Motivating Engagement for Physical Activity in the Elderly - Day Program
Phase: NA
Conditions: Physical Activity, Aging, Geriatrics
Sponsor: Bruyère Health Research Institute.

 
 
 
 
 
 
 
 
 
 
 
 
 
Unique Protocol ID:  
Motiview Project 
 
Brief Title: 
Motivating Videos to Encourage Cycling for Geriatric 
Rehabilitation 
 
NCT ID: 
 
 
Not yet assigned. 
 
DATE: 
 
 
January 3rd, 2018 
 

Figure 1: TheraTrainer 
BACKGROUND 
 
As the Canadian population continues to age with life expectancy being prolonged, creative ways to 
encourage activity of older adults is vital. Aging is associated with a reduced motivation for physical 
activities (Etnier et al., 2017), a decline in motor skills, mobility impairment resulting in a higher risk of 
falls. These complications are compounded when the older adult sustains an injury (e.g. hip fracture) and 
must undertake rehabilitation. According the World Health Organization, the aim of rehabilitation is to 
maximize function and minimize limitation of activity and restriction of participation resulting from an 
underlying impairment or disease. In order to reach these aims, modalities must optimize effectiveness 
through optimal engagement of the participant. Aerobic exercise activity has been recommended for older 
adults as it has been shown to reduce age-related decline and improve functional capacity (Lemura, von 
Duvillard, & Mookerjee, 2000). It has also been shown to enhance cognitive function (Colcombe & 
Kramer, 2003).   
 
Motiview, the solution by Motitech, provides a possible solution for elderly reducing unnecessary 
emergency department visits, preventing falls/fall-injuries, improving management of complex health 
conditions, and improving brain health/cognitive fitness. Motiview was developed in 
2013 and has been rolled out to more than 60 Nordic municipalities. Motiview is a 
motivational tool that stimulates elderly to increase their physical activity and cognitive 
training. By using videos, music and sound displayed on a TV screen, the user can take 
a cycle trip through familiar surroundings and memories. Motiview is coupled to a 
mobile user-adapted cycle-trainer (TheraTrainer (Figure 1)) that elicits activity as the 
individual pedals the virtual trip. TheraTrainer facilitates activity for numerous 
populations by allowing motor-operated (passive), motor-assisted or active movement 
training (using your own muscle power) from the safety of a chair, armchair or 
wheelchair. Motiview is a large and continuously growing video- and music-
library with the ability to create new cycle trips according to the users’ wishes and 
memories. Incorporating appropriate music into activity programs adds interest and serves to facilitate 
participation and adherence. By lessening the perceptions of difficulty, monotony, and discomforts 
associated with physical activity, participation and the experience  
is enhanced.  
 
Additionally, since the virtual cycle trip is displayed on the TV screen, observers (family members, other 
residents, staff, etc.) may receive secondary benefits of reminiscence which may in-turn facilitate 
continued conversation of past experiences. Reminiscence, defined as inducing a vocal or silent recall of 
past activities, events, and experiences in the life of a person by using tangible prompts (Huang, Chen, & 
Chen, 2015), has been shown to be effective in improving cognitive functions while reducing depressive 
symptoms. While Motiview is a large and continuously growing video- and music-library, the ability to 
create new cycle trips according to the users’ wishes and memories increases reminiscence for that 
individual. 
 
Therefore, the research protocol of this project is designed to document the added value of Motiview for 
achieving activity participation.  Qualitative data will be gathered on the social aspects and reminiscence 
observed with the video/audit overlay in order to capture user satisfaction and staff and caregiver 
perceptions.  
 

DESIGN & METHODS 
Implementation will be conducted in two settings (Geriatric Day Hospital (GDH) (Elisabeth Bruyere 
Hospital and the Day Treatment Centre (DTC) Baycrest Health Sciences)). The settings selected have 
similar client profiles in terms of age, frailty, cognition, etc. Three subject groups will be included to 
obtain a holistic understanding of the use of this technology: geriatric program clients (clients) and their 
carers (carer) and staff (staff). All subjects (clients, carers and staff) will consent to participate prior to 
continuing with study involvement as documented below.  
 
