The effect of leap motion controller based exergame therapy on hand function, cognitive function and quality of life in older adults. A randomised trial
Abstract
Objective. To evaluate the effect of leap motion controller based exergame therapy (LMCBET) on hand function, cognitive function and quality of life (QoL) in older adults.
Design. A parallel, double-blind trial with participants allocated (1:1) to one of two groups as the structured exercise (SE) and LMCBET.
Setting. The study was conducted in “Barınyurt Nursing Home and Elderly Care Center” in Istanbul.
Participants. Thirty-two older adults who had adequate hand function, ability to follow commands, 24 points or more in the mini mental state examination (MMSE) were included and 30 were analyzed.
Interventions. SE Group performed a Structured Hand Exercise program while LMCBET group performed “ErgoActive’’ and “HandROM” exercise apps focusing on hand exercises and fine motor skills along 30-45 minute sessions, 2 days a week, over 8 weeks.
Main outcome measures. Participants were evaluated with box and block test (BBT), Purdue Pegboard test (PPT), hand dynamometer, Duruöz hand index (DHI), stroop test (ST), digit span test (DST), and World Health Organization QoL instrument-older adults module (WHOQOL- OLD) at the beginning (T0), at 8 (T1), and 16 (T2) weeks after the study started.
Results. There were significant differences in BBT, PPT, DHI, and WHOQOL-OLD in the SE group (p < 0.05). BBT, right, left, couple, total scores of PPT, DHI and WHOQOL-OLD were found significant in the LMCBET group (p < 0.05). In Time*Group evaluations, there were no differences (p > 0.05).
Conclusions. SE and LMCBET were effective on hand function and QoL in healthy older adults.
Contribution of paper
- LMCBET is a feasible and effective method for healthy older adults to improve the hand function and QoL.
- LMCBET is an alternative to conventional approaches and recommended as home exercises in rehabilitation.
- Further research should be conducted to evaluate the effect of exergame therapy in adults more focusing on the cognitive improvements.
Abbreviations
ADL: activities of daily living
BBT: box and block test
DHI: Duruöz hand index
DST: digit span test
GDS: geriatric depression scale
LMC: leap motion controller
LMCBET: leap motion controller based exergame therapy
MMSE: mini mental state examination
PPT: Purdue Pegboard test
PRPS: Pittsburgh rehabilitation participation scale
QoL: quality of life
SE: structured exercise
ST: Stroop test
WHOQOL-OLD: World Health Organization quality of life instrument older adults module
INTRODUCTION
Aging is a natural process from adulthood to death, associated with decline in body functions which results in metabolic based diseases while having a remarkable impact on activities of daily living (ADL) and quality of life (QoL) 1. The functional loss is mainly mediated by a decrease in sensory function, tendon reflexes, motor movements, cognitive function and result in fine and gross motor skill problems in ADL 2. Hand grip strength is the main indicator of upper extremity strength, guides in evaluating life independence and cognitive aging 3. The loss of two-way interaction between cognition and motor systems lead to disturbances in hand-eye coordination 4. Along with physiological changes and cognitive decline, unfavorable alterations in motor planning, muscular endurance, and coordination may become more prominent in aging individuals and subsequently affect ADL 4. However, the amount of ADL can be preserved by preventing the decrease in cognitive function 4,5. Depression, another common age-related condition, can be developed via the loss of social communication, decreased self-esteem and courage plus altered biologic or physical function which results in limitation of the daily activities 6. Due to decreased productivity and economic income, elderly starts dealing with the feel of uselessness which might result in isolated lifestyle or low attendance to the activities which causes other physical limitations in the long term 6. With an altered neurochemical changes in the brain and the prolonged burden of sleep deprivation, aged individuals seem more prone to depression compared to younger individuals in accordance with decline in cognitive and physical function 6. Based on this multifactorial disease feature, the rehabilitation process requires a multidisciplinary intervention as well as adapting medication usage, psychotherapy, cognitive approaches, social structure, self-confidence, nutritional support and most importantly, incorporating physical activity into daily routine 6. While an elderly with a depression is facing with decreased performance due to the laziness and loss of motivation in later stages of the disease, the rehabilitation approaches should mainly focus on improving the function, cognition, motivating the person for social life attendance by incorporating the family and friend support to the process 6.
