THE USE OF NOVEL TECHNOLOGY TO DELIVER FALLS PREVENTION EXERCISE TO OLDER ADULTS Sarah Howes BSc. (Hons) Physiotherapy Faculty of Life and Health Sciences of Ulster University This thesis is submitted for the degree of Doctor of Philosophy May 2018 I confirm that the word count of this thesis is less than 100, 000 words CONTENTS 1 INTRODUCTION ........................................................................................................ 1 1.1 BACKGROUND .......................................................................................................... 1 1.1.1 An ageing population ....................................................................................... 1 1.1.2 Healthy ageing ................................................................................................. 2 1.1.3 Technology for health ...................................................................................... 4 1.2 RATIONALE .............................................................................................................. 5 1.3 AIMS AND ORGANISATION OF THE THESIS ................................................................. 6 1.3.1 Aim .................................................................................................................. 6 1.3.2 Objectives ........................................................................................................ 6 1.3.3 Organisation of the thesis ................................................................................. 6 2 GAMING FOR HEALTH: A SYSTEMATIC REVIEW AND META- ANALYSIS OF THE PHYSICAL AND COGNITIVE EFFECTS OF ACTIVE COMPUTER GAMING IN OLDER ADULTS ........................................................... 9 2.1 CHAPTER OVERVIEW ................................................................................................ 9 2.2 BACKGROUND ........................................................................................................ 10 2.3 AIMS AND OBJECTIVES ........................................................................................... 12 2.3.1 Aim ................................................................................................................ 12 2.3.2 Objectives ...................................................................................................... 12 2.4 METHODS ............................................................................................................... 12 2.4.1 Data sources and searches .............................................................................. 12 2.4.2 Study Selection .............................................................................................. 13 ii 2.4.3 Data extraction and quality assessment ......................................................... 15 2.4.4 Data Synthesis and Analysis: ......................................................................... 15 2.5 RESULTS ................................................................................................................. 16 2.5.1 Description of studies ..................................................................................... 16 2.5.2 Intervention delivery ...................................................................................... 34 2.5.3 Risk of bias in included studies ...................................................................... 38 2.5.4 Effects of interventions .................................................................................. 38 2.6 DISCUSSION ............................................................................................................ 44 2.6.1 Limitations ..................................................................................................... 46 2.7 CONCLUSION .......................................................................................................... 47 3 DEVELOPMENT OF THE CONTENT FOR THE ACG SYSTEM ................... 48 3.1 CHAPTER OVERVIEW .............................................................................................. 48 3.2 BACKGROUND ........................................................................................................ 48 3.2.1 Technology for health .................................................................................... 48 3.2.2 Interdisciplinary Collaboration ...................................................................... 50 3.2.3 User-centred design (UCD) ........................................................................... 54 3.3 AIMS AND OBJECTIVES ........................................................................................... 57 3.3.1 Aim ................................................................................................................. 57 3.3.2 Objectives ....................................................................................................... 57 3.4 METHODS ............................................................................................................... 59 3.4.1 Information gathering for prototype 1 ........................................................... 59 iii 3.4.2 Design and development of prototype 1 ........................................................ 60 3.4.3 Piloting of prototype 1 ................................................................................... 61 3.4.4 User testing of prototype 1 ............................................................................. 62 3.4.5 Design and development of prototype 2 ........................................................ 62 3.4.6 User testing of prototype 2 ............................................................................. 63 4 DESCRIPTION OF PROTOTYPE 1 ...................................................................... 64 4.1 CHAPTER OVERVIEW .............................................................................................. 64 4.2 INFORMATION GATHERING ..................................................................................... 64 4.2.1 Evidence base ................................................................................................. 64 4.2.2 Interdisciplinary workshop ............................................................................ 67 4.2.3 PPI – service providers consulted .................................................................. 74 4.3 DESIGN AND DEVELOPMENT OF PROTOTYPE 1 ........................................................ 75 4.3.1 Interdisciplinary collaboration ....................................................................... 76 4.3.2 PPI - Service user involvement ...................................................................... 94 4.4 PILOTING THE SYSTEM WITH HEALTHY ADULTS...................................................... 95 4.5 USER TESTING OF PROTOTYPE 1 ............................................................................. 95 5 OLDER ADULTS’ EXPERIENCE OF ACG AND VR – PHASE 1 .................... 97 5.1 CHAPTER OVERVIEW .............................................................................................. 97 5.2 BACKGROUND ........................................................................................................ 97 5.3 AIMS AND OBJECTIVES ........................................................................................... 99 5.3.1 Aim ................................................................................................................ 99 iv 5.3.2 Objectives ..................................................................................................... 100 5.4 METHODS ............................................................................................................. 100 5.4.1 Study design ................................................................................................. 100 5.4.2 Setting .......................................................................................................... 100 5.4.3 Participants ................................................................................................... 100 5.4.4 Materials – study software and study hardware ........................................... 102 5.4.5 “Otago World” mini-games ......................................................................... 102 5.4.6 Interaction .................................................................................................... 104 5.4.7 Study conditions ........................................................................................... 106 5.4.8 Procedure ..................................................................................................... 106 5.4.9 Participant safety .......................................................................................... 108 5.4.10 Outcome measures ..................................................................................... 108 5.4.11 Data analysis .............................................................................................. 112 5.5 RESULTS ............................................................................................................... 112 5.5.1 Recruitment .................................................................................................. 112 5.5.2 Demographics .............................................................................................. 113 5.5.3 Safety and usability ...................................................................................... 115 5.5.4 Usability and acceptability ..........................................................................