital setting is feasible with less than 15% drop out and over 70% compliance; H2) The perceived ease of use, acceptability, and benefit is high as assessed using a validated technology acceptance model survey; H3) IG has less deconditioning and better mental health outcomes compared to CG at the time of discharge; H3) At 4 weeks post-discharge, the self-reported activity of daily living (ADL) and life space (LSA) would be higher in IG compared to CG. Impact: There is no existing contact-less in-hospital MP that is available for hospitalized COVID-19 population. If the feasibility and effectiveness of the proposed tele-exergame MP is demonstrated, it will address the current challenges for implementing in-hospital MP for COVID-19 patients and also open new avenues to deliver personalized exercise for non-COVID-19 patients with limited mobility including bedbound and hospitalized patients.

传统的面对面的院内活动计划(MP)对新冠肺炎患者来说是不切实际的，因为它 医院工作人员以及其他住院患者的相关感染风险。为了解决这一差距，我们 提出了一种新的基于游戏的虚拟监督(非接触式)脚踝锻炼，称为远程锻炼游戏， 作为一种替代和实用的选择。此SPIRE应用程序的主要目标是测试可行性， 运动游戏在新冠肺炎患者中的可接受性和概念验证有效性 传统的住院MP，以减少住院期间活动能力的丧失和精神健康的下降。 运动游戏是数字或基于网络的游戏，它使用身体运动来促进身体活动和 通常包括力量、平衡和柔韧性练习。我们团队开发的电子竞技游戏MP， 使用远程监督和基于游戏的方法，这有助于提高患者的积极性和 参与对认知要求很高的锻炼计划。例如，远程游戏MP包括Foot 以及具有显式增强视觉反馈的踝关节运动任务(即，患者的运动控制 在屏幕上显示对象，从而提供对动作学习至关重要的实时视觉和音频反馈)。 监测和反馈是通过在脚上佩戴的可穿戴传感器来实现的。我们的基于游戏的练习 包括一系列安全的非负重锻炼任务，适合卧床不起的患者，并且是 灵感来自一项循证锻炼计划。可以玩的流行游戏(飞行射击游戏) 无论是坐在床上还是躺在床上，都将使用快速、交替的脚踝背屈和趾屈。这个 脚的运动被翻译成虚拟化身玩游戏的运动；例如，在游戏中“射击”目标 一块屏幕。脚上的传感器可以量化运动和认知表现(例如，缓慢，虚弱， 精疲力竭和工作记忆)，定义为认知脆弱，使用我们的 一队。使用远程医疗平板电脑远程演示练习，受试者的移动 由研究人员实时监控。 论证远程游戏MP、新冠肺炎或PUI(被调查者)的可行性 获准进入MEDVAMC(n=60)的参与者，预计停留时间至少为3天 被招募了。参与者将被随机(n=1：1)分为干预组(IG)和对照组(CG)。两者都有 团体将得到标准的护理。IG还将接受远程游戏MP治疗。电子竞技游戏 疗程将根据患者的能力从3-10分钟不等，每天两次。主要结果 包括可接受性、去条件性(认知脆弱)和心理健康(例如，抑郁和焦虑) 在基线、出院时和出院后1个月进行评估。次要结果包括不利的 事件(例如，静脉血栓栓塞症(VTE)、跌倒等)、日常生活工具活动和社区 活动能力，将在基线和出院后一个月进行评估。 我们的主要假设是：1)在医院环境下远程操练游戏是可行的，辍学率低于15% 合规性超过70%；h2)通过以下方式评估的易用性、可接受性和益处很高 经过验证的技术接受模型调查；H3)IG免责条件更少，心理健康更好 出院时与对照组的结果比较；H3)出院后4周，自我报告的 与对照组相比，干预组的日常生活能力(ADL)和生活空间(LSA)更高。 影响：目前没有住院新冠肺炎可用的非接触式住院MP 人口。如果拟议的远程游戏MP的可行性和有效性得到证明，它将 应对当前对新冠肺炎患者实施院内MP的挑战，并开辟新的 为包括卧床在内的活动受限的非新冠肺炎患者提供个性化锻炼的途径 和住院病人。