Validation of a Motor-Cognitive Assessment for a Stepping Exergame in Older Adults: Use of Game-Specific, Internal...

To comprehensively validate an assessment tailored to an exergaming training program with motor-cognitive challenges. Fifty-eight cognitively intact, multimorbid, independently living older adults (mean age [standard deviation]: 78.3 [6.5] years) with moderate functional limitations participated in the study. For construct validity, Spearman's rank correlations (r_s) between game parameters and established cognitive (Number-Connection-Test [Zahlen-Verbindungs-Test], Simple Response Time Task, Simon Task) and motor (Short Physical Performance Battery, Physiomat^® balance tests) measures were calculated. Test-retest reliability was documented by intraclass correlation coefficients (ICCs), sensitivity to change by effect sizes using partial eta squared (η²), and feasibility by mean completion time and completion rates. Good construct validity of the assessment was observed, with on average moderate-to-high correlations between game parameters and cognitive tests, measures of lower extremity function and dynamic balance (range of r_s including extreme outliers = 0.00-0.70, P < 0.001-0.998). Test-retest reliability was good, with ICCs mostly ranging from moderate to high (ICCs = 0.37-0.93, P < 0.001-0.130), and sensitivity to change was excellent (η² = 0.16-0.81, P < 0.001-0.044). Completion rates for the initial challenge levels were 100%, mean completion time 36.3 minutes, and no clinical events or safety problems were observed. Study results documented on average good validity, test-retest reliability and feasibility, with an extraordinary high responsiveness of the presented game-based assessment in older adults with moderate functional limitations. The innovative, data-based assessment validated in this study may serve as a blueprint for future, tailored assessments for exergaming.