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.

传统的面对面住院流动计划（MP）对COVID-19患者来说是不切实际的，因为它 对医院工作人员以及其他住院患者的相关感染风险。为了解决差距，我们 提出了一种新的基于游戏的虚拟监督（非接触式）的脚和脚踝锻炼，称为远程游戏， 作为一种替代和实用的选择。SPiRE应用程序的主要目标是测试可行性， 可接受性，以及在COVID-19患者中验证游戏作为替代方案的概念有效性， 传统的住院MP，以减少住院期间的流动性损失和心理健康下降。 电子游戏是数字或基于网络的游戏，使用身体运动来促进身体活动， 通常包括力量、平衡和柔韧性练习。远程exergame MP，由我们的团队开发， 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， 参与认知要求高的锻炼计划。例如，远程游戏MP包括脚 以及具有明确的增强视觉反馈的踝关节锻炼任务（即，病人的运动控制着 屏幕上的对象，从而提供对运动学习至关重要的实时视觉和音频反馈）。 监测和反馈是通过使用脚上的可穿戴传感器来实现的。我们基于游戏的练习 包括广泛的安全非负重运动任务，适合卧床病人， 受到一个循证锻炼计划的启发一个流行的游戏（飞行射击游戏），可以发挥 无论是坐着还是躺在床上，都将使用快速交替的踝背屈和跖屈。的 脚的运动被转换成化身的运动来玩游戏;例如，“射击”目标。 一个屏幕脚上的传感器可以量化运动和认知性能（例如，迟钝，虚弱， 疲劳和工作记忆），定义为认知脆弱，使用我们开发的验证算法， 团队演习演示远程使用远程医疗平板电脑，和受试者的运动是 由研究人员实时监测。 演示远程游戏MP、COVID-19或PUI（被调查人员）的可行性 进入MEDVAMC的受试者（n=60），预计住院时间至少为3天， 招募的受试者将被随机（n=1：1）分配至干预（IG）组或对照（CG）组。两 将得到标准的护理。IG还将接受远程游戏MP治疗。电子游戏 根据患者的能力，治疗时间为3-10分钟，每天完成两次。主要结局 包括可接受性、去适应（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。次要结局包括不良 事件（例如，静脉血栓栓塞（VTE）、福尔斯等）、日常生活的工具性活动和社区 活动性，将在基线和出院后1个月进行评估。 我们的主要假设是H1）在医院环境中的远程游戏是可行的，辍学率低于15 和超过70%的依从性; H2）使用评估的易用性、可接受性和受益较高 经过验证的技术接受模型调查; H3）IG具有更少的失调和更好的心理健康 出院时与CG相比的结局; H3）出院后4周， 日常生活（ADL）和生活空间（LSA）在IG中比CG更高。 影响：目前没有可用于住院COVID-19的非接触式住院MP 人口如果所提出的远程演习MP的可行性和有效性得到证明，它将 解决当前为COVID-19患者实施院内MP的挑战，并开辟新的 为行动不便的非COVID-19患者提供个性化运动的途径，包括卧床 和住院病人。