Effectiveness and usability of the system for assessment and intervention of frailty for community-dwelling pre-frail older adults: A pilot study

Ren Siang Tan; Eileen Fabia Goh; Di Wang; Robin Chung Leung Chan; Zhiwei Zeng; Audrey Yeo; Kalene Pek; Joanne Kua; Wei Chin Wong; Zhiqi Shen; Wee Shiong Lim

doi:10.3389/fmed.2022.955785

Effectiveness and usability of the system for assessment and intervention of frailty for community-dwelling pre-frail older adults: A pilot study

Front Med (Lausanne). 2022 Nov 17:9:955785. doi: 10.3389/fmed.2022.955785. eCollection 2022.

Authors

Ren Siang Tan¹, Eileen Fabia Goh¹, Di Wang², Robin Chung Leung Chan², Zhiwei Zeng², Audrey Yeo¹, Kalene Pek¹, Joanne Kua^{1

3}, Wei Chin Wong^{1

3

4}, Zhiqi Shen^{2

5}, Wee Shiong Lim^{1

3

4}

Affiliations

¹ Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore.
² Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly, Nanyang Technological University, Singapore, Singapore.
³ Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
⁴ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
⁵ School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore.

Abstract

Background: Effective multicomponent interventions in the community targeted at preventing frailty in at-risk older adults can promote healthy ageing. However, there is a lack of studies exploring the effectiveness of technology-enabled autonomous multi-domain community-based interventions for frailty. We developed a novel end-to-end System for Assessment and Intervention of Frailty (SAIF) with exercise, nutrition, and polypharmacy components. This pilot study aimed to explore SAIF's effectiveness in improving frailty status, physical performance and strength, and its usability in pre-frail older adults.

Materials and methods: This is a single arm 8-week pilot study in 20 community-dwelling older adults who were pre-frail, defined using the Clinical Frailty Scale (CFS) as CFS 3 + (CFS 3 and FRAIL positive) or CFS 4. For outcomes, we assessed frailty status using the modified Fried Frailty Phenotype (FFP) and CFS; physical performance using Short Physical Performance Battery (SPPB); and Hand Grip Strength (HGS) at baseline and 8-week. User experience was explored using the System Usability Scale (SUS), interest-enjoyment subscale of the Intrinsic Motivation Inventory and open-ended questions. We analyzed effectiveness using repeated-measures tests on pre-post scores, and usability using a convergent mixed-method approach via thematic analysis of open-ended responses and descriptive statistics of usability/interest-enjoyment scales.

Results: Sixteen participants (71.8 ± 5.5 years) completed the 8-week study. There was a significant improvement in FFP score (-0.5, p < 0.05, effect size, r = 0.43), but not CFS (-1.0, p = 0.10, r = 0.29). Five (31.3%) improved in frailty status for both FFP and CFS. SPPB (+1.0, p < 0.05, r = 0.42) and HGS (+3.5, p < 0.05, r = 0.45) showed significant improvements. Three themes were identified: "Difficulty in module navigation" (barriers for SAIF interaction); "User engagement by gamification" (facilitators that encourage participation); and "Perceived benefits to physical health" (subjective improvements in physical well-being), which corroborated with SUS (68/100) and interest-enjoyment (3.9/5.0) scores. Taken together, user experience results cohere with the Senior Technology Acceptance and Adoption Model.

Conclusion: Our pilot study provides preliminary evidence of the effectiveness of SAIF in improving frailty status, physical performance and strength of pre-frail older adults, and offers user experience insights to plan the follow-up large-scale randomized controlled trial.

Keywords: community research; frailty; health technology; intervention; older adults; pre-frail; usability.