Recruitment & Consent Procedures: 
 
- Baycrest –  
 
Clients 
 
DTC clients will undergo their usual intake assessment conducted by the DTC clinical team. Any clients 
who are determined to be medically unstable based on this assessment will not be recruited for this study. 
At the end of this assessment, any clients who are eligible for the study will be introduced to the study by 
the intake team. If they verbally consent to finding out more details about the project, their contact 
information will be provided to a research assistant (RA) who will then call the client with more 
information. If the client agrees to participate, they will be scheduled to meet the RA when they attend 
their regular DTC session during a time that does not conflict with treatment interventions or regular 
programming. At this point, the clients may choose to take part in a consenting session with the RA, 
followed by baseline testing. As a risk management strategy, the DTC clinical team will inform the 
research staff if a client is determined to be unable to continue participation at any point in the study.  
 
Consent: Carers will be asked to contact the RA if they have any questions regarding the research project 
or if they would like to participate. On this call, the RA will confirm their understanding of their 
involvement in the research project. If the carers agree to participate, they will attend a session at 
Baycrest. During this session, the details of participation will be explained and the carers will be asked to 
repeat the information that has just been discussed, in order to ensure that they understand the consent 
form. Once they are fully informed, they will sign the consent form.  
 
Staff 
 
Following an informational session, consent forms will be left with the staff for them to read on their 
own. They will be told to contact the RA if they have any questions regarding the research project or if 
they decide to participate. The RA will then go to them at the DTC to collect the consent form and will 
ensure understanding of their participation at this time. 
 
- Bruyere – 
  
Clients 
 
On the initial intake call by the GDH staff, all clients will be informed that there are research projects at 
the GDH that they may be eligible for. A verbal consent to contact will be obtained over the phone during 
this initial call. Contact information will then be sent to a recruitment coordinator who will then obtain 
consent for chart review to assess for eligibility for the research projects. Provided the client meets the 
inclusion criteria for the research project, the recruitment coordinator will then call back to inform them 
that they are eligible for participation and asked for verbal consent to be contacted by a member of the 
research team. If the client agrees to participate, they will be then invited to Bruyere prior to their GDH 
program to provide written consent and for baseline testing. 

 
Carers 
 
 Following consenting and baseline testing with the client, the client will be told that the project is also 
interested in the perceptions of carers (family, informal carers). Clients will be asked to inform their 
carers of the study and to provide the RA’s contact information so the carer can call with any questions. 
The carer will be subsequently invited to attend the baseline testing to provide written consent and to 
complete a semi-structured interview. 
 
Staff  
 
An informational session regarding Motiview will be provided to inform staff about the research project. 
Consent forms will be left at the end of the meeting for staff to read through on their own. If they decide 
to participate, they can leave their signed forms with the DTC (Baycrest) or GDH (Bruyere) reception for 
the research assistant in sealed envelopes that will be provided to them. 
 
Study Methods 
 
- Baycrest – 
 
Clients 
 
Participation: After the consenting and initial (baseline) testing session (which will be held at a time 
convenient to the client attending the DTC program, and which does not interfere with their regular 
programming/treatment intervention), the client will attend their day treatment program as usual (i.e., 3 
hours a day, twice a week on either Monday & Wednesday or Tuesday & Thursday, for a duration of 
approximately 12 weeks). At Baycrest, assignment to the experimental or control group will be 
determined by their day treatment program schedule. If clients are scheduled for their program on 
Monday and Wednesday, they will be provided with the opportunity to use the TheraTrainer with 
Motiview (Experimental group). If they are scheduled for the program on Tuesday and Thursday, they 
will be provided with the opportunity to use the TheraTrainer without Motiview (allocated to the control 
group). Both groups will be informed that they have the option to use the TheraTrainer during any free 
time between their scheduled treatment appointments, for the duration of their day treatment program. 
Free time was selected so as to not disrupt a client’s regularly scheduled treatment plans.  
 
Every time a participant chooses to use the TheraTrainer, an occupational/physical therapy assistant hired 
for this project will assist the participant with his/her safe transfer onto and from the TheraTrainer. The 
assistant will set up the TheraTrainer (and Motiview system, if applicable). The assistant will record any 
field notes that are relevant for the study. After the completion of a cycling session, participants will be 
asked micro-interview questions once per week to collect qualitative data about their cycling session. In 
addition, the participants will be continuously observed by the occupational/physical therapy assistant for 
the duration of each cycling session in the event that any participant experiences adverse responses to the 
physical activity. If any concerns arise related to the participants’ ability to safely continue the cycling 
session, the session will be ended. 
 