In parallel with the high impact of physical activity on QoL and cognition, interventions that focus on muscle function and strength are essential 7. While exercise promotes neuroplasticity, blood circulation, the prevention of the chronic and cognitive diseases, structured exercise (SE) programs which are more preferable as a supervised exercise than a home exercise alone, can be applied in geriatric rehabilitation 8. In a study examining the effectiveness of physical exercises in conjunction with a mental task, the combination of the cognitive and physical training is emphasized to improve cognition 9. So focusing on various domains in rehabilitation can provide better outcomes instead of a single intervention alone 9. It is also suggested that a combination of mobility, endurance, strength and aerobic exercises two/three times a week can improve mental health and QoL, while some studies explain the sedentary lifestyle in older adults as reduced motivation for movement 10,11.
Technology and game-based rehabilitation systems such as exergames can contribute to the development of both motor and cognitive functions with task-specific upper extremity exercises, by providing fun and challenging tasks that enable participants to rehabilitate without being aware of it 12. The leap motion controller (LMC) can be used for hand exercises with advantages like cheap, no sensor needed, portable, safe and inspiratory environment 13. The LMC based exergame therapy (LMCBET) is widely used, particularly in pediatric rehabilitation, to evaluate hand fine motor function 14. Although the LMCBET has been applied for a specific disease group in previous studies 14,15, to our knowledge, there is no study focusing on virtual reality and cognitive function in healthy older adults. This study is intended to be a pioneering study.
The aim of this study was to evaluate the effectiveness of the SE and LMCBET in hand function, cognitive function and QoL in older adults.
METHOD
STUDY DESIGN
This study is a parallel, double-blind (participants and evaluators) trial with participants allocated (1:1) to one of two groups.
STUDY POPULATION
The study was conducted with participants who were living in Nursing Home and Elderly Care Center. The study was conducted between June 2021 and March 2022.
The participants who were ≥ 50 years old, had hand and cognitive function ability to follow commands, and got ≥ 24 points in the mini mental state examination (MMSE) were included in the study. The exclusion criteria were defined as presence of exercise contraindications, getting ≥ 14 points on the geriatric depression scale (GDS), diagnosis of dementia and acute upper extremity injury.
Thirty-nine participants were screened, thirty two participants who met the inclusion criteria were included in the study. During the study process, one is excluded due to not following the exercise sessions and one is dropped out due to the COVID-19 related death. In total, the study was completed with 30 participants. The algorithm for allocation was shown in Figure 1.
The sample size was determined using the “G*power sample size calculator” and was calculated as 30 subjects using “ANOVA: Repeated measures, within-between interaction” design for two groups, with a power of 95% (α = 0.05, β = 0.95) and an effect size of 0.35 16.
EXPERIMENTAL DESIGN
Thirty two participants were included in the study and were randomly divided into two groups using block randomization in Microsoft Excel ‘RAND(WS)’ function as the SE (n = 16) and LMCBET group (n = 16). Participants were evaluated at the beginning of the study (T0), at 8 (T1), and 16 (T2) weeks after the study started.
T0-T1 period
An 8-week active washout period in which both groups resumed their usual physical activity routines and ADLs. The logic of the active control period was dissociating the affect of the current daily life activities or the experimental intervention prescribed by the study protocol. Because of the participants were already taking a physical therapy or a group exercise session based on balance or postural parameters twice a week in the usual nursing home setting, the continuation of the routine was asked from all participants for the first 8 weeks and then they randomized into two groups. This period was thought-out to answer the question of "Did the development in the outcome measures is occured under favour of the personal daily routine activities or one or two of the structured exercise programs?" to increase the reliability of the achievements. Adding the control group into rehabilitation design was suggested in some other studies which practiced the exergame systems 15.
T1-T2 period
An intervention period in addition to the routine physical activities of participants. Participants in the SE Group performed a structured hand exercise program in the form of 30-45 minute sessions, 2 days a week, over 8 weeks. Participants in the LMCBET Group performed “ErgoActive” and “HandROM” exercise apps in the form of a 30-45 minute session, 2 days a week, over 8 weeks.
SE PROTOCOL
Structured hand exercises were applied in 30-45 minute sessions, 2 days a week, over 8 weeks. They consisted of warm-up, basic exercise, and cognitive exercise phases (Tab. I). Each exercise was performed as 10 repetitions. The weights were used in the wrist exercises and the difficulty level of the cognitive games were started at the intensity that the participants could tolerate and adapt in the first session, in accordance with the beginner level. Exercise intensity was increased in accordance with the BORG scale 17.
LMCBET PROTOCOL
The LMC device, which was the design of the “Becure (formerly Fizyosoft)” system, whose validity and reliability was specified, and which was developed with the cooperation of a physiotherapist and an engineer, was used in this protocol 18.
