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

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 () 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 (), 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 including extreme outliers = 0.00-0.70,  < 0.001-0.998). Test-retest reliability was good, with ICCs mostly ranging from moderate to high (ICCs = 0.37-0.93,  < 0.001-0.130), and sensitivity to change was excellent ( = 0.16-0.81,  < 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.