Follow-up outcomes: At the end of the study, participants will be asked to participate in a post-
participation semi-structured interview. 
 
Carers 
 

Participation: After consent is obtained, the carers will be taken through a semi-structured interview to 
gain feedback about their opinions about their study partner’s involvement with the TheraTrainer and/or 
Motiview. Also, they will be asked about their general characteristics. 
 
Follow-up: None for this group.  
 
Staff 
 
Participation: Following the study period, the staff will be taken through a semi-structured interview to 
gain feedback about their opinions about the client’s involvement with the TheraTrainer and/or Motiview. 
Also, staff will be asked about their general characteristics. 
 
Follow-up: None for this group.  
 
- Bruyere – 
 
Client 
 
Participation: If they agree to participate, they will be invited, along with their caregiver to Bruyere for 
one visit of approximately 30 minutes prior to their participation in the GDH. During this session, they 
will be told again of their involvement requirements for this study and signed written consent will be 
obtained. Subsequently, baseline outcome measure testing will be done. 
 
They will then attend the rehabilitation program as usual and will be encouraged by the staff as part of 
their regular GDH program to use the TheraTrainer (one group with Motiview, one group without 
Motiview). At certain times throughout the study, when a participant uses the TheraTrainer as part of this 
investigation, study staff will take field notes to capture the clients’ level of social engagement, and other 
behavioural or anecdotal findings that may emerge immediately prior to, during, or shortly after the 
exercise session.  
 
To assess clients’ experiences, they will be approached by study staff once a week (on different days 
throughout the week, depending on the client’s schedule). The study staff will ask the clients if they 
would like to answer a few short questions related to their experience with the TheraTrainer (either with 
or without Motiview). Following their assent, the clients will be asked a maximum of four short questions 
related to their exercise experiences, reminiscence, and general health and well-being during each micro-
interview. Each client will have the opportunity to take part in up to six micro-interviews in total 
throughout the study. The clients’ responses will be audio recorded with their assent; for those who do not 
wish to have their responses recorded, study staff will take field notes related to the clients’ responses 
instead (if assent is provided).  
 
Follow-up: When each client has completed their GDH program, they will be asked to return to the 
Bruyere Continuing Care (room 441D) to complete the baseline outcome measures as a pre-post design. 
 
Semi-structured interview questions will be posed to all clients who elect to take part in interview session 
as part of the study. The interviews will be held at the end of the study period. The questions were 
developed with the aim of employing a phenomenological approach, enabling the clients to elicit their 
own responses and experiences. Using the interview guide to lead the discussion, client responses may be 
probed to gain further clarity or insight. The interviews will be audio recorded by study staff. Study staff 
will also write field notes to document client responses and other observations to supplement and provide 
context for the transcripts. 
 

Recruitment will continue until 15 clients (control group) have been enrolled and all have completed their 
geriatric rehabilitation program. After 15 clients have finished the study, Motiview will be placed into the 
GDH and recruitment of 15 (experimental group) additional clients will commence. 
 
Carer 
 
Same as Baycrest protocol. 
 
Staff 
 
Participation: Prior to the first client enrollment, staff will participate in a brief session (approximately 10 
minutes) on proper use of the TheraTrainer, Motiview. The staff will be encouraged to use the 
TheraTrainer and Motiview as part of their rehabilitation protocol (TheraTrainer activity bikes will be 
used in place of the NuStep cycle currently in the GDH).  
 
Follow-up: Semi-structured interview questions will be posed to all staff members who elect to take part 
in an interview session as part of the study. The interviews will be held after 15 clients use the 
TheraTrainer alone as well as after the 15 clients that use TheraTrainer and Motiview. The questions were 
developed with the aim of employing a phenomenological approach, which provides staff with the 
opportunity to elicit their own responses and experiences. Using the interview guide to lead the 
discussion, staff members’ responses may be probed further to gain additional clarity or insight. The 
interviews will be audio recorded by study staff. Study staff will also write down field notes to capture 
any notable observations and to add further context to clients’ responses, which will ultimately 
supplement the transcripts. 
 