“ErgoActive” and “HandROM” exercise apps focusing on hand exercises and fine motor skills were performed in the form of an average 30-45 minute session, 2 days a week, over 8 weeks.
“ErgoActive”
It includes 6 different exercises (Master Chef, Key Flip, Piano, Hold Book, Pinch Peg, and Hold And Put) allowing participants to perform similar movements in their ADL (Tab. II).
“HandROM”
It includes 4 different exercises (LeapBall, LeapPong, LeapMaze, CatchaPet) allowing participants to perform exercises and evaluates the range of motion (ROM) of the fingers and wrist (Tab. III).
Each exercise was performed first right and then left hand, respectively together with a certified physiotherapist who is blinded to the group randomisation. The intensity of the sessions and the level of the games were determined according to the cognitive and motor performance of the participants in the first session. After the first session trial, the number of targets or the duration was determined in accordance with the wrist angle values or the time he was able to focus on the task and continue the game. Participants who were successful at the previous level, who could continue this success for a few sessions, and who were able to reach the goal with less verbal cues, were moved to the next level. The participant’s ability to easily reach the goal in the game was accepted as the necessary criterion for transitioning to the next level. In case of high difficulty during the session, it was returned to a lower level.
OUTCOME MEASUREMENTS
Demographic information was taken from participants at the beginning of the study and Pittsburgh rehabilitation participation scale (PRPS) was taken at the end of each session. Participants were evaluated by a physiotherapist in terms of gross motor skills and coordination with box and block test (BBT), in terms of fine motor skills and coordination with Purdue Pegboard test (PPT), in terms of grip strength with hand dynamometer, in terms of hand activity limitation and daily living skills with Duruöz hand index (DHI), in terms of executive functions with Stroop test (ST), in terms of attention with digit span test (DST), and in terms of QoL with World Health Organization QoL instrument-older adults module (WHOQOL-OLD) at the beginning of the study (T0), at 8 (T1), and 16 (T2) weeks after the study started.
Demographic Information Form
It was prepared to record the sociodemographic characteristics of participants.
PRPS
It is a 6-likert scale (1-none/6-excellent) and examines the participation in therapy and motivation. Test duration is 5 minutes 19.
BBT
It examines unilateral gross motor skills 20. A stopwatch, a wooden box with a middle section, and 150 wooden cubes are the required materials. It lasts 2-5 minutes. BBT can be applied between the ages of 6 and 65. Within 60 seconds, which is kept by the stopwatch, it is requested to pass the cubes one by one from one compartment to the other and the number of cubes is noted. It is applied separately for both extremities 21.
PPT
It consists of a board with holes into which metal pegs are inserted by the patient. It comes with washers and collars to be placed on the pins. PPT measures movements, coordination and speed of hand and finger dexterity 22. The participant is asked to use their right hand to properly insert as many pins as possible into the holes within 30 sec. Then the same process is repeated for the left hand. The participant is then given 30 sec to simultaneously place the pins, washers and collars using both hands. At the final stage, the participant is asked to perform a combined task with the pins within prescribed 60 sec.
Grip strength.
A hand dynamometer (pinch meter gauge; Jamar® Hand Dynamometer - Hydraulic - 200 lb Capacity. Patterson Medical Illinois, USA) was used to determine the grip strength. The shoulder was measured in adduction and neutral rotation, the elbow was in 90° flexion, and the forearm and wrist were measured in neutral position. Each test was repeated three times and the average score was obtained for the affected extremity 23.
DHI
It is an 18-item, self-answered scale that assesses hand activity limitations and its effect on ADL. It is scored from 0 to 90, and high scores indicate low functioning 24.
ST
It measures the processing speed, the ability to suppress habitual behavior, focused attention, the ability to do unusual behavior, the ability to change the perceptual setup according to changing demands, and under a disturbing effect 25,26.
DST
It consists of forward and backward number range, and evaluates attention 27. Numbers 1 to 9 are said in a predetermined and mixed order. In the forward span, it is expected to repeat the numbers in the same order. In the backward span, it is expected to say the numbers from the back to the beginning. The point corresponding to the last correctly known line is recorded as the score.
WHOQOL-OLD
Evaluates QoL in elderly individuals. WHOQOL-OLD consists of 6 sections: sensory skills, autonomy, past-present-future activities, social participation, death and relationships, and each section contains 4 items with a total of 24 questions 28.
