Effectiveness of Serious Gaming During the Multidisciplinary Rehabilitation of Patients With Complex Chronic Pain or Fatigue (2018) Vrijhoef et al.

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https://www.jmir.org/2018/8/e250/


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Original Paper
Effectiveness of Serious Gaming During the Multidisciplinary Rehabilitation of Patients With Complex Chronic Pain or Fatigue: Natural Quasi-Experiment


1Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands

2Mert Medical, Utrecht, Netherlands

3Leiden Institute for Brain and Cognition, Department of Health Medical and Neuropsychology, Leiden University, Leiden, Netherlands

4Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium

5Department of Patient & Care, Maastricht University Medical Center, Maastricht, Netherlands

6Panaxea BV, Amsterdam, Netherlands

Corresponding Author:
Miel AP Vugts, MSc



Tranzo Scientific Center for Care and Welfare

Tilburg School of Social and Behavioral Sciences

Tilburg University

PO Box 90153

Tilburg, 5000 LE

Netherlands

Phone: 31 13 466 2969

Email: m.a.p.vugts [at] uvt.nl


ABSTRACT
Background: Current evidence for the effectiveness of specialist multidisciplinary programs for burdensome chronic pain and functional somatic syndromes drives the effort to improve approaches, strategies, and delivery modes. It remains unknown to what extent and in what respect serious gaming during the regular outpatient rehabilitation can contribute to health outcomes.

Objective: The objectives of our study were to determine the effect of additional serious gaming on (1) physical and emotional functioning in general; (2) particular outcome domains; and (3) patient global impressions of change, general health, and functioning and to determine (4) the dependency of serious gaming effects on adherence.

Methods: We conducted a naturalistic quasi-experiment using embedded qualitative methods. The intervention group patients received an additional guided (mindfulness-based) serious gaming intervention during weeks 9-12 of a 16-week rehabilitation program at 2 sites of a Dutch rehabilitation clinic. Simultaneously, 119 control group patients followed the same program without serious gaming at 2 similar sites of the same clinic. Data consisted of 10 semistructured patient interviews and routinely collected patient self-reported outcomes. First, multivariate linear mixed modeling was used to simultaneously estimate a group effect on the outcome change between weeks 8 and 16 in 4 primary outcomes: current pain intensity, fatigue, pain catastrophizing, and psychological distress. Second, similar univariate linear mixed models were used to estimate effects on particular (unstandardized) outcomes. Third, secondary outcomes (ie, global impression of change, general health, functioning, and treatment satisfaction) were compared between the groups using independent t tests. Finally, subgroups were established according to the levels of adherence using log data. Influences of observed confounding factors were considered throughout analyses.

Results: Of 329 eligible patients, 156 intervention group and 119 control group patients (N=275) with mostly chronic back pain and concomitant psychosocial problems participated in this study. Of all, 119 patients played ≥75% of the game. First, the standardized means across the 4 primary outcomes showed a significantly more favorable degree of change during the second part of the treatment for the intervention group than for the control group (beta=−0.119, SE=0.046, P=.009). Second, the intervention group showed a greater outcome change in depressive mood (b=−2.748, SE=1.072, P=.011) but not in “insufficiency” or concentration problems. Third, no significant group effects on secondary outcomes were found. Fourth, adherence was generally high and invariant.

Conclusions: The findings of this study suggest a very small favorable average effect on relevant health outcomes of additional serious gaming during multidisciplinary rehabilitation. The indication that serious gaming could be a relatively time-efficient component warrants further research into if, when, how, and for which patients serious gaming could be cost-effective in treatment and why.

Trial Registration: Netherlands Trial Registry NTR6020; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6020 (Archived by WebCite at http://www.webcitation.org/71IIoTXkj)

J Med Internet Res 2018;20(8):e250
doi:10.2196/jmir.9739

KEYWORDS
 
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I'm mildly curious about what 'serious gaming' is, but not enough to actually open the paper.
I guess it would be the opposite of “casual” gaming. Oh guess not. It’s a game with some (purported) purpose.

Here’s the game they used, description from the paper:

The serious game LAKA is an adventure game where patients take the role of an Avatar during a virtual trip around the world. The game is easy to control using a touch-screen tablet computer and takes on average 2.5 hours to complete (Multimedia Appendix 1 shows the screenshots).

In LAKA, patient players perform alternate tasks vicariously; they select optional responses in various encounters with other characters, monitor and evaluate satisfaction about selected responses (and their consequences), and meditate (3-minute exercises). First, players select between a male or female Avatar and assign a name. It was prompted that Avatar choices reflect those of the player. A cut-scene sets up the story; the Avatar, who wants change after experiencing a deterioration in physical and social functioning, meets a nonplaying character (NPC) named LAKA. LAKA challenges the Avatar to make “conscious” decisions during 16 “encounters” with other NPCs, for example, when standing in line, on getting invited to someone’s home, and at 4 destinations (ie, London, Turkey, Asia, and Africa) on a trip around the world. Each “encounter” is built as a flow of Avatar actions and NPC responses.

For each Avatar action, 1 of 5 options (eg, physically interact, verbally react, or ignore something) can be preselected and confirmed by players. These options are modeled after a set of reference values—generosity, moral discipline, forbearance, and enthusiastic perseverance. NPC responses are unpredictable, for example, a friendly act can result in a kind response or being scammed. At the end of each destination, LAKA asks the Avatar to self-rate the level of “satisfaction” regarding his or her choices. Indirect feedback, in the form of a number of puzzle pieces, is given by (1) the degree of correspondence of Avatar choices with the reference values and (2) the degree to which that correspondence agrees with satisfaction ratings. When the Avatar is depicted “mind-wandering” when traveling across destinations, instructions are received for a basic meditation exercise (focused attention and open monitoring) [50]. These model-based elements are interspersed with short action games, puzzle games, images, and information associated with the location of the Avatar to be enjoyed or skipped by preference.
 
So the game is a slightly elaborate questionnaire with weird feedback interspersed with what I condescendingly assume to be an old person's interpretation of the concept of action games then?

Yes, I am being deliberately snarky because I just assume that this will most likely be used as an excuse to not spend time on doing something effective if it ever leads to anything in clinical practice.

Any change in e.g. pain levels associated with doing an activity will likely be very fleeting if said activity does not do something about what causes the pain in the first place I'd guesstimate, so really, wtf are we looking at here?
 
The game is easy to control using a touch-screen tablet computer and takes on average 2.5 hours to complete
The intervention group patients received an additional guided (mindfulness-based) serious gaming intervention during weeks 9-12 of a 16-week rehabilitation program
Of all, 119 patients played ≥75% of the game.
So they spent 4 weeks playing a game that takes 2.5 hours to complete, yet not all finished it? I think @James Morris-Lent must be right.
 
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