This is surprising as not only a decline in physical functions is responsible for gait impairments and higher risks of falls, but also impaired cognitive performance including impairments in executive functioning ( Holtzer et al., 2006 Yogev-Seligmann et al., 2008 de Bruin and Schmidt, 2010 Segev-Jacubovski et al., 2011 Mirelman et al., 2012). Currently, clinical practice guidelines do not refer to combined cognitive and physical training programs ( Laver et al., 2016 Shaji et al., 2018). There is compelling evidence that physical activity improves strength, endurance, balance, gait stability, gait speed, and overall wellbeing in older adults with MNCD ( Forbes et al., 2015 Groot et al., 2016 Lam et al., 2018). In order to reduce the risk of falling in older adults with MNCD residing in long-term care facilities, physical activity should be an important component of the multidisciplinary approach ( Forbes et al., 2015 Vancampfort et al., 2020). The burden of MNCD on health care systems is further compounded by a high risk of falling and associated injuries and disability ( Sharma et al., 2018). This is imposing a compelling burden on health care systems and has resulted in MNCD being considered a global public health priority ( WHO, 2016). Older adults with MNCD often require added assistance with their activities of daily living ( Arvanitakis et al., 2019) and this can ultimately lead to the displacement to a long-term care facility ( Forbes et al., 2015). MNCD is a clinical syndrome marked by cognitive decline, motor deficits and psychological and behavioral problems ( LoGiudice and Watson, 2014). The number of older adults with major neurocognitive disorder (MNCD) is increasing, primarily driven by population aging ( Alzheimer’s Disease International, 2019). The results indicate that the stepping exergame is usable in older adults with MNCD. There were no adverse events nor dropouts.Ĭonclusion: Participants evaluated the usability of the exergames positively. Five main themes emerged from the thematic content analysis: (1) perceived user friendliness and acceptability of the exergames (2) interactional experience (3) motivational factors (4) training modalities and (5) risks. System usability was rated “ok to good” with a mean SUS score of 57.8 ( SD = 12.3) with scores ranging from 37.5 to 90.0. Results: Twenty-two participants with MNCD were included. Audio files were transcribed and a thematic content analysis of the think aloud data, field notes and interviews were performed using NVivo 12. Following the exergames, participants completed the System Usability Scale (SUS) and a semi-structured in-depth interview about usability including their personal experiences. During the exergames, the think aloud method was used, and field notes were taken by the facilitator. Participants played exergames for 30 min on one try-out session. Materials and Methods: A mixed methods study was conducted. Purpose: This study investigates the usability of a stepping exergame in older adults with major neurocognitive disorder (MNCD) residing in a long-term care facility.
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2Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zurich, Switzerland.1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.de Bruin 2,3*, Chantal Dumoulin 4,5, Melanie Thalmann 2, Vânia Guimarães 6, Jacqueline De Jong 7, Mathieu Vandenbulcke 8,9 and Davy Vancampfort 1,8