STATISTICAL ANALYSIS
IBM SPSS (statistical package for social science) version 25.0 was used for statistical analysis. Kolmogrov Smirnov was used for normality assessment and all variables were found in normal distribution. Mean, standard deviation and percentage values were presented in the descriptive statistics of the data. The nominal data of the independent variables were evaluated with the Chi-Square test, and the numerical data were evaluated with the Independent Sample-T Test. Time-dependent differences within groups were analyzed with Two-Way Repeated Measure ANOVA. Intention to treat analysis is performed by adjusting time as dependent and group as independent variable to use Time*Group variable for analysis with intent to view the effect of the interventions. Time*Group interactions between groups were analyzed with MANOVA. Bonferroni correction was used for Post-Hoc tests. The significance value was accepted as p < 0.05.
RESULTS
DEMOGRAPHIC DATA
Demographic datas of the participants were shown in Table IV. There was no statistically significant difference in terms of age, gender, MMSE, education, job, history of injury, history of upper extremity surgery, and PRPS between groups (p > 0.05).
WITHIN GROUP DIFFERENCES
Within-group differences in the SE Group were shown in Table V. There were significant differences in terms of BBT, PPT, DHI, and WHOQOL-OLD in favor of the T1-T2 period (p < 0.05). There were no differences in terms of grip strength, ST and DST (p > 0.05).
Within-group differences in the LMCBET group were shown in Table VI. Significant differences in terms of BBT, right, left, couple, and total scores of PPT, DHI, and WHOQOL-OLD were found in favor of the T1-T2 period (p < 0.05). There were no differences in terms of grip strength, ST and DST (p > 0.05).
BETWEEN GROUP DIFFERENCES
Between-group differences and Time*Group interactions were shown in Table VII. In T0, there were significant differences in terms of PPT-Both hands score and ST-Color time score in favor of the LMCBET Group (p < 0.05). In T1, significant differences were found in terms of PPT-Both hands score and DHI in favor of the LMCBET group (p < 0.05). In T2, there were no differences between groups (p > 0.05). In Time*Group evaluations, no difference was found (p > 0.05).
DISCUSSION
In the present study, we investigated the effectiveness of the LMCBET in hand function, cognitive function and QoL in healthy older adults. We observed that SE and LMCBET were effective on hand function and QoL in healthy older adults.
Degeneration in the central nervous system begins to progress with aging, causing loss of muscle mass and strength, decrease in coordination, fine motor skills, hand sensation, and ultimately loss of manual function in ADL 29. In a study involving 24 older adults to evaluate hand pinch and grip strength, a correlation was found between the DHI and grip strength parameters, and it was suggested that grip strength is the main predictor of manual function 29. In our study, while there were significant improvements in hand activity limitations after both treatments, we did not find any significant change in hand grip strength 29. We believe that older adults tolerance to exercises requiring muscular endurance, such as holding the hand 25 cm above the LMC device during playtime, and difficulties during hand resistance training is significantly reduced 29. With aging, motor deficiencies, cognitive impairments, and impairments in function and QoL can be seen 30. In particular, functional impairment may affect bilateral and coordinated hand movements more. In our study, we observed that one-handed tasks performed in a shorter time compared to two-handed tasks in PPT 30. McGrath et al., reported that the amount of grip strength in the elderly with appropriate motor unit and skeletal muscle activation was half that of healthy older adults 31. It is important to consider a holistic approach in rehabilitation, as hand functions can be affected by dominant hand use, age, gender, and ADL 32.
Cognitive decline, seen in 15-20% of older adults over the age of 65, is another complication associated with aging and is affected by the reduction in ADL 33. A SE program may result in better improvements in hand and cognitive function in people with cognitive decline 33. It has been reported that for every 5 kg increase in muscle strength in elderly individuals, the risk of cognitive decline will decrease by 3% 30. Therefore, engaging in regular physical activity can prevent neurodegeneration and cognitive decline, thereby preventing the consequences of aging on the brain and muscles 30. In our study, we examined the effects of LMCBET and SE on hand functions and compared their superiority over each other. Participants who underwent SE enjoyed PRPS and showed significant improvements in hand function and QoL outcomes, although there was no significant change in grip strength. We observed that SE is beneficial in improving the QoL secondary to the improvement in hand functions in the elderly.