 
 

STATISTICAL ANALYSIS PLAN (SAP) 
 
Qualitative Analysis   
All of the audio recordings (with clients/residents, staff, and informal caregivers or family members) will 
be transcribed verbatim, and any of the audio recordings obtained with French-speaking clients will be 
translated and transcribed into English. All of the transcripts will first be reviewed by each study site to 
ensure that no personally identifiable information is present (any that is will be de-identified by each 
study site); the de-identified transcripts will then be sent to the Baycrest study staff for coding and 
analysis. Moreover, the field notes will be typed and de-identified by study staff at each site, and the 
Baycrest staff will receive the de-identified notes for analysis. Similarly, open-ended survey questions 
will also be typed and de-identified by research study staff at each site, who will then send these 
responses to Baycrest study staff.  
 
Following these initial steps, the transcripts and field notes will be uploaded into qualitative analysis 
software (NViVo). Baycrest research staff members will begin coding the data based on the various 
themes and sub-themes that emerge in the clients’ comments and responses. Interim analyses will be 
performed on an ongoing basis to determine if additional questions need to be asked during the micro-
interviews, or to assess whether the interview guide questions or open-ended survey questions need to be 
revised (particularly if new themes emerge during the analysis process). Once coded, thematic analysis 
will be performed to highlight the major themes and sub-themes that arose from the clients’ responses, 
which will be supplemented by de-identified quotes to illustrate these themes. Further, a comprehensive 
report featuring all themes, subthemes, and the associated de-identified quotes will be compiled and 
disseminated to the research leads/teams at all three research sites. 
 
Quantitative Analysis 
All quantitative data will be analyzed using SPSS 20 software with an α of 0.05.  
 
Descriptive statistics (mean ± standard deviation, frequencies, and proportions, where appropriate) will be 
used for clinical, professional and demographic group characteristics. Between group (control vs 
experimental and between sites) differences will be assessed using t- tests and chi-square tests.  
 
RISK AND BENEFITS 
 
Potential Risks 
 
Potential risks 
o There are no risks during the use of the TheraTrainer beyond the risks that may normally 
be associated with any type of physical activity (e.g., fatigue resulting from exertion). 
The audio/visual component of the Motiview technology should not pose additional risks. 
 
Procedures to reduce risks 
o Activity sessions will be closely monitored by trained research associates and/or staff.  
 
Procedures to maintain confidentiality 
o Every individual enrolled will be assigned a participant code: 
 
Client: CL01, CL02 etc. 
 
Carer: CA01, CA02 etc.  
 
Staff: ST01, ST02 etc. 
o Original documents will be encrypted and/or password protected. All data will be stored 
on Baycrest's encrypted V: drive, located on Baycrest's servers; no data will be kept on 
individual employees' computer desktops or on public computers/servers. Moreover, any 
paper copies of documents or USB drives will be stored in locked file cabinets with 
limited access by study staff only. 

o All individuals that are involved with the project that may be on site during data 
collection/recruitment will have completed Tri-Council Policy Statement Ethics 2 
(TCPS2) training. 
Potential Benefits 
 
Potential benefits 
o As this is the first study assessing the potential benefits of Motiview, the benefits are 
uncertain. We hypothesize that the addition of Motiview to the TheraTrainer will result in 
a more enjoyable and effective activity modality.  
 
Risk/benefit assessment 
o Although there may be some risks (detailed above) to the participants as a result of 
participating in this study, there will also be procedures in place to reduce these risks. 
Thus, it is anticipated that the level of actual risk to participants will be low. Given the 
nature of this study, there is a high chance that participants in this study will provide 
valuable feedback on the Motiview system to inform its use in healthcare settings through 
this evaluation.  
 
FUTURE DIRECTIONS 
 
Following this project, de-identified and aggregated summary results will be provided to Motitech 
(industry partners) for dissemination. Any limitations to implementation and use will be described to the 
industry partner for improvements to the technology.  
 
The results for this project will ultimately be submitted to peer-reviewed journals for academic 
dissemination.