In recent years, the use of exergames such as LMCBET, which can be used to increase motivation and movement in all age groups, especially for hand functions, is gaining popularity 34. Yıldırım et al. reported that LMCBET provides improvements in ROM, fine motor skills, hand grip, and compression strength 15. Similar to studies using LMCBET and reporting improvements in hand function and bilateral coordination, we achieved positive results in the dual task of PPT using LMCBET in older adults 35,36. We think that this result is due to the fact that exergame includes both cognitive and motor activities. 71.7% of the participants find the exergames easy to use and fun, and want to repeat the game 33. The similarity of PRPS results in individuals who underwent LMCBET and SE in our study suggests that the use of exergame in rehabilitation may also be preferred by older adults. On the other hand, it is claimed that even though exergames do not include all ADLs, they can improve non-repetitive ADL by improving their general problem-solving skills 32. We found that LMCBET improved QoL and hand function. We are of the opinion that LMCBET in healthy older adults can provide significant improvements in hand function and QoL without major differences in grip strength and cognitive function.
STRENGTHS OF THE STUDY
This study’s capacity to evaluate both cognitive and functional outcomes and to compare LMCBET versus SE in healthy older adults was one of its great strengths. The second strength of the study was that we added some cognitive tasks to equate the SE group with the LMCBET group to avoid any bias during the study. The third strength of the study was the better results obtained in dominant manual tasks, showing that focusing on ADL in healthy older individuals should be one of the main goals of rehabilitation programs.
LIMITATIONS OF THE STUDY
The limitation of this study is the inability to use an objective neuroimaging tool for cognitive outcome measures. And since the loss of achievements in elderly is expected without the continuation of the intervention, the follow up period might be needed and maybe added into the study design in our future studies.
CONCLUSIONS
In conclusion, SE and LMCBET can be effective in increasing hand function and QoL in healthy older adults. Consequently, LMCBET can be used as an alternative to conventional approaches and recommended as home exercises in rehabilitation.
Acknowledgements
We gratefully acknowledge Dr. Bülent Özsezikli, PT, PhD, for his encouragement and providing the resources required for us to conduct this study at a Nursing Home and Elderly Care Center.
Conflict of interest statement
The authors declare no conflict of interest.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author contributions
SA: the conception and design of the study, acquisition of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be submitted; DT: the conception and design of the study, acquisition of data, the analysis and interpretation of data, final approval of the version to be submitted; FH: the conception and design of the study, drafting the article or revising it critically for important intellectual content, final approval of the version to be submitted; MB: the analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be submitted.
Ethical consideration
The protocol of the study was registered at (NCT05317377). This trial was approved by the Non-interventional Ethics Committee at Istanbul Medipol University, Turkey (protocol number: E-10840098-772.02-3137).
The research was conducted ethically, with all study procedures being performed in accordance with the requirements of the World Medical Association’s Declaration of Helsinki.
Written informed consent was obtained from each participant/patient for study participation and data publication.
Figures and tables
Figure 1.Flow-chart for the participant allocation. RCT: randomized controlled trial.
Table I.Structured hand exercise program.
Table II.LMCBET- “ErgoActive”.
Table III.LMCBET- “HandROM”.
| SE group (n = 15) | LMBET group (n = 15) | x/t | P value | ||
|---|---|---|---|---|---|
| Age (Avg ± SD) | 75.93 ± 8.85 | 73.73 ± 12.46 | 0.557 | 0.582 | |
| Gender (n / %) | Female | 5/33.3 | 9/60 | 2.143 | 0.143 |
| Male | 10/66.7 | 6/40 | |||
| MMSE (Avg ± SD) | 25.86 ± 1.68 | 26.53 ± 1.59 | -1.112 | 0.276 | |
| Education (n/%) | Illiterate | 0/0 | 1/6.7 | 4.154 | 0.527 |
| Primary school | 7/46.7 | 1/6.7 | |||
| Middle school | 1/6.7 | 6/40 | |||
| High school | 6/40 | 7/46.7 | |||
| University | 1/6.7 | 0/0 | |||
| Job (n/%) | Housewife | 10/66.7 | 2/13.3 | 11.273 | 0.010* |
| Officer | 1/6.7 | 0/0 | |||
| Small business | 1/6.7 | 5/33.3 | |||
| Self-employment | 3/20 | 8/53.3 | |||
| History of injury (n/%) | No injury | 13/86.7 | 10/66.7 | 1.725 | 0.422 |
| Hand and wrist tendon injury | 1/6.7 | 2/13.3 | |||
| Shoulder fracture, subluxation or frozen shoulder | 1/6.7 | 3/20 | |||
| History of surgery (n/%) | Yes | 0/0 | 0/0 | -- | -- |
| No | 15/100 | 15/100 | |||
| PRPS (n/%) | None | 0/0 | 0/0 | 5.943 | 0.114 |
| Poor | 0/0 | 0/0 | |||
| Fair | 3/20 | 2/13.3 | |||
| Good | 6/40 | 2/13.3 | |||
| Very good | 4/26.7 | 3/20 | |||
| Excellent | 2/13.3 | 8/53.3 | |||
| SE: structured exercise; LMCBET: leap motion based exergame; Avg: average; SD: standard deviation; n: number of persons; %: percentage; MMSE: mini-mental state examination; PRPS: Pittsburgh rehabilitation participation scale- *p < 0.05. | |||||
| T0 | T1 | T2 | F | Effect size (Cohen’s d) | P value | ||
|---|---|---|---|---|---|---|---|
| Avg ± SD | Avg ± SD | Avg ± SD | |||||
| Box and block test | Right | 34.00 ± 14.06 | 32.73 ± 16.98 | 36.80 ± 16.26 | 4.421 | 0.240 | 0.025* |
| Left | 28.06 ± 10.09 | 28.33 ± 13.49 | 32.26 ± 14.41 | 5.529 | 0.283 | 0.015* | |
| Purdue Pegboard test | Right | 6.60 ± 2.89 | 6.13 ± 3.64 | 7.66 ± 3.47 | 9.929 | 0.415 | 0.001* |
| Left | 5.80 ± 2.93 | 6.00 ± 3.42 | 7.20 ± 3.52 | 8.767 | 0.385 | 0.001* | |
| Both hands | 3.20 ± 1.61 | 3.06 ± 1.62 | 4.13 ± 2.26 | 7.655 | 0.353 | 0.006* | |
| Combined | 1.73 ± 1.38 | 1.80 ± 1.56 | 2.46 ± 1.84 | 6.241 | 0.308 | 0.009* | |
| Total | 22.53 ± 12.28 | 22.53 ± 14.19 | 28.86 ± 16.06 | 15.000 | 0.517 | 0.000* | |
| Grip strength | Right | 0.37 ± 0.17 | 0.34 ± 0.18 | 0.35 ± 0.17 | 0.491 | 0.034 | 0.547 |
| Left | 0.34 ± 0.14 | 0.32 ± 0.14 | 0.34 ± 0.16 | 0.702 | 0.048 | 0.462 | |
| Duruöz hand Index | 25.73 ± 16.93 | 26.80 ± 17.45 | 21.46 ± 17.16 | 15.223 | 0.521 | 0.001* | |
| Stroop test | Reading time | 53.15 ± 39.88 | 53.37 ± 42.19 | 61.34 ± 49.84 | 1.806 | 0.114 | 0.200 |
| Colour time | 166.69 ± 82.91 | 160.24 ± 100.65 | 168.17 ± 120.59 | 0.068 | 0.005 | 0.921 | |
| Time difference | 76.59 ± 67.91 | 63.58 ± 96.72 | 68.78 ± 117.47 | 0.300 | 0.021 | 0.659 | |
| Digit Span test | Forward | 5.26 ± 1.48 | 5.20 ± 1.82 | 5.06 ± 1.90 | 0.566 | 0.039 | 0.554 |
| Backward | 2.60 ± 1.76 | 2.66 ± 1.87 | 2.53 ± 1.92 | 0.286 | 0.020 | 0.726 | |
| WHOQOL-OLD | 70.80 ± 9.42 | 69.80 ± 9.95 | 75.53 ± 11.63 | 13.401 | 0.489 | 0.001* | |
| SE: structured exercise; Avg: average; SD: standard deviation; n: number of persons; %: percentage; WHOQOL-OLD: World Health Organization quality of life ınstrument-older adults module. *p < 0.05. | |||||||
| T0 | T1 | T2 | F | Effect Size (Cohen’s d) | p value | ||
|---|---|---|---|---|---|---|---|
| Avg ± SD | Avg ± SD | Avg ± SD | |||||
| Box and block test | Right | 38.00 ± 10.67 | 38.33 ± 12.65 | 45.60 ± 12.79 | 10.974 | 0.439 | 0.000* |
| Left | 34.46 ± 11.35 | 34.66 ± 10.56 | 39.06 ± 10.50 | 7.960 | 0.355 | 0.003* | |
| Purdue Pegboard test | Right | 7.40 ± 2.74 | 7.86 ± 1.76 | 9.33 ± 2.25 | 8.760 | 0.385 | 0.001* |
| Left | 7.40 ± 2.61 | 8.06 ± 2.49 | 8.66 ± 2.25 | 6.032 | 0.301 | 0.009* | |
| Both hands | 4.60 ± 2.02 | 4.73 ± 1.57 | 5.66 ± 2.09 | 9.333 | 0.400 | 0.002* | |
| Combined | 2.46 ± 0.99 | 2.44 ± 0.91 | 2.86 ± 0.99 | 3.308 | 0.191 | 0.054 | |
| Total | 29.33 ± 10.65 | 30.26 ± 8.77 | 35.13 ± 10.04 | 8.979 | 0.391 | 0.003* | |
| Grip strength | Right | 0.39 ± 0.15 | 0.38 ± 0.14 | 0.39 ± 0.17 | 0.223 | 0.016 | 0.775 |
| Left | 0.37 ± 0.13 | 0.36 ± 0.14 | 0.34 ± 0.14 | 1.542 | 0.099 | 0.232 | |
| Duruöz hand index | 25.53 ± 10.99 | 15.73 ± 10.97 | 11.33 ± 8.84 | 25.386 | 0.645 | 0.000* | |
| Stroop test | Reading time | 54.67 ± 48.96 | 64.81 ± 56.33 | 55.43 ± 39.62 | 2.575 | 0.155 | 0.101 |
| Colour time | 114.48 ± 50.25 | 110.60 ± 30.71 | 103.02 ± 42.69 | 0.577 | 0.040 | 0.517 | |
| Time difference | 79.27 ± 64.04 | 87.75 ± 0.97 | 56.96 ± 67.19 | 2.478 | 0.150 | 0.131 | |
| Digit Span test | Forward | 4.86 ± 1.59 | 5.00 ± 1.60 | 5.06 ± 1.03 | 0.237 | 0.017 | 0.758 |
| Backward | 3.00 ± 1.73 | 3.00 ± 1.41 | 2.93 ± 1.33 | 0.055 | 0.004 | 0.899 | |
| WHOQOL-OLD | 71.13 ± 11.10 | 69.93 ± 11.24 | 77.60 ± 7.25 | 21.832 | 0.609 | 0.000* | |
| LMCBET: leap motion controller based exergame therapy; Avg: average; SD: standard deviation; n: number of persons; %: percentage; WHOQOL-OLD: World Health Organization quality of life ınstrument-older adults module. *p < 0.05. | |||||||
| Between-groups | Time*Group interactions | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| T0 | T1 | T2 | Mean Difference | CI (lower to upper) | F | Effect Size (Cohen’s d) | P value | ||||||||
| SE group (n = 15) | LMCBET group (n = 15) | P value | SE group (n = 15) | LMCBET group (n = 15) | P value | SE group (n = 15) | LMCBET Group (n = 15) | P value | |||||||
| Avg ± SD | Avg ± SD | Avg ± SD | Avg ± SD | Avg ± SD | Avg ± SD | ||||||||||
| Box and block test | Right | 34.00 ± 14.06 | 38.00 ± 10.67 | 0.388 | 32.73 ± 16.98 | 38.33 ± 12.65 | 0.315 | 36.80 ± 16.26 | 45.60 ± 12.79 | 0.111 | 6.133 | -4.035 to 16.302 | 2.245 | 0.074 | 0.119 |
| Left | 28.06 ± 10.09 | 34.46 ± 11.35 | 0.114 | 28.33 ± 13.49 | 34.66 ± 10.56 | 0.163 | 32.26 ± 14.41 | 39.06 ± 10.50 | 0.151 | 6.511 | -2.051 to 15.074 | 0.034 | 0.001 | 0.961 | |
| Purdue Pegboard test | Right | 6.60 ± 2.89 | 7.40 ± 2.74 | 0.444 | 6.13 ± 3.64 | 7.86 ± 1.76 | 0.108 | 7.66 ± 3.47 | 9.33 ± 2.25 | 0.131 | 1.400 | -0.629 to 3.429 | 1.520 | 0.051 | 0.229 |
| Left | 5.80 ± 2.93 | 7.40 ± 2.61 | 0.126 | 6.00 ± 3.42 | 8.06 ± 2.49 | 0.069 | 7.20 ± 3.52 | 8.66 ± 2.25 | 0.186 | 1.711 | -0.381 to 3.803 | 0.752 | 0.026 | 0.466 | |
| Both hands | 3.20 ± 1.61 | 4.60 ± 2.02 | 0.046* | 3.06 ± 1.62 | 4.73 ± 1.57 | 0.008* | 4.13 ± 2.26 | 5.66 ± 2.09 | 0.064 | 1.533 | 0.204 to 2.862 | 0.221 | 0.008 | 0.745 | |
| Combined | 1.73 ± 1.38 | 2.46 ± 0.99 | 0.107 | 1.80 ± 1.56 | 2.44 ± 0.91 | 0.210 | 2.46 ± 1.84 | 2.86 ± 0.99 | 0.466 | 0.578 | -0.349 to 1.505 | 0.617 | 0.022 | 0.531 | |
| Total | 22.53 ± 12.28 | 29.33 ± 10.65 | 0.117 | 22.53 ± 14.19 | 30.26 ± 8.77 | 0.083 | 28.86 ± 16.06 | 35.13 ± 10.04 | 0.211 | 6.933 | -1.931 to 15.797 | 0.280 | 0.010 | 0.714 | |
| Grip strength | Right | 0.37 ± 0.17 | 0.39 ± 0.15 | 0.679 | 0.34 ± 0.18 | 0.38 ± 0.14 | 0.535 | 0.35 ± 0.17 | 0.39 ± 0.17 | 0.595 | 0.033 | -0.090 to 0.155 | 0.119 | 0.004 | 0.888 |
| Left | 0.34 ± 0.14 | 0.37 ± 0.13 | 0.653 | 0.32 ± 0.14 | 0.36 ± 0.14 | 0.455 | 0.34 ± 0.16 | 0.34 ± 0.14 | 1.000 | 0.021 | -0.086 to 0.128 | 1.498 | 0.051 | 0.234 | |
| Duruöz hand index | 25.73 ± 16.93 | 25.53 ± 10.99 | 0.061 | 26.80 ± 17.45 | 15.73 ± 10.97 | 0.047* | 21.46 ± 17.16 | 11.33 ± 8.84 | 0.052 | -10.467 | -20.969 to 0.036 | 0.354 | 0.012 | 0.582 | |
| Stroop test | Reading time | 53.15 ± 39.88 | 54.67 ± 48.96 | 0.927 | 53.37 ± 42.19 | 64.81 ± 56.33 | 0.534 | 61.34 ± 49.84 | 55.43 ± 39.62 | 0.722 | 2.346 | -31.470 to 36.162 | 3.100 | 0.100 | 0.058 |
| Colour time | 166.69 ± 82.91 | 114.48 ± 50.25 | 0.046* | 160.24 ± 100.65 | 110.60 ± 30.71 | 0.078 | 168.17 ± 120.59 | 103.02 ± 42.69 | 0.059 | -55.669 | -106.103 to -5.235 | 0.217 | 0.008 | 0.781 | |
| Time difference | 76.59 ± 67.91 | 79.27 ± 64.04 | 0.912 | 63.58 ± 96.72 | 87.75 ± 0.97 | 0.442 | 68.78 ± 117.47 | 56.96 ± 67.19 | 0.738 | 5.009 | -51.359 to 61.377 | 1.339 | 0.046 | 0.267 | |
| Digit Span test | Forward | 5.26 ± 1.48 | 4.86 ± 1.59 | 0.484 | 5.20 ± 1.82 | 5.00 ± 1.60 | 0.752 | 5.06 ± 1.90 | 5.06 ± 1.03 | 1.000 | -0.200 | -1.322 to 0.922 | 0.645 | 0.023 | 0.511 |
| Backward | 2.60 ± 1.76 | 3.00 ± 1.73 | 0.536 | 2.66 ± 1.87 | 3.00 ± 1.41 | 0.587 | 2.53 ± 1.92 | 2.93 ± 1.33 | 0.513 | 0.378 | -0.838 to 1.593 | 0.035 | 0.001 | 0.955 | |
| WHOQOL-OLD | 70.80 ± 9.42 | 71.13 ± 11.10 | 0.930 | 69.80 ± 9.95 | 69.93 ± 11.24 | 0.973 | 75.53 ± 11.63 | 77.60 ± 7.25 | 0.564 | 0.844 | -6.518 to 8.206 | 0.764 | 0.027 | 0.417 | |
| SE: structured exercise; LMCBET: leap motion controller based exergame therapy; Avg: average; SD: standard deviation; n: number of persons; %: percentage; WHOQOL-OLD: World Health Organization quality of life ınstrument-older adults module. *p < 0.05. | |||||||||||